What action should the credentialing committee take for a surgeon without formal training or certification in vascular surgeries who is requested to perform complex vascular surgeries?

Credentialing Committee Action for Surgeon Without Vascular Surgery Training

The credentialing committee must request review for approval only after the surgeon completes formal vascular surgery training, as performing complex vascular surgeries without proper training is risky, contrary to patient welfare, and constitutes poor medical practice.

Primary Recommendation

The American College of Cardiology explicitly states that "the practice of peripheral angioplasty by the untrained physician should be avoided; it is risky and contrary to patient welfare and good medical practice," and that responsible healthcare institutions must insist on documentation of accredited training 1, 2. This principle applies broadly to all complex vascular procedures, not just angioplasty.

General surgical competence does not equate to vascular surgical competence 2. Success in other surgical domains does not substitute for the specialized knowledge and technical skills required for vascular surgery 3.

Required Training Pathways

For a surgeon without vascular surgery certification, the American College of Cardiology recommends completion of a structured vascular surgery residency program after board certification in general surgery 2. Current accredited pathways include 4:

• Traditional 5+2 pathway: 5 years general surgery plus 2 years vascular surgery fellowship
• Early specialization 4+2: 4 years general surgery plus 2 years vascular surgery
• Integrated 0+5: 5 years dedicated vascular surgery training
• Independent 3+3: 3 years core surgery plus 3 years vascular surgery

All pathways require minimum 2 years core surgery training and 3 years advanced vascular training 4.

Why Brief Courses Are Inadequate

A brief course cannot provide the comprehensive training necessary for safe vascular surgery practice. Required competencies include 1, 2:

• Understanding of vascular disease pathophysiology and natural history
• Skills in noninvasive vascular assessment
• Knowledge of alternative interventions (conservative, surgical, endovascular, thrombolytic)
• Management of procedure-specific complications (renal failure, stroke, bleeding, emergency bypass)
• Minimum procedural experience: 100 diagnostic peripheral angiograms and 50 peripheral angioplasty procedures under supervision 1, 2

Why Supervised Practice Without Training Is Inappropriate

While proctoring is appropriate for fellowship-trained surgeons beginning independent practice 5, it cannot substitute for formal training. The American College of Cardiology specifies that physicians without prior vascular training must complete formal fellowship programs before any clinical privileges are granted 2. Supervision assumes baseline competence that can only be achieved through structured training 5.

Critical Pitfalls to Avoid

The credentialing committee must not 2:

• Confuse general surgical competence with vascular surgical competence - these are distinct skill sets requiring separate training
• Allow institutional financial pressures to override patient safety requirements - the hospital's desire to expand services cannot justify inadequate credentialing
• Grant privileges based solely on past success in other surgical areas - vascular surgery requires specialized knowledge and technical skills

Patient Safety Considerations

Lack of proper vascular surgery training directly increases morbidity and mortality risk 2. The specialized knowledge required includes 1:

• Anatomic changes occurring with vascular disease
• Noninvasive patient assessment techniques specific to vascular pathology
• Indications, risks, and benefits of different therapeutic modalities
• Management of thrombolytic agents

These competencies cannot be acquired through brief courses or supervised practice alone 1, 2.

Appropriate Committee Action

The credentialing committee should deny current privileges and require the surgeon to complete an accredited vascular surgery fellowship program before reapplying 1, 2. Upon completion of formal training, the surgeon should provide 5:

• Comprehensive list of cases attended and performed as primary operator
• Documentation of complications encountered during training
• Letter from program director confirming adequate training and capability for independent practice
• Initial proctored cases before unrestricted privileges are granted