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This letter is in response to the article in the December 2002 issue by Feasby et al¹ and the editorial by Dr Barnett.² Although the appropriate reaction to this study might support Dr Barnett's recommendations, the restriction of endarterectomy by volume creates the conundrum of how one manages to accumulate the requisite number of surgical procedures per year as one begins a career in surgery. Do the procedures done in training count? It also creates the problem of how a given hospital might begin to do such procedures or increase its numbers if a regulatory process prevents it from doing so.

This process would likely cause a seniority system to develop in which the successful prevent anyone else from succeeding or have great selective power as to whom they pass on (or sell, for that matter) their "gift." Would we as neurologists accept such a system if it applied to . . . [Full Text of this Article]

Gregory Pittman, MD
Louisville, Ky

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Carotid Endarterectomy: Turning Up the Volume?—Reply
Thomas E. Feasby, Hude Quan, and William A. Ghali
Arch Neurol. 2004;61(2):296-297.
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