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U.S. Faces Shortage of Heart Surgeons

Too many aging Americans, too few new doctors spell trouble, experts say

THURSDAY, Sept. 10 (HealthDay News) -- The United States faces a dire shortage of cardiologists in the coming years, a shortage made even more critical given the increasing demands of a population rapidly growing older and heavier.

The shortfall could reach 16,000 cardiologists by 2050, according to a new report from the American College of Cardiology (ACC). As of right now, there are already 3,000 too few cardiologists in this country, the report finds.

"We have a gap now, and it's a tremendous gap, and our feeling is that it's going to be getting worse as we have the baby boomers cresting at age 65," report author Dr. George Rodgers, chairman of the ACC's Board of Trustees Workforce Task Force, said during a Thursday teleconference. "Our guess is that the deficit in cardiologists is going to probably widen, and even double, by the time we get to 2030 or 2050."

That means that in order to keep up with demand, the United States will need to have twice as many cardiologists in 2050 as it had in 2000.

"In order to care for increasing numbers of patients who are managing their multiple chronic conditions, we will of course need additional highly skilled people," said Dr. Janet Wright, the ACC's vice president for science and quality.

Yet the forces working against this are formidable, including a dwindling number of training spots available for budding cardiologists.

The report appears in the Sept. 22 issue of the Journal of the American College of Cardiology.

Heart disease is the top killer of both men and women in the United States.

According to the American Heart Association, at least 80 million people in the United States had at least one type of cardiovascular disease in 2006, including a history of acute heart attack (almost 8 million individuals), stroke (6.5 million people) and heart failure (5.7 million).

In 2005, 864,480 people died of heart disease, but this is actually an improvement. Over the past eight years, both deaths and disability attributable to heart disease have gone down 29 percent, the ACC reported.

"Even though there has been this nice drop, it translates into more and more people managing multiple cardiac problems in addition to other health issues," Wright said. "Our population is living longer, thank goodness, but we're going to need additional highly skilled people to help manage them."

"In a way, we're victims of our own success," Rodgers added.

In the study, the authors surveyed people involved in the hiring of cardiologists. Based on that survey, the ACC projects a shortfall of up to 16,000 of these professionals within the next four decades.

The main reason: a 25 percent reduction in the number of slots available for cardiology training in medical schools spurred by an assumption that family practitioners would be able to provide much of the care for heart disease patients.

That has not turned out to be the case.

Other findings from the report:

  • Close to half of cardiologists currently working are over 55 and are scheduled to retire either on time or early, due to concerns about malpractice insurance costs and highly demanding practices.
  • Only 6 percent of cardiologists in practice are black or Hispanic, even though these two groups make up a quarter of the U.S. population. Only 12 percent of cardiologists are women. Meanwhile, Hispanic and black patients say they prefer to see doctors of the same race/ethnicity. "There would be an improvement in care with parity," Rodgers said.
  • Other health-care providers such as nurse practitioners could help pick up the slack, but aren't being tapped nearly enough at this point.
  • The Centers for Medicare & Medicaid Services has proposed cuts to reimbursements for doctors of 25 percent to 42 percent, which could take effect as early as January 2010, Wright noted. "This could be really devastating for both access to and cost of health care," she said.

One clear solution would be to increase the number of fellowship positions available. Currently there are 1.5 candidates for each available position, Rodgers said. "It's not a pipeline problem," he said, but rather a funding problem.

"We also need to make the work environment more sustainable," Rodgers said. "The demands on cardiologists are tremendous. We need to work out a better work-life balance."

The ACC is also encouraging team-based approaches incorporating nurse practitioners and non-cardiologist health-care professionals.

More information

There's more on heart disease at the American Heart Association.

SOURCES: Sept. 10, 2009, teleconference with Janet Wright, M.D., vice president, science and quality, American Cardiology Association (ACC), and George Rodgers, M.D., chairman, ACC Board of Trustees Workforce Task Force; Sept. 22, 2009, Journal of the American College of Cardiology

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