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Jerome S. Reich, MD
American Board of Cardiovascular Disease North Miami Beach, Fla

JAMA. 1993;270(15):1812.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—In the February 10 issue of JAMA, there were several articles regarding the appropriateness of medical procedures, especially cardiac bypass surgery and angiography, and the efforts to decrease a number of procedures and therefore lower the cost of health^1-4

It is certainly beneficial to decrease the number of unnecessary cardiac procedures, but it is extremely difficult to accomplish this in community practice, because cardiology and other subspecialty academic training programs continually overtrain residents in interventional cardiology and interventional procedures. When new physicians enter practice trained in doing procedures, it is difficult to have them not do these procedures. The correction of this problem has to begin at the university level, and the universities have to become more responsible for cost-effective health care.

These letters were shown to Dr Hilborne and to Dr Hannan, who declined to reply.—ED. . . . [Full Text PDF of this Article]

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