ACC survey: Cardiologist shortage could get worse

Results of a recent survey identify drivers of supply and demand, and offer solutions for the current and future states of the CV workforce.

The United States is currently experiencing a shortage of cardiologists, a problem that is expected to severely worsen over the next 20 to 30 years. According to data from a report released by the American College of Cardiology, the current 3,000-person shortage could reach 16,000 by the year 2050 if changes are not made.

“This is a very complex issue and it’s difficult to make predictions,” George P. Rodgers, MD, chair of the ACC Board of Trustees Workforce Task Force and cardiologist in private practice in Austin,Texas, said during a press briefing. “We don’t have a crystal ball, but our guess is that the deficit in numbers of cardiologists is probably going to widen and even double by the time we get to 2030 or 2050.”

Two years ago, after results from the ACC 35th Bethesda Conference were published, the ACC Board of Trustees Workforce Task Force was created to further examine CV workforce issues and make recommendations for possible solutions to the problem. Together with The Lewin Group and the Association of American Medical Colleges, Rodgers and colleagues began to identify reasons for the shortage.

The researchers determined the current supply of cardiologists and made projections for the future using data from the American Medical Association and the AAMC Over 50 Survey. In addition, they determined the demand for CV specialists by examining the number of open and available positions for cardiologists, and performed analyses to discover which factors affect a graduate’s decision to practice internal medicine or one of nine subspecialties.

Contributing factors

Forty-three percent of practicing cardiologists are 55 years or older and may be facing retirement, a factor that will undoubtedly contribute to the massive shortage the field faces. According to Rodgers, while there is no shortage of internal medicine residents interested in becoming CV specialists, there is a lack of funding for fellowship programs for interested candidates.

“There are 179 fellowship programs in the country today, and most of them say they could certainly expand, they have the faculty and the patient volume, but they don’t have the funding to do it, so that’s a key problem we need to address with Washington,” Rodgers said.

The issue of underrepresented minorities in CV care is also problematic. Currently blacks, Hispanics and Native Americans account for about 25% of the United States population but only 6% of the CV workforce, according to the researchers. A lack of women in the field is also concerning; though men and women are evenly represented in medical school, only 12% of the cardiology field is comprised of women.

The researchers evaluated demographics, lifestyle, economic growth, expansion of insurance coverage and technological advances as five major drivers of the demand for CV services. According to their findings, between the years 2010 and 2020 the number of people in the United States aged between 65 and 84 years will increase by 3.3% each year due to the baby boomer generation, resulting in an increased demand for CV care.

According to the researchers, the success of health care reform will also contribute to the pending shortage. If passed, the plan will provide insurance and better access to care for 47 million previously uninsured Americans.

“The other issue is that we’re victims of our own success,” Rodgers said. “Twenty or 30 years ago, many of these patients would have just died outright; however, we’re now much more successful at keeping patients with heart disease alive and hopefully healthier, but that means that we have more people to take care of.”

Reversing the problem

Rodgers and his colleagues at the taskforce created recommendations to improve the CV workforce in the areas of advocacy and professional society initiatives.

In addition to increasing funding for fellowship training programs in general cardiology, the taskforce recognizes the need for the addition of non-physician practitioners. The implementation of a team care approach — collaboration between CV specialists, nurse practitioners and physician assistants — will help improve the workforce. However, such a collaborative effort will require the training of both cardiologists and non-physician staff.

“The [ACC] is working on a core curriculum to help supplement the training that these professionals have so they can be more adept, specifically at CV care, but what we also need to do is teach the cardiologist how to work in a team care environment; that is a bit of a paradigm shift for many.”

To increase the number of underrepresented minorities in the CV workforce, the taskforce proposes the initiation of loan forgiveness programs and shortened fellowship track. Due to problems in the pipeline, they also recommend interventions at the middle school, high school and college levels. In addition, improving the delivery of care to underserved populations is possible through government and charitable programs to increase cultural proficiency in the cardiology field.

“We have a gap now and it’s tremendous,” Rodgers said. “In the next 20 to 30 years it’s going to get worse, so we need to start now to try to solve this problem.”

To read other Cardiology Today articles about the CV workforce shortage, including editorials by Chief Medical Editor Carl J. Pepine, MD, please click here. – by Stacey L. Adams

Rodgers GP. J Am Coll Cardiol. 2009;doi:10.1016/j.jacc.2009.08.001