Meeting the growing demands of cardiovascular care presents a challenge to the current cardiovascular workforce as cardiovascular disease continues to be the leading cause of death in the U.S., according to a Council Perspective from ACC’s Fellows in Training (FITs) Council published Oct. 3 in the Journal of the American College of Cardiology.

Akhil Narang, MD, chair of the FIT Leadership Council, et al., examine the factors that influence the supply and demand of the cardiovascular workforce including demographics, health care reform, training and access to care. A 2007 survey of the workforce found that geographic maldistribution is more marked in cardiology than in primary care, with the Midwest and Western states in the U.S. falling significantly behind more population dense regions in terms of access to cardiologists. While an analysis from 2013 to 2014 showed a 20 percent increase in general cardiology fellows since 2005, there is still a shortage of up to 12,000 specialists predicted by 2025. Narang, et al., add that “whether the modest increase in FITs in the past decade suffices to ensure that Americans have adequate access to cardiovascular specialists remains unclear.”

In terms of health care reform, the Council notes that the Medicare payment shift from volume to value under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) “will likely result in a direct effect on cardiovascular practice models through the nation,” as reimbursement may influence the specialties FITs choose after general cardiology fellowship. In addition, an increase in the number of patients with insurance as provided for under the Affordable Care Act may likely result in a greater demand for care from cardiovascular specialists.

To balance the supply and demand of the cardiovascular workforce, the Council puts forth three suggestions: increase the focus on cardiovascular disease prevention; utilize a cardiovascular care team; and adapt the training pathway of future cardiologists. Increasing the focus on cardiovascular disease prevention may subsequently alleviate the burden on the cardiovascular workforce, while streamlined care that includes members of the cardiovascular care team has been shown to improve quality and safety of patient care.

Narang, et al., further add that “with the transition toward competency-based milestones … opportunities exist to reconsider the length of training to achieve successful competency.” They explain that with competency-based training, the time in which fellows achieve competency will vary considerably, with the potential to allow those early-achieving fellows to move into subspecialty training sooner. Such changes to cardiovascular training could increase the supply of the cardiovascular workforce to meet the ever-growing demand.

The Council concludes that “careful consideration of how the changing health care climate influences the job market, career decisions and the cardiovascular workforce for young cardiologists is paramount.”

Keywords: Cardiovascular Diseases, Cause of Death, Fellowships and Scholarships, Health Care Reform, Leadership, Medicare, Patient Care, Patient Protection and Affordable Care Act, Physicians, Primary Health Care, Specialization, Medicare Access and CHIP Reauthorization Act of 2015

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