HRJ: Demand for EPs rises due to procedural growth

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Source: Mount Sinai’s Heart Center
There are increasing demands for electrophysiology (EP) professionals as a result of shifting demographic trends, evolving healthcare reform policies and improved procedural outcomes, according to a workforce study published in the September issue of the HeartRhythm Journal. The analysis also found substantial growth in the overall volume and complexity of cardiac procedures performed in the past decade.

The study, commissioned in 2009 by the Heart Rhythm Society, provides data from nearly 700 respondents (9 percent response rate), including EPs, allied professionals and basic scientists currently working in cardiac electrophysiology. The median age of physician respondents was 50 years. While the average work week for physician respondents is 60 hours, nearly 30 percent work between 61 and 75 hours a week. For every respondent age-range queried, the work load is expected to increase over the next five years for EPs, allied professionals and basic scientists alike.

“As seen from this study, electrophysiologists must embrace the advancements in technology and adapt to the changes in healthcare reform in order to continue to deliver high-quality care to a growing patient population,” said lead author Thomas F. Deering, MD, from Piedmont Heart Institute in Atlanta.

Deering and colleagues found that most physicians anticipate an increased workload in response to several key factors, including an aging patient population; broader access to care; possible expansion in indications for therapies, such as device implantation and ablation procedures; increasingly complex procedures; and a potentially decreasing workforce as the current workforce gets older, cuts their hours and/or retires.

Approximately 25 percent of physicians are highly specialized in the type of procedural work they perform, with 25 percent of the physician respondents spending more than 85 percent of their procedural work time on either device or ablation procedures, the researchers reported.

For workload considerations, practice time is predominantly spent on device implantations, device follow-up and ablations. Some of these activities, such as complex device or ablation procedures, are being tasked to younger physicians indicating a growing need for more well-trained allied professionals to assume a greater role in device management. Furthermore, nearly two-thirds of all respondents are currently at or exceeding their perceived workload capacity for device therapies and catheter ablation.

More than 55 percent of the physician respondents indicated that the total number of implantation procedures they performed each year had increased relative to five years ago. Additionally, the follow-up of implanted devices was the largest percentage of activity reported: on average more than 200 annually per respondent.

Currently, allied professionals play a “significant role” in managing device patient follow-up, and this need will “steadily increase as the number of device patients continues to rise,” as trained allied professionals “assume a greater role in device management,” the authors wrote

Overall, device implantation accounts for nearly one-fourth of the survey respondents' workweek. And, pacemaker and implantable cardioverter-defibrillator implantations are performed equally by physician respondents of all ages; whereas, cardiac resynchronization therapy device implantation is more common among young or mid-career physicians.

The median proportion of time each respondent spends on ablation procedures during the workweek is 15.8 percent, according to the study. Supraventricular tachycardia (SVT) procedures were the most common—with 76.9 percent of survey respondents having performed an SVT in the last twelve months. SVT ablation became less common as the age range of respondents increased.

Like SVT ablations, older respondents were less likely to perform ventricular tachycardia (VT) ablations and atrial fibrillation (AF) ablation. In general, the survey found that AF and VT ablations are almost exclusively performed by early and mid-career physicians.

Work capacity is expected to increase to offset some of the economic drivers; however, recruitment of new EPs could be “challenging and uncertain,” wrote Deering and colleagues. Specifically, geographic mobility (more than 50 miles) appears to be minimal at present, and unlikely to significantly change for the majority of physicians once they have established themselves in a given community following the completion of their training.

The perception of competition varied by respondent age and geographic location but, in general, was felt to be at least moderate by most respondents. Furthermore, the respondents spoke to concerns that increasing competition may dilute operator experience and potentially lower high-quality outcomes if increasing competition leads to lower procedural volumes.

“Although specific areas will require further analysis, overall, the current EP workforce is stable, with the exception of geographic dispersion,” the authors concluded. “However, the workforce must adapt to the key economic drivers (demand) and address future recruitment challenges.”