The status of vascular surgery as an independent specialty in Europe: are the relationships with general and cardiothoracic surgery a problem?

Vascular surgery has established a clear clinical and scientific profile in Europe over the last decade, but it presents a highly complex, disorganized, and unplanned pattern. It is a specialty in the majority of the present member states of the European Union (EU), but in the United Kingdom, Germany, the Netherlands, and Sweden this is not the case. With the current expansion of the EU with 13 countries, mainly from the former Eastern Bloc, it will be even more necessary to ensure at least some level of convergence in the standards of training, certification, quality assured practice, continuing medical education, recertification, access to and quality of care, etc, because free migration of doctors, and patients, is a derivative of the cornerstones of the EU treaties, namely free movement of the citizens (and capital). The profession has been successful in creating a simple and coherent system for organization within the European Union of Medical Specialists with a board of vascular surgery, for a (voluntary) European proficiency test for specialists (the EBSQ-Vasc), and for European continuing medical education, all in close collaboration with the premier scientific society, the European Society for Vascular Surgery. The fantastic reductions in working hours for young doctors in the EU represent a serious threat to standards of training and, ultimately, to the patients. This, in connection with increased litigation and compensation demands for incompetence and negligence, makes it even more necessary to establish European minimum standards for training, professional competence, and an obligatory European specialist examination. A key element in this difficult process is the establishment of vascular surgery as a specialty in all member states. Day-to-day collaboration with radiologic interventionalists has developed pragmatically at the local level in most places, but only when the administrative structures mature and vascular surgery becomes a specialty in all countries will the necessary tools be available for the avoidance of professional conflicts with colleagues from other specialties.