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Who is a cardiologist? An answer to this question is essential if a common training programme is to be devised in Europe. Yet the answer is very varied. The UK is exceptional in reserving the term for a highly trained specialist, usually with a further research degree, and in scant numbers—approximately 8 per million population. At the other extreme, in some countries the cardiologist has often had minimal training, may be just in outpatient clinical and non-invasive skills, has no research experience, and is in plentiful supply—80 or so per million population. Most countries, such as, France, Germany, and Scandinavia, fall between these two extremes with 20 to 30 cardiologists per million population, all of whom are trained to diagnose and manage the common clinical problems with competence; some will be trained to university or specialist centre standards of expertise.
There is free interchange of labour between the member states of the European economic area (European Union, Norway, Iceland, and Liechtenstein). Criteria by which doctors and specialists can be recognised are therefore necessary. Mutual recognition of the basic medical degree was achieved only after years of deliberation when it was realised that the wide variety of systems for educating doctors all resulted in a rather similar end product; hence the short cut was simply to agree to recognise the medical degrees granted by established schools in other countries. There is no great concern about the capabilities of the basic doctor, although the numbers per 100 000 population do vary from a minimum of 164 in the UK, 196 in Canada, 214 in the United States, 256 in Germany, 314 in France, to 424 in Italy.
How doctors subsequently specialise and gain employment is determined largely by the national health care system. Unemployment and hence the desire to emigrate is however a …