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 and distribution of cardiovascular specialists. We need to create opportunities for those who follow, particularly as the healthcare needs of our patients increase.” He notes that if the cardiovascular workforce supply is unable to meet the demand, patients’ access to quality care could be threatened. The anticipated workforce gap cannot be met solely by expanding the ranks of non-physician advanced practitioners.
During a presentation at the 2014 annual meeting of the Society for Cardiovascular Angiography and Interventions, Dr. O’Gara suggested several possible means by which to address the problem, including stabilizing Medicare reimbursements for graduate medical training, piloting attempts to shorten the duration of cardiology training, creating new funding opportunities for research, and helping fellows realize that different skill sets will be required to lead the transformation to a value-based healthcare delivery system. “Expectations need to be recalibrated,” Dr. O’Gara says. “We need to develop creative approaches by working together as a physician community. Through collaboration, we can begin to find some solutions to the workforce challenges that confront us.”
Readings & Resources (click to view)
Society for Cardiovascular Angiography and Interventions. Press release. SCAI 2014 Scientific Sessions Hildner Lecture Tackles Looming Shortage of Interventional Cardiologists. Presented: May 30, 2014. Available at: http://www.scai.org/Press/detail.aspx?cid=a76b8894-27aa-4c9a-b4b6-00c13015b01b#.U43DC9GYa70.
Fuster V, van der Zee S, Elmariah S, Bonow RO. Academic careers in cardiovascular medicine. Circulation. 2009;119:754-760.
Saxon LA, Rao AK, Klarich KW. Shortage of female cardiologists: exploring the issues. Mayo Clin Proc. 2008;83:1022-1025.
Williams JL. Projecting the general cardiology workforce shortage. Am Heart Hosp J. 2007;5:203-209.
Kostis JB, Ahmad B. International medical graduates and the cardiology workforce. J Am Coll Cardiol. 2004;44:1172-1174.
Fye WB. Cardiology’s workforce shortage: implications for patient care and research. Circulation. 2004;109:813-816.