Where Have All the Cardiologists Gone?

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Every day for the next 19 years, 10,000 baby boomers will reach age 65, according to the Pew Research Center. By 2030, all members of the baby boomer generation, which encompasses 26 percent of the U.S. population, will be 65 or older at a time when physicians may be in short supply. Nearly 80 percent of seniors have at least one chronic health condition, such as hypertension or heart disease, and 50 percent have at least two, according to U.S. Census data. What are the implications of this aging population and how will the dwindling number of cardiologists keep up with this demand?

Facts, figures & driving forces

Each year, cardiovascular disease strikes 1 to 2 percent of the U.S. population, and according to 2009 data from the American College of Cardiology (ACC), this trend will continue over the next two decades. While clinicians have worked to slash cardiovascular mortality, the ACC Board of Trustees Workforce Task Force has estimated that deaths from heart disease will increase 128.5 percent between 2000 and 2050.  

But will there be enough cardiologists to serve them? Fifteen percent of C-suite and cardiovascular professionals surveyed by the ACC in March said that recruiting cardiologists and other  professionals was one of the biggest hurdles. And a 2010 survey by MedAxiom showed that cardiologists saw an uptick in the number of new patients. On average, cardiologists reported seeing 349 new patients in 2009 alone. To deal with this spike, the number of cardiologists must double.

“The workforce shortage has built up over time,” says Suzette Jaskie, MBA, president and CEO of MedAxiom Consulting in Neptune Beach, Fla. “We now have a large number of cardiologists in their late 50s and older hitting retirement age, which could eventually perpetuate this shortage.” In fact, it has been estimated that 10 percent of cardiologists will retire in the next 10 years.

Fellowship programs for interventional cardiologists and general cardiologists are also few and far between, Jaskie says. “We are not taking in as many cardiologists and we also have had a big drop-off in interventional volumes.” This, combined with the economic downturn and cardiologists working longer, leaves few openings for younger cardiologists. “We will see some real issues as cardiologists begin to reach retirement age,” Jaskie says.  

In 2009, the ACC’s Workforce Task Force issued a survey about potential workforce challenges and outlined strategies to thwart this deficit. Many open cardiologist positions were left unfilled, says George P. Rodgers, MD, cardiologist at the Seton Heart Institute in Austin, Texas, and ACC Workforce Task Force committee member. There were 1,685 open positions for general cardiologists, 660 open positions for electrophysiologists and 1,941 open positions for interventionalists.

Many independent cardiologists may be “skittish on taking on more mouths to feed,” due to the dwindling economy and reimbursement cuts, says Rodgers. “Hiring has decreased, yet there is still a demand. This will eventually become unsustainable.”   

The healthcare reform bill also could perpetuate this shortage, he says. “If those without insurance are insured, it will increase the demand for cardiovascular services,” says Rodgers. However, accountable care organizations (ACOs) could alleviate this problem through attempts to divvy up resources more efficiently. In addition, the ACO focuses on quality and outcomes rather than procedures performed. “You get what you incentivize,” Rodgers says. “If you incentivize quality outcomes, then that’s what you will get, but if you incentivize a lot of procedures, it will result in more procedures.”

Feast or famine

Joseph E. Marine, MD, director of arrhythmia services at the Johns Hopkins Bayview Medical Center in Baltimore, challenged the conclusions of the ACC’s task force in a 2010 letter to the editor when he questioned whether cardiologists are actually in a shortage, or a surplus. He says the task force may have failed to examine whether there is a surplus of specialists, which may ultimately drive “excessive” healthcare spending (J Am Coll Cardiol 2010;55:838-839).

He referenced a Dartmouth Atlas of Health Care project brief, published in 2009, that assessed physician capacity and workforce variations in the U.S. The brief found that physician workforce varied by region—sometimes by as much as 300 percent. San Francisco, for example, had more than 100 primary care physicians (PCPs) per 100,000