June 5, 2014 — The president of the American College of Cardiology (ACC), Patrick O’Gara, M.D., recently explored what is causing the looming interventional cardiologist shortage, how it could threaten the quality of patient care and what can be done about it in the annual Hildner Lecture at the 2014 Society for Cardiovascular Angiography and Interventions (SCAI) scientific sessions.
In many parts of the United States, there aren’t enough interventional cardiologists for all of the patients who need them, a problem that could worsen in the future unless critical steps are taken to change the way doctors are trained. “This problem affects all of cardiovascular medicine,” O’Gara said. “If we are unable to restore the cardiovascular workforce to the numbers needed, patients’ access to quality care could be threatened.”
O’Gara is director of clinical cardiology and a professor of medicine at Harvard Medical School in Boston. He took the helm as president of the ACC in March 2014.
Some 15 years ago, the outlook for cardiologists was far different. At that time, there was widespread concern that too many specialists were being trained in this country, and resources were shifted to educating more primary care physicians. Today several factors are creating a shortage of cardiologists, including the following:
- An enlarging gap between the demand for cardiovascular specialists and the supply: An aging population, scientific advances and the anticipated effects of the Affordable Care Act all create the need for more cardiologists, not fewer.
- The gender gap in cardiology: Although women make up slightly more than half of medical school graduates, fewer than one in five cardiovascular specialists are women, a ratio that shrinks to one in ten among interventional cardiologists.
- An ethnic/racial gap: Hispanics and African Americans are particularly under-represented in cardiology.
- Marked geographic variations across the United States: There are many cardiologists in major metropolitan areas, but shortages in smaller towns and rural areas limit access to cardiovascular care.
“These are not easy problems to fix,” O’Gara said. “Unfortunately, it is not as simple as just increasing the number of medical school graduates. We need to take a step back and ask the question, ‘Where are we going with the current training and distribution of cardiovascular specialists in the United States?’”
One possible solution is to revamp Medicare-based funding of residencies and fellowships that lead to careers in cardiology and interventional cardiology. Another important step could be to improve funding for research into heart disease, as this would strengthen academic medical programs — the training ground for all cardiovascular specialists.
Additional creative approaches will be developed by working together, O’Gara said. “I am deeply appreciative of the opportunity to speak to the members of SCAI, not only as a representative of the ACC, but also individually,” he said. “As a community, we can begin to come up with some solutions to the workforce challenges that confront us.”
For more information: www.scai.org