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Workforce Trends

The U.S. is facing a growing shortage of cardiovascular specialists that will hinder access to care and undermine the vital research efforts of cardiovascular physician researchers.

Why a shortage?

In the early 1990’s, the commonly held belief was that the U.S. was producing too many specialist physicians, including cardiologists. The rapid growth of for-profit managed care with its gatekeeper model and obstacles to specialty services contributed to this belief. As a result, the number of first-year and total adult cardiology training positions fell by 20% and 10%, respectively, between 1994 and 1999.

The managed care model did not gain traction as expected, and access to specialists has not been limited as expected. The projected surplus did not come to fruition; however, the number of first-year training positions and total adult cardiology trainees is still below 1994 levels.

This, in addition to the aging of the population and rising risk factors for cardiovascular disease, has led to a shortage of cardiovascular specialists.

What is driving the demand for cardiovascular specialists?

Cardiovascular “Demand Catalysts”

  1. Population: An aging population with more chronic cardiac patients living longer.

  2. Metabolic syndrome: The “epidemics” of obesity and type 2 diabetes leading to more cardiovascular disease.

  3. Superior outcomes: Compelling evidence that heart patients have better outcomes if they receive at least part of their care from a cardiologist.

  4. Managed care decline: The decline of managed care’s gatekeeper model that blocked access to specialists.

  5. Consumerism: A better informed public with growing expectations in terms of their personal healthcare.

  6. Women: Increasing awareness among women that they are more likely to die from cardiovascular disease than from cancer.

  7. Clinical innovation: Continuing technological and procedural innovations and their rapid diffusion into practice.

  8. Screening: More widespread use of cardiovascular screening tests that result in more referrals and procedures.

  9. Subspecialization: Progressive subspecialization within cardiology that results in more “internal” referrals.

Source: Fye WB, Hirshfeld JW, et al. Cardiology’s workforce crisis: a pragmatic approach. Presented at the 35th Bethesda Conference, Bethesda, Maryland, October 17-18, 2003. J Am Coll Cardiol 2004; 44:215-75.

Heart Disease Facts and Statistics
Trends in cardiovascular disease by population
Trends in cardiovascular disease risk factors
Trends in cardiovascular disease (miscellaneous)

Supply of cardiovascular specialists

174 ACGME-accredited cardiovascular disease fellowship training programs, many in collaboration with local private cardiology practices, provide the necessary training to produce the cardiovascular specialists that treat patients and conduct valuable research efforts. In the 2006-2007 academic year, these programs collectively had 2,427 ACGME-approved training positions, of which 2,302 were filled. The 125 positions that went unfilled were vacant largely because the institutions lacked the funding to fill those slots with one of the many qualified applicants that were denied admission. In addition, as a result of workforce predictions of the early 1990s predicting a major surplus of specialist physicians, the number of first-year cardiology fellowship positions was reduced by 20% between 1994 and 1999; as of the 2006-2007 academic year, the number of cardiology fellows is still below 1994 levels.

The Association of American Medical Colleges (AAMC) conducted a survey of physicians under the age of 50. Preliminary findings indicate that:

  • One out of three doctors over 50 would retire today if they could afford to do so

  • Older physicians cite increased regulation of medicine as the key factor influencing retirement plans

  • One out of three, or 33 percent of doctors under 50, are not interested in working longer hours for more money

  • Seventy-one percent of young doctors identify having family and personal time as an important factor in a desirable practice.


For more information on workforce trends, read the ACC's 2009 Survey Results and Recommendations: Addressing the Cardiology Workforce Crisis .