To the Editor: As representatives of the Clinical TMS Society, a professional organization representing approximately 400 providers of repetitive transcranial magnetic stimulation (rTMS) therapy from a variety of practice settings, we welcome the recent publication of consensus recommendations for rTMS treatment of depression developed by the National Network of Depression Centers (NNDC) and the American Psychiatric Association Council on Research (APACR). 1 It is auspicious that this set of consensus recommendations comports highly with our own society's consensus recommendations published in 2016. 2 The high degree of concordance between them is an indication that the clinical practice of treating depression with rTMS has matured significantly since the first FDA clearance of a TMS device for major depression in 2008 and signals that the basic features of a standard of care has emerged for this modality of depression treatment.However, the NNDC/APACR paper provides surprisingly little specific guidance on the appropriate role of the physician in the TMS treating team. Our position, which is delineated in our 2016 consensus recommendations, 2 is that the prescribing TMS physician is responsible for obtaining informed consent and assessing a patient's suitability for rTMS, although we disagree that this routinely requires a full physical examination. The physician is also ultimately responsible for the overall daily management of the TMS treatment and should regularly review the clinical course of treatments to determine if the treatment plan remains appropriate or needs modification.Regarding qualifications for the TMS physician, we believe that the NNDC/APACR recommendation that he or she be "a clinician with prescriptive privileges who is knowledgeable about, trained, and credentialed in rTMS" is too broad. It is our current position that for all rTMS indications, the TMS physician should have the extensive background in brain physiology that is obtained during residency training in psychiatry, neurology, or neurosurgery. The physician should also have a deep understanding about the neurophysiological effects of rTMS and certification in administration of rTMS. Moreover, the complex psychiatric status of the typical patient undergoing rTMS for depression (chronic, severe, resistant to medication and therapy, and commonly comorbid with other psychiatric conditions) warrants that when the indication is depression, the TMS physician should be a psychiatrist or one of the other medical brain specialists collaborating very closely with a psychiatrist in the patient's treatment.With regard to the qualifications of the TMS operator, we agree with the NNDC/APACR recommendations that he or she should be trained to recognize and effectively respond to seizures. However, we do not agree that operators should have professional medical training. The last 8 years has revealed that rTMS treatment is very safe and seizures are rare. Furthermore, the limited actions expected of first responders to a seizure in an office setti...