One of cardiology’s many ongoing staffing issues is the lack of heart failure (HF) specialists available in the United States. According to a new commentary written by three cardiologists, leaders can address this issue by finding more internal medicine specialists who are willing to undergo additional HF training. These HF internists, the group explained in JACC: Heart Failure, could go a long way toward improving the quality of care for patients with advanced heart disease.
“The burden of HF in the United States is massive and growing,” wrote first author Eiran Z. Gorodeski, MD, MPH, a cardiologist who specializes in HF at University Hospitals Harrington Heart & Vascular Institute in Cleveland, and colleagues. “Per published American Heart Association statistics, it is anticipated that >8.5 million adults will be affected by 2030. Further, HF diagnostic and therapeutic modalities have become increasingly more complex and involve multiple stakeholders. In the context of this increased complexity, it is perhaps not surprising that HF care is often suboptimal.”
Gorodeski et al. noted that the American Board of Internal Medicine certified training programs in advanced heart failure and transplant cardiology (AHFTC) back in 2009. While these AHFTC programs were designed for cardiology trainees, interest within the specialty has declined in recent years, helping contribute to the country’s shortage in HF specialists. This lack of interest among cardiologists is a significant problem—and one that the authors think can be addressed by encouraging more physicians from other specialties to undergo AHFTC training.
“In practice, internists, hospitalists, and primary care physicians care for the largest number of patients with HF,” the authors wrote. “Among cardiologists, general cardiologists are the primary workforce caring for the HF population. But there are only modest Core Cardiology Training Symposium requirements for dedicated HF content in general cardiology training, and >40% of U.S. cardiology fellowship programs do not have an AHFTC-trained specialist on staff.”
What is an HF internist?
HF internists, the group wrote, are internal medicine residency graduates who complete additional training under the guidance of experienced AHFTC subspecialty cardiologists and their colleagues. Some U.S. training programs already offer this exact type of training, and it is often pursued by internal medicine physicians who failed to match into cardiology and still hope to find a career treating heart patients.
Demand is high for this level of training. If more professional societies can start to embrace this career path, it could result in more opportunities for HF internists to thrive.
Challenges to the group’s proposal
Gorodeski and colleagues did not that there are certain challenges when it comes to recruiting more HF internists. For example, a “standardized milestone-based curriculum that is tailored to noncardiologists” is needed; the group suggested this could be done in the near future.
Another potential challenge is that these programs could add an additional year of training for physicians who already spend a significant number of years before they can practice medicine.
“Although we are not proposing that an HF-focused year is required to care for patients with HF, we do believe that the additional expertise will be of great benefit to communities/populations of patients,” the authors wrote. “We also want to empower and validate recent graduates and current trainees seeking out this added training.”
Funding could also be a challenge, the group added, but this should be less and less of an issue as more in the healthcare industry learn about this approach and learn about its clear benefits for patient care.
One final challenge worth highlighting is the potential for conflict between HF internists and cardiologists who specialize in HF. Would physicians with these two backgrounds clash in clinical care? Would patients get confused about the two titles in a way that impacts their care? The authors did bring up these concerns, but they also shared their confidence that internists and cardiologists would be able to work together to find solutions.
Although many strategies should be identified and formalized to improve the care of the ever-increasing population of patients living with HF, we feel that elevating the HF internist is one such approach that should be considered,” the group concluded.
Click here to read the full commentary.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.