Cardiology's Workforce Crisis
The U.S. is facing a growing
shortage of cardiovascular specialists that will hinder access to care
and undermine the vital research efforts of cardiovascular physician researchers.
Why a shortage?
In the early 1990’s,
the commonly held belief was that the U.S. was producing too many specialist
physicians, including cardiologists. The rapid growth of for-profit managed
care with its gatekeeper model and obstacles to specialty services contributed
to this belief. As a result, the number of first-year and total adult
cardiology training positions fell by 20% and 10%, respectively, between
1994 and 1999.
The managed care model
did not gain traction as expected, and access to specialists has not been
limited as expected. The projected surplus did not come to fruition; however,
the number of first-year training positions and total adult cardiology
trainees is still below 1994 levels.
This, in addition to the
aging of the population and rising risk factors for cardiovascular disease,
has led to a shortage of cardiovascular specialists.
What is driving the demand for cardiovascular specialists?
Cardiovascular “Demand
Catalysts”
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Population: An aging
population with more chronic cardiac patients living longer.
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Metabolic syndrome:
The “epidemics” of obesity and type 2 diabetes leading to
more cardiovascular disease.
-
Superior outcomes: Compelling
evidence that heart patients have better outcomes if they receive at least
part of their care from a cardiologist.
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Managed care decline:
The decline of managed care’s gatekeeper model that blocked access
to specialists.
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Consumerism: A better
informed public with growing expectations in terms of their personal healthcare.
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Women: Increasing awareness
among women that they are more likely to die from cardiovascular disease
than from cancer.
-
Clinical innovation:
Continuing technological and procedural innovations and their rapid diffusion
into practice.
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Screening: More widespread
use of cardiovascular screening tests that result in more referrals and
procedures.
-
Subspecialization: Progressive
subspecialization within cardiology that results in more “internal”
referrals.
Source: Fye WB, Hirshfeld
JW, et al. Cardiology’s workforce crisis: a pragmatic approach.
Presented at the 35th Bethesda Conference, Bethesda, Maryland, October
17-18, 2003. J Am Coll Cardiol 2004; 44:215-75.
Heart Disease Facts and
Statistics
Trends in cardiovascular
disease by population
Trends in cardiovascular
disease risk factors
Trends in cardiovascular
disease (miscellaneous)
Supply of cardiovascular
specialists
174 ACGME-accredited cardiovascular disease fellowship training programs,
many in collaboration with local private cardiology practices, provide
the necessary training to produce the cardiovascular specialists that
treat patients and conduct valuable research efforts. In the 2006-2007
academic year, these programs collectively had 2,427 ACGME-approved training
positions, of which 2,302 were filled. The 125 positions that went unfilled
were vacant largely because the institutions lacked the funding to fill
those slots with one of the many qualified applicants that were denied
admission. In addition, as a result of workforce predictions of the early
1990s predicting a major surplus of specialist physicians, the number
of first-year cardiology fellowship positions was reduced by 20% between
1994 and 1999; as of the 2006-2007 academic year, the number of cardiology
fellows is still below 1994 levels.
The Association of American
Medical Colleges (AAMC) conducted a survey of physicians under the age
of 50. Preliminary findings indicate that:
-
One out of three doctors over 50 would retire today if they could
afford to do so
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Older physicians cite increased regulation of medicine as the key
factor influencing retirement plans
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One out of three, or 33 percent of doctors under 50, are not interested
in working longer hours for more money
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Seventy-one percent of young doctors identify having family and personal
time as an important factor in a desirable practice.
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Cardiology
Training Programs and Trainees in the U.S. (1950-2006)
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