The overwhelming majority of patients with CHD are now expected to live well into and through adulthood (10), although they remain at risk for long-term and life-defining sequelae related to their CHD ((1),11). In addition, these patients are at equal or sometimes greater risk of and from adult (internal medicine) comorbidities (including atherosclerosis, systemic hypertension, hyperlipidemia, diabetes, obesity, thyroid disease, psychiatric illness, and cancer), activities, and life milestones (such as pregnancy) ((11),(12),(13),(14),15). Although it might be tempting to consider growing adults with a chronic medical condition such as CHD to have a physiology with constant ramifications that can be cared for by a singular team, it is increasingly clear that adults with CHD have unique healthcare needs that are different from their pediatric counterparts. The complex inter-relationships between congenital heart lesions, changing physiologies, demands of aging, and comorbidities acquired in adulthood require expertise in both CHD and adult internal medicine and cardiovascular care. To serve this population of patients, an insufficient but growing number of ACHD clinical and training programs are evolving; most combine resources from partnering pediatric and adult internal medicine programs and facilities. Standardization of such training via aligned ABP and American Board of Internal Medicine collaboration toward ACHD subspecialty board certification is underway. In addition, numerous task forces have been established to develop strategies to improve access to specialized ACHD care in collaboration with primary care teams. A better understanding of patterns of referral and of perceived barriers to ACHD care seems important in optimizing the essential partnership between pediatric cardiologists and ACHD care practitioners in such initiatives.