There are not enough cardiologists to care for patients with heart disease in the U.S. and the shortage is only getting worse, according to a report released today by the American College of Cardiology (ACC). The report projected that the number of practicing cardiologists will need to double between 2000 and 2050 to adequately care for the anticipated new cases of heart disease with the aging baby boomers, escalating obesity and as more people live longer with chronic heart disease.

“We have a significant shortage of 3,000 cardiologists in the workplace today, and all indicators are that it’s going to get worse if we don’t do something,” said George P. Rodgers, MD, a private practice cardiologist with PinnacleCare in Austin, Texas, and chair of the ACC Board of Trustees Workforce Task Force.

If current trends persist, Rodgers said that there will be 16,000 too few cardiologists in 2050. These estimates are based on the analysis of a survey of employers within private and academic practices—those who hire cardiologists and are aware of the market needs and willing to pay for cardiologist services—to assess whether and how many open positions there are to meet demand and provide quality care, as well as other observed trends in cardiovascular care.

“Without boosting our supply of cardiologists, we may threaten the incredible progress we have made to date,” Rodgers said.

According to the ACC, the mortality and morbidity related to heart disease has been reduced by 29 percent over the past eight years.

The full report, to be published in the Sept. 22 issue of the Journal of the American College of Cardiology, also outlined factors that influence physicians to become cardiologists, the underrepresentation of women and minorities in the field, as well as the lack of an adequate number of training spots and funding.

According to the report, the current shortage stems from a decision by policymakers in the early 1990s that, with the ushering in of managed care, assumed the family practitioner would be the main gatekeeper for people with heart disease, which resulted in a 25 percent cut in the number of cardiology training spots.

In addition to the expected demand for cardiology services over the next 20 years and the lack of training opportunities and funding in cardiology, several other issues are fueling experts’ concern:

• More than 40 percent of cardiologists in the current workforce are over the age of 55 and may retire early for a variety reasons, including malpractice insurance costs, cuts in reimbursement and arduous call schedules.
• There is an underrepresentation of minorities and women in cardiology; while African Americans and Hispanics comprise 25 percent of the U.S. population, they only represent 6 percent of cardiologists in active practice, and women only comprise 12 percent of cardiologists.
• Non-physician providers are underutilized even though they could help to work up, screen, educate and discharge new patients.
• Proposed Centers for Medicare & Medicaid Services (CMS) cuts in the range of 25 to 42 percent may hinder access to services that help diagnose and treat cardiovascular disease.

The report offers solutions, including expanding the number of fellowship positions, establishing better work-life balance, reducing known “hassle factors” that may encourage early retirement, creating incentives for underrepresented minorities to consider cardiology, as well as encouraging a team-based approach to cardiology care that leverages the skills and expertise of other non-physician providers (e.g., nurse practitioners, physician assistants).

“We need to advocate for more training spots and funding for cardiovascular specialists and, in the meantime, find creative and more effective ways of delivering care,” Rodgers said. “Team-based care is a major opportunity for improving the current and future workforce crisis.”