A Roadmap for the Twilight Zone

Abstract

Time is a one way street—except in the Twilight Zone! — —Rod Serling, host of the cult CBS television series Predictions of the demise of US preeminence in the sciences appear to have been exaggerated1; at least for now, objective measurements of the investment in and the impact of biomedical research in the United States suggest that it continues to dominate Europe, Japan, and China.2 The particular inequities of access to healthcare delivery in the United States are well documented,3,4 and objective measures of population health suggest that Americans, on average, are seriously disadvantaged, particularly compared with some Europeans.5 However, although a disproportionate investment of dollars in health care6 may not translate to universal benefit in the US system, it has created well-resourced centers of excellence that, if accessed, have the potential to deliver superior care.7 In the case of cardiology, these centers typically have well-established training programs that integrate diversified opportunities for specialized clinical training with access to mentors skilled in basic, translational, and clinical research. The comprehensive nature of these programs and their multiplicity remain unique to the United States and are sufficient reasons for every aspiring cardiologist or cardiovascular physician-scientist to consider seriously a period of training in this system. Every year, international trainees come to the United States to advance their careers in cardiovascular medicine. In 2006, international medical graduates (IMGs) from 127 countries filled 31% of accredited cardiovascular disease fellowship posts, 33% of clinical cardiac electrophysiology positions, and 46% of the interventional cardiology posts.8 In addition to clinical training, the potential for international trainees to perform cardiovascular research in the United States is considerable. Realizing the benefits of the training environment within the United States requires one to become familiar with institutional, state, and federal training requirements …