The past year has seen a whole lot of change for the field of cardiology, but it’s hard to discern where that leaves us as we prepare for 2020. MedAxiom President Jerry Blackwell, MD, MBA, helped clarify the situation at the organization’s annual fall meeting this October.
Blackwell, who kicked off this year’s CV Transforum in Dana Point, Calif., with the “State of Cardiology,” explained that as demand for cardiovascular services continues to increase, cardiologists themselves need to be able to adapt to a new landscape. And while many of the problems the specialty is facing are somewhat familiar—burnout, innovation, value-based care—it’s time to move on them.
“Our situation is complex and it’s real, but it ain’t new,” Blackwell said. “No doubt, we’ll figure this out.”
It’s great that we’re living in an era of intense innovation and data-gathering, but more data also means more to digest, Blackwell said. In 1980 it took seven years for medical information to double, and by 2010—just three decades later—information was doubling at twice the speed. In 2020 we’ll double our medical information every 73 days, or 0.2 years, meaning medical students who graduate next year will see four doublings of information while they’re in school.
“What happens is that information competes for attention,” Blackwell said. “So if you have a lot of information, you tend to have a poverty of attention. And then you have to allocate this properly. So this is a big deal for us to try to deal with.”
The result of the information overload is graduates who, while well-educated, are already on the path to burnout. Burnout is an established and real phenomenon, with a 2019 Medscape survey finding just 27% of cardiologists reported being “very” or “extremely” happy at work, and Blackwell said the stakes are high. The same survey found that around 43% of cardiologists admitted to being burned out, 10% reported being colloquially depressed and 4% reported being clinically depressed.
And real outcomes of burnout, like depression, can and often do affect patient care. Blackwell cited the Yerkes-Dodson human performance curve to note that while most of us need a little bit of stress to reach our full performance potential, exceeding that threshold results in reduced productivity. The demand for cardiologists today is increasing, not decreasing, so it’s important to manage stress at every level.
“It’s an information age—and, dare say, information overload,” Blackwell said. “Tons of information, but not nearly enough wisdom.”
An age for the learners, not the learned
In 2019, Blackwell said, adaptability is a more useful tool for cardiologists than efficiency. Both factors are important, but our current solutions just aren’t cutting it; this year, for the first time in 50 years, we learned that deaths from heart disease were on the rise.
But a lot has happened in those five decades, according to Blackwell, including a major shift in the U.S. from a predominantly manufacturing workforce to one where 70% of people are employed in the healthcare and social assistance sectors. The current culture favors innovators and problem-solvers.
“This age favors the learners, not the learned,” Blackwell said.
He said innovators need to address a whole host of missed opportunities in current practice, including a failure to elicit and follow patients’ goals and needs and a failure to diagnose. Physicians often fall short on making simple risk factor modifications, as well, which could reduce patients’ odds of CVD by as much as 80%. Cardiologists struggle to use proven first-line treatments—43% of patients on statins are nonadherent at one year—and often don’t refer chronically ill patients for palliative care that could improve their quality of life.
Another factor? Using newer, more innovative treatments. Blackwell said just one-third of people who are prescribed PCSK9 inhibitors actually get their hands on them due to issues like patient education and prior authorization.
The ‘secret sauce’ for success
CVD is increasing in both prevalence and expense across the world, and health is becoming a bigger priority for many companies. Some are “strange bedfellows,” Blackwell said, nodding to Best Buy’s recent foray into healthcare, but new, nontraditional partners offer an opportunity for cardiology to grow.
He said that right now the industry is siloed—broken up into groups like hospitals, physician practices, post-acute and urgent care, home health and payors—but that needs to change. Industry and payor revenues dwarf those of healthcare systems, and there’s “a lot of waste to be eliminated.”
There are lots of opportunities for the future of cardiovascular care, including new tech, a renewed focus on value and improved transparency. Care episodes will inevitably increase, new entities will enter the marketplace and we’ll undergo a shift from outpatient to more home-based care. But the “secret sauce” for success, Blackwell said, will be patient-centered, physician-led programs.
Moving from silos to integrated business units that place patients at the center of care would support the idea of value over payment and help enable the distillation of information from data points to actionable wisdom—but it’ll take work.
“We’ve gotta do something different, folks,” Blackwell said. “We’re in a service industry, and that’s a blessing. We actually subordinate our needs to the needs of patients and society. If you don’t feel that way as a physician, you shouldn’t be a physician.”