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Letters
September 2, 2009

Physician Certification and Implantable Cardioverter-Defibrillators—Reply

JAMA. 2009;302(9):941-943. doi:10.1001/jama.2009.1236

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.

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