As a participant in the creation of the original Accreditation Council for Graduate Medical Education fellowship training standards for Endovascular Surgical NeuroRadiology, I read the article concerning fellowship suspension with great interest.1 The paper is timely and thorough. It is unfortunate that the neurointerventional world is dealing with so many unknowns. We do not seem to know how many we are, where we work, what we do, or where we were trained. The problem is very well summarized at the end of the paper. We seem to be spreading our patient population among too many practitioners, which subsequently restricts the number of patients available to each practitioner to stay in practice, make a living and be proficient.

The first line states: ‘The purpose of any training program is to provide a supply of skilled workers to address an unmet demand for their services’. The authors discuss numbers of procedures and extrapolate implications but do not discuss what the training was that got these people out into the world. Further, there is no clear statement as to what these unmet needs are. These workers might perhaps be skilled in certain areas but do not know anything about other subjects.

Adequacy of …