Population aging is expected to increase demand for cardiovascular care in the U.S., and a recent report published in JACC: Advances found that cardiologists per 100,000 U.S. population declined alongside substantial workforce aging, despite modest increases in total cardiologist numbers.

Abraham Kyei Carboo, MD, et al., obtained active cardiologist counts from the American Medical Association Physician Masterfile for 10 reporting years from 2005 to 2023. Cardiologists per 100,000 U.S. population were calculated for each year. Age-stratified data (2005-2021), preclassified as proportions aged <55 and ≥55 years, were used to derive the younger-to-older replacement ratio (age <55/age ≥55). Researchers extracted sex distribution and medical training background (international medical graduate [IMG], U.S. allopathic medical graduate, Doctor of Osteopathic Medicine). Log-linear regression was used to estimate annual changes in number of cardiologists, and linear regression assessed trends in workforce aging, replacement ratio, sex representation and training pathway composition.

Results showed that from 2005 to 2023, the number of active cardiologists increased by about 1,000, but population growth outpaced workforce expansion, corresponding to a significant 0.29% annual decline in cardiologists per 100,000 population (−0.37% to −0.20%; p<0.001). Declining trends were consistent across candidate knot specifications.

Further, the cardiology workforce aged substantially between 2005 and 2021, with the proportion of cardiologists aged 55 years or older rising from 37% to 65%, while the rate at which younger cardiologists replaced older physicians declined significantly by 0.065 per year (−0.089 to −0.041; p<0.05). Notably, female cardiologist representation increased from 9% in 2005 to 17% in 2023, and male representation fell from 91% to 83%, reducing the male-to-female ratio from 10.1:1.0 to 5.0:1.0.

"This study demonstrates [three] concurrent structural shifts in the U.S. cardiology workforce: declining density, rapid aging and deteriorating renewal balance," write the authors. Strategies such as utilizing late-career cardiologists for outpatient consults and leveraging a team-based approach "combined with expanding fellowship training positions, reducing barriers for underrepresented groups and sustained policy support for IMGs, will be essential to safeguard cardiovascular care capacity. Future studies incorporating geographic granularity and subspecialty detail may further clarify regional heterogeneity in workforce distribution."