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The Cardiology Workforce Supply

The Cardiology Workforce Supply

Previous workforce estimates implied that inadequate numbers of cardiologists were being trained to meet the needs of an expanding and older population of Americans. “There has been deep concern that a projected shortage in the cardiologist workforce could impact the care of patients with heart disease,” explains Patrick T. O’Gara, MD, FACC. “More recently, however, these forecasts have been called into question. Healthcare systems have shifted from volume-based care to value-based care. Both invasive and non-invasive procedural volumes have declined, as have the associated reimbursements. These trends have placed additional stress on providers and limited the hiring of newly graduating fellows, especially in geographically desirable locations.” A Multifaceted Problem Several factors are influencing the supply of cardiologists, including the aging and increasing population, the cost and duration of training, scientific advances, and the effects of the Affordable Care Act. There are also gender and racial/ethnic gaps in the cardiology workforce and geographic variations throughout the United States. Many cardiologists are practicing in major metropolitan areas, but there are fewer practicing in smaller towns and rural areas. “Many hospitals are rethinking how many cardiologists they need on staff, especially as they see their procedural volumes fall,” says Dr. O’Gara. “There is no longer the lack of invasively trained cardiologists as previously feared. It’s becoming more difficult for newly trained cardiologists to find attractive jobs. In addition, cardiologists are not retiring as rapidly as predicted.” Collaboration Needed to Find Solutions These problems affect all of cardiovascular medicine and are not easy to fix, according to Dr. O’Gara. “As a community, we need to ask where we’re going with the current training...
ICD Use in the Under-Represented

ICD Use in the Under-Represented

Implantable cardioverter-defibrillators (ICDs) have emerged as an important treatment option for select patients with heart failure, those with reduced left ventricular function, and individuals at risk for cardiac arrest or sudden cardiac death. “For years, these devices have served as an effective means of stopping life-threatening abnormal heart rhythms,” explains Venu Menon, MD. Recommendations on ICD use in clinical practice have been provided in guidelines sponsored by the American College of Cardiology (ACC), the American Heart Association (AHA), Heart Rhythm Society (HRS), and the European Society of Cardiology. However, recent guideline updates are lacking because most clinical trials tend to focus on the effectiveness of ICDs that provide cardiac resynchronization therapy (CRT) rather than outcomes of non-CRT defibrillators. “Although many patients have benefited from ICD implants, there are still groups who fall outside the standard guidelines for treatment,” says Dr. Menon. Smaller patient populations or unique circumstances are not typically provided with indications for treatment. As a result, guideline indications for ICD therapy are limited specifically to patients who would have been eligible for enrollment in clinical trials. “Clinicians are often asked to make decisions about ICD therapy for patients who were not included or who were poorly represented in prior clinical trials,” Dr. Menon says. “For these individuals, there are no specific indications for ICD therapy.” Addressing an Important Need In 2014, the ACC, HRS, and AHA released an expert consensus statement, published in the Journal of the American College of Cardiology, on ICD use in patients not included or not well represented in clinical trials. “The statement provides direction on ICD therapy that specifically targets patients who...

Anesthesia vs. Surgery: Can’t We All Just Get Along?

A surgeon did an operation under local anesthesia with sedation in a very anxious, elderly patient. Everyone was aware of the patient’s anxiety, and she was maintained on midazolam (Versed) by an anesthesiologist throughout the procedure, which went smoothly. When she returned a few weeks later for a similar procedure at another site, a different anesthesiologist was involved and refused to sedate the patient, who complained bitterly after the case. She said if she had known that sedation was not going to be given for the second procedure, she would not have undergone it. She filed a formal complaint with hospital administration as did the surgeon. The preoperative nurse told the surgeon that she had spoken with the second anesthesiologist and informed him that the patient was anxious and wanted a similar type of sedation for the second case, but he refused to give it. He accused the nurse of telling him how to do his job. For now, the anesthesiologist in question is no longer being assigned to the surgeon’s cases. What happens when anesthesia and surgery disagree? There is no simple answer to this issue. Anesthesia is one of the few specialties that you must consult and work with but have no control over who is assigned to your cases. You may have a couple of “go to” internists or cardiologists. You can ask your favorite radiologist to look at an x-ray for you. But anesthesiologists are assigned to you by the chief of anesthesia or the anesthesiologist-in-charge for the day. So no matter how incompetent or disagreeable a particular anesthesiologist is, you may have to work...
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