What the delegates say - What obstacles are there to becoming a specialist in your country 

Mehmet Ziya Erkal, Trainee Cardiologist, Giessen, Germany:
There are no problems in becoming a cardiologist in Germany, it is straightforward. There are plenty of training places and sufficient posts afterwards. Hospitals are well equipped; general hospitals carry out a smaller range of procedures including angioplasty and won’t have the whole range of equipment, but Germany has a lot of specialist centres which are extremely well equipped. The cost of treatment is covered; patients carry a card and there are no fears that their care will depend on whether they can pay. Cardiology is a popular specialty in Germany. The system works.

Jayanthi Vasudevan Naiker, Cardiologist, Birmingham, UK:
The main problem is the over-emphasis on research. If you haven’t done research and published widely, you are not recognised as a good doctor. To me, if you can read and understand research, it should be enough. Not everybody is cut out to be a researcher; it’s a totally different skill. If you mix research and clinical work, you will get poor doctors who are good researchers. If you use this criteria to choose cardiologists - or any other specialists – then you are actually bringing your system down. It’s getting worse in the UK and it is sad to see: clinical skills and experience are not valued.

Sahar Azab, Cardiologist, Alexandria, Egypt:
The government will pay for young doctors who have excellent degrees from university to train in cardiology. There are no real barriers to becoming a cardiologist. However, it is difficult to carry out research. There is not much funding for research in cardiology in Egypt; and to make it even more difficult, patients usually have no scientific background and are often very afraid of taking part in any research projects. This makes it a less exciting specialty than it should be. Cardiology is less well funded than other areas of medicine in Egypt; and with heart disease on the increase, we really need more money.

Karl Andersen, Preventive and General Cardiologist, Reykjavik, Iceland:
We don’t have any training programmes in cardiology in Iceland; all training is done abroad. Doctors mostly go to Scandinavian countries or the US, and will have to stay there for at least five years, often ten. There are no barriers to doctors training abroad, but there are a limited number of posts in Iceland, and most are in Reykjavik; there are only three or four posts outside of the city. Once doctors are trained, it may be difficult for them to move if they have teenage children, for example, but also, they often can’t get as good a post at home as they are offered abroad. Many don’t move back.