Cardiology employment models undergoing a dramatic shift
The world of cardiology is undergoing a quiet revolution in the way cardiologists are employed, governed and integrated into the broader healthcare system.
Fifteen years ago, nearly 90% of cardiologists operated in independent private practices. Today, that model has nearly vanished. Cardiology Business spoke with Gerald G. Blackwell, MD, MBA, president and CEO of MedAxiom and a practicing cardiologist at the Ballad Health CVA Heart Institute, to hear more about these massive changes in how cardiologists are employed. He spoke on this topic in business sessions at ACC.25, the American College of Cardiology 2025 annual meeting.
“The landscape has inverted," he said. "Now, 90% of cardiovascular specialists are employed, and only about 10% remain independent. It happened very quickly for a variety of regulatory reasons that drove it."
Blackwell detailed the fast-paced evolution of employment models in cardiovascular care. The move toward employment has created a new spectrum of practice structures. What was once a binary conversation, independent vs. employed, has now become a landscape of increasing complexity. This has led to a time of abundance in terms of various types of employment options.
“There’s tremendous heterogeneity in today’s employment models,” Blackwell said. “Health systems used to dominate, but now we’re seeing more physicians employed by payer organizations, private equity-backed groups, and management service organizations," he said.
This structural change also comes at a time when cardiology, like many medical specialties, faces a severe and growing workforce shortage. The issue, which began before the COVID-19 pandemic, has only intensified since the pandemic, particularly in rural areas. Recruiters at conferences have more than doubled in number since 2019, reflecting a heightened urgency to fill roles in underserved regions.
"The various models are trying to figure out how can we serve the community. There are many that are focused on team-based care. There are a whole variety of things that are specifically trying to address the needs and issues in the urban communities, in the suburban communities. And I happen to serve a very rural population that has a very different set of needs. So the employment models have to really match up with the folks that they're trying to serve," Blackwell explained.
Blackwell also cautioned employers against viewing clinicians as mere expenses on a balance sheet.
"My advice to the organizations is, really be sure that you're tight in understanding how you want to lead and how you want your organization to perform. One of the colloquialisms I say to folks these days is that you want to be sure that inside these various employment models, that you are the product, as opposed to just an expense," Blackwell said.
He concluded his presentation with a striking visual — a cartoon showing two cardiologists on one side of a train car and a oversized team of administrators on the other. The administrators suggest that one of the cardiologists may need to be let go due to cut costs. It’s a tongue-in-cheek reference, he said, but it highlights an uncomfortable truth about the administrative bloat in healthcare.
"It really speaks to the current state of affairs. And it also speaks to how complicated the business has gotten. We have to right size that, shall we say," Blackwell said.
Physician leaders also need to focus on professionalism, he added, and ensure they are being the captain of the overall enterprise. It is also important the different members of the care team work together at all times.
"We can't be competing. We have to be on the same team. I'm an optimist, but I think we're getting better at that. There's a lot of concern about shortages in various parts of the country. I happen to believe that because of technological changes, because we're getting better at the team-based care model, it's going to be okay," Blackwell said.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]