Changing of the Card: MD Employment, Exodus & Exploration

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The cardiology profession, like healthcare, is in a state of flux. With large numbers of physicians at or near retirement age, there could be an exodus of talent. Today’s newly trained specialists are finding that their career path bears little resemblance to that of their elders.

For older cardiologists, you could call it the imperfect storm. Those who saw their investment portfolios tank with a souring economy a few years ago had to retrench rather than retire, despite reluctance to undergo the changes demanded in healthcare reform.

“There had been a freezing in place of practitioners after the crash,” says Jeff Goldsmith, PhD, president of Health Futures and a sociologist in the department of public health sciences at the University of Virginia, both in Charlottesville.  His research includes factors that influence physician career moves. “The crash nuked a lot of the people’s retirement funding and the value of their medical real estate, which is equally important.  A lot of [physicians] postponed their retirement.”

One of every five cardiologists is 60 years old or older, according to the consulting firm MedAxiom. With stock markets recovering and reform the new reality, some senior cardiologists may be poised to leave the profession and pass their shingles over to early career physicians. But those younger physicians and the environment where they practice differ from years of yore.

Debt burdens

Today’s newly minted physicians in the U.S. carry significant educational debt, a millstone that likely influences their early career decisions. Median debt levels for medical school graduates rose faster than inflation for two decades, according to a 2013 Association of American Medical Colleges (AAMC) report, Physician Education Debt and the Cost to Attend Medical School. Medical school debt on average has increased 6.3 percent annually since 1992. In comparison, the Consumer Price Index edged up 2.5 percent annually.

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Source: Merritt Hawkins

A medical school graduate who completed training in 1992 faced a median deficit from his or her education of $50,000, or a shade under $82,000 in 2012 dollars. A graduate in 2012 was in the hole financially for a median $170,000 and graduates of private institutions could expect to add another $20,000 to the I.O.U. In 2011, 86 percent of medical school graduates reported they had medical school debt, and about a third still faced bills from undergraduate schooling.

“Debt absolutely is an issue in medicine,” says James A. Youngclaus, MS, a senior education analyst at AAMC and co-author of the education debt report. “It is common among medical students to hear them talk about the amount of debt they will incur.”

Other research supports that observation. Epocrates, a digital solutions company that is part of Aetna Health, identified debt as “a major stress point” in a 2012 survey of medical students. Some 30 percent said paying off loans was among their biggest concerns in 2012, up from 17 percent in 2007.

In hock & risk averse

Physicians pursuing a cardiovascular specialty may tack three to four years on for a fellowship and then additional years of training and education for a subspecialty (Am J Cardiol 2011;108:1508–1512). That could add up to more than a decade of training after college. “This is a heavy investment in their skill set,” points out Thomas Tu, MD, director of the catheterization laboratory with the Louisville Cardiology Medical Group in Kentucky and co-chair of the Interventional Career Development Committee at the Society of Cardiovascular Angiography and Interventions (SCAI).

2012/13 Income Offered

Cardiologist Low Average High
Non-Invasive $250,000 $447,000 $550,000
Invasive $300,000 $461,000 $675,000
Source: Merritt Hawkins 2013 Review of Physician and Advanced Practitioner Recruiting Incentives

Early career cardiologists weighed down by debt look at employment in a different light than their predecessors. “[They] are looking at how long it takes to repay loans,” says Goldsmith. “It has been a major driver of people’s interest in salaried employment, particularly by hospitals. The amount of debt has gradually tilted the playing field away from private practice of medicine and toward corporate practice.”

Joel Sauer, vice president of Neptune Beach, Fla.-based MedAxiom Consulting, concurs. “The majority of young physicians coming out of fellowship are looking for employment,” he says, preferring job security over what could be a more financially risky independent model. “They