Addressing staffing shortages in cardiology
There has been a growing shortage of cardiologists in the United States for several years, but the issue was accelerated due to burnout from the COVID-19 pandemic, falling reimbursements and increasing administrative burdens. In fact, the number of recruiters at the American College of Cardiology (ACC) meeting this year saw a four-fold increase compared to 2019.
While the shortage is most acute among general cardiologists, it also is beginning to impact subspecialty areas such as cardiac imaging and electrophysiology (EP). Rural practices also are hurting for cardiologists. Some health system recruiters at ACC said they have had rural positions open for years. Others say staffing has been a revolving door, where younger cardiologists gain some experience and they are then hired away by bigger or more urban health systems.
This prompted a joint session on this topic with the ACC and the Heart Rhythm Society (HRS) at the 2024 HRS meeting. ACC President Cathie Biga, MSN, FACC, president and CEO of Cardiovascular Management of Illinois, former ACC president Edward Fry, MD, chair of the Ascension National Cardiovascular Service Line, and Parin Patel, MD, head of electrophysiology with the Ascension St. Vincent Heart Center, Indianapolis, spoke in the session. They also teamed up for an exclusive interview with Cardiology Business.
Critical shortage of cardiologists and potential solutions
Fry highlighted the acute mismatch between supply and demand, particularly in electrophysiology due to the rising prevalence of atrial fibrillation (AFib) and the growing number of cases. He stressed the importance of professional societies such as the ACC and HRS collaborating to propose timely and practical solutions.
"There is acute tension between supply and demand supply of trained staff. And it's no longer just numbers, it is also the right person or the right staff, adequately trained, correctly motivated as part of the team. There has just been an incredible surge in demand," Fry explained.
Patel emphasized the importance of addressing the training pipeline, starting as early as high school, to ensure a steady influx of future cardiologists and electrophysiologists. He advocated for greater engagement between practicing physicians and communities to nurture interest in these fields.
Biga pointed out the broader healthcare workforce crisis, particularly among nurses, and the necessity of fostering interest in bedside nursing. She underscored the need for systemic changes to address these challenges in both the short and long term.
"The thing about the session that was so interesting was we had a number of nurses share with us their understanding of the workforce crisis and the fact that so many of our nurses aren't necessarily interested in bedside nursing anymore. And what are we going to do about that? Not just today, but three, four or five years from now. That pipeline for all of our healthcare professionals is so tight, and it's really going to become more of a crisis than it is now," Biga explained.
During the session, solutions were discussed, including the two-plus-two training model for EP, which reduces training time by combining two years of general cardiology and two years of electrophysiology. Fry highlighted the potential of artificial intelligence (AI) to help improve efficiency, reduce administrative burdens, and enhance work-life balance, thereby making the profession more attractive.
Utilizing AI and technology
AI's role in easing cardiology's administrative burdens, such as electronic health records (EHR) completion and pre-authorization processes, was another focal point. Biga emphasized how AI could help reduce the time physicians spend on paperwork, thus alleviating burnout. Fry also discussed the potential of predictive analytics to better align resources with patient needs, significantly impacting both financial outcomes and quality of life for providers.
"There's got to be a way that we can utilize that machine learning to help us reduce that administrative burden that I think is a big part of the burnout that we're seeing within our profession," Biga said.
Fry said predictive analytics will also be a huge.
"We probably expend 80% effort and costs to care for 20% of the patient population. If we could better understand how to align resources with the needs that would be very impactful, both financially as well as quality of life, and in terms of the workload," Fry added.
"I do think that leveraging technology is definitely going to be a key part of this. As EPs, we're already at the forefront of using technology, whether it's remote monitoring or wearables or any of that data that we get. Can we use that to make practice more efficient and in turn make that work life balance better enough that it attracts more workers," Patel explained.
Addressing financial and rural challenges
Despite recent reimbursement cuts, particularly in EP, Patel and Biga provided a more optimistic outlook, noting that the field has managed to adapt and maintain stability. They stressed the importance of focusing on the intrinsic motivations for entering the profession, such as patient care, rather than solely on financial incentives.
To tackle the shortage in rural areas, Biga suggested innovative delivery models, including telehealth and AI tools, to extend the reach of specialized care without requiring physical relocation of specialists. Fry mentioned ongoing legislative efforts to extend reimbursement for telehealth services, which could significantly improve access to care in underserved regions.
Converting the payment system away from RVUs
Medicare plans to move from the current fee-for-service payment model used to pay cardiologists to a fee-for-value model by 2030. The focus will be more on the quality of care delivered rather than the volume of care. Patel said this will help focus on the quality of what cardiologists do on a daily basis, rather than focusing on relative value units (RVUs) which focus on volume of services provided.
"I think that will go a long way towards alleviating some of the anxiety around reimbursement points," Patel explained.
Future directions to address the cardiologist shortage
All three experts said there is a need to expanding the training pipeline and offer more support for foreign doctors eager to practice in the U.S. Biga highlighted the need for legislative action to remove barriers and increase the number of residency slots. Patel proposed rethinking the traditional training pathway to shorten the time to practice, making the profession more appealing by allowing earlier entry into the workforce.
"There's no doubt that the bottom line is our pipeline needs to get bigger because as Americans age and we live longer, and we are maybe not as healthy as we should be. We need physicians and we need that care team to surround us. And so that pipeline is going to become more critical as time goes on," Biga said.
Patel said shortening training would also go a long way to making cardiology more attractive.
"I think coming out of high school and going straight to medical school in some fashion will shave off some time, make it a little bit more incentivized because you start working earlier, and you start earning earlier rather than delaying true earning until your thirties," Patel explained.
Fry said some health systems are now are funding their own training positions due to the limited number of residency positions available.
"I think we'll see more of that. CMS has a finite pot of money, and they're not going to expand expenditure on graduate medical education. And so the health systems are going to have to step forward to help support some of that. We may even see programs such as what people saw with the big three automakers in the forties and fifties where you trained the people who worked with you and with that, you retain them for a certain period of time," Fry explained.
Biga said efforts are being made to pressure and expand telehealth reimbursement as a way to increase efficiency in workflow with regular patient checkins and simple questions. It also can help alleviate demand for care in rural areas. She also predicts AI will see an increase use in rural areas to help deliver care and identify patients who truly need to see a specialists at big hospitals hours away.
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: dfornell@innovatehealthcare.com