Despite the fact that heart disease remains the leading killer of Americans, there aren’t enough cardiologists to care for these patients, according to a report released today by the American College of Cardiology (ACC). This finding is especially concerning given that the demand for cardiology services is only expected to increase amid an aging baby boomer population, the escalating obesity epidemic and as more people are living longer with chronic heart disease. In fact, based on the new data, authors project the number of practicing cardiologists will need to double between 2000 and 2050 in order to adequately take care of anticipated new cases of heart disease.
“We have a significant shortage of 3,000 cardiologists in the workplace today, and all indicators are that it’s going to get worse if we don’t do something,” said George P. Rodgers, M.D., F.A.C.C., chair of the ACC Board of Trustees Workforce Task Force and a cardiologist in private practice in Austin, TX.
If current trends persist, Dr. Rodgers says there will be 16,000 too few cardiologists in 2050. These estimates are based on the analysis of a survey of employers within private and academic practices—those who hire cardiologists and are keenly aware of the market needs and willing to pay for cardiologist services—to assess whether and how many open positions there are to meet demand and provide quality care, as well as other observed trends in cardiovascular care.
“Patients are surviving heart attacks and are living better and longer with heart disease, which is a good thing, but they will need ongoing cardiac care and surveillance,” Dr. Rodgers said. “Without boosting our supply of cardiologists, we may threaten the incredible progress we have made to date.”
According to ACC, the mortality and morbidity related to heart disease has been reduced by 29 percent over the past 8 years.
The full report, published in the September 22, 2009, issue of the Journal of the American College of Cardiology, also outlines factors that influence physicians to become a cardiologist, the underrepresentation of women and minorities in the field, as well as the lack of an adequate number of training spots and funding.
The current shortage stems from a decision by policymakers in the early 1990s that, with the ushering in of managed care, assumed the family practitioner would be the main gatekeeper for people with heart disease. This resulted in a 25 percent cut in the number of cardiology training spots.
In addition to the expected demand for cardiology services over the next 20 years and the lack of training opportunities and funding in cardiology, several other issues are fueling experts’ concern:
- More than 40 percent of all cardiologists in the current workforce are over the age of 55 and may retire early for a variety of reasons (e.g., malpractice insurance costs, cuts in reimbursement, arduous call schedules with no opportunity to “wind down” closer to retirement).
- There is an underrepresentation of minorities and women in cardiology; while African Americans and Hispanics comprise 25 percent of the U.S. population, they only represent 6 percent of cardiologists in active practice, and women only comprise 12 percent of cardiologists.
- Non-physician providers are underutilized even though they could help to work up, screen, educate and discharge new patients
- Proposed Medicare cuts in the range of 25 to 42 percent for key cardiology services may hinder access to services that have improved countless lives by diagnosing and treating cardiovascular disease
The report offers suggested solutions, including expanding the number of fellowship positions, establishing better work-life balance, reducing known “hassle factors” that may encourage early retirement, creating incentives for underrepresented minorities to consider cardiology, as well as encouraging a team-based approach to cardiology care that leverages the skills and expertise of other non-physician providers (e.g., nurse practitioners, physician assistants).
“We need to advocate for more training spots and funding for cardiovascular specialists and, in the meantime, find creative and more effective ways of delivering care,” said Alfred A. Bove, M.D., F.A.C.C., president of the ACC. “Team-based care is a major opportunity for improving the current and future workforce crisis.”
ACC is actively promoting team-based care by working with non-physician providers and practice administrators and through the development of a curriculum and workshop to educate cardiologists about how to work effectively with other providers.
The Workforce Task Force was started by ACC following the 35th Bethesda Conference in 2004. The present survey was conducted by ACC and the American College of Cardiology Foundation with the Lewin Group and the Association of American Medical Colleges to better understand the factors affecting the supply of and demand for cardiologists, the magnitude of the shortage and projected trends.