The growing population of patients with congenital heart lesions surviving to adulthood necessitates a fresh look at the clinical training required to care for these patients. Physicians in pediatric and medical cardiology, general pediatrics, general medicine, family practice, obstetrics and gynecology and other specialities will all have a role in the care of these patients. Most likely, training will need to be incorporated into existing pathways with a clear delineation of a body of knowledge necessary to assimilate to complete the training program. The authors favor a certificate of added qualification for the treatment and management of adults with congenital heart disease to encourage excellence in preparation of physicians to care for this complex patient population.