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In Reply: Drs Ghali and Schreiber observe that, compared with electrophysiologists, the absolute differences in outcomes among implants performed by thoracic surgeons were larger compared with those of other nonelectrophysiologist physician categories. We agree that focusing on thoracic surgeon implants may serve as a good starting point for efforts to improve the outcomes associated with nonelectrophysiologist implants. However, our study reflects average performance for the entire group, and it is likely that there are thoracic surgeons who achieve excellent outcomes. Furthermore, a narrow focus on thoracic surgeons misses the broader question raised by our study: given the available evidence, what purpose is served by the majority of nonelectrophysiologist implants? In the absence of significant barriers to access, our findings support that these devices should be implanted by the physicians who have undergone the most rigorous training.

We understand the concerns of Dr Lick and colleagues that the characteristics of patients . . . [Full Text of this Article]

Jeptha P. Curtis, MD
jeptha.curtis@yale.edu
Department of Internal Medicine
Yale University School of Medicine
New Haven, Connecticut

Jeffrey Luebbert, MD
Department of Internal Medicine
Thomas Jefferson University School of Medicine
Philadelphia, Pennsylvania

Harlan M. Krumholz, MD, SM
Department of Internal Medicine
Yale University School of Medicine

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