Declining reimbursements, the exodus of retiring cardiologists and burnout are three of the biggest challenges facing the cardiology field, according to leaders in the industry.
These 12 leaders recently connected with Becker's to explain the largest challenges cardiologists and cardiac surgeons are currently up against.
Note: Responses were lightly edited for clarity and length.
Question: What are the biggest challenges facing cardiologists and/or the cardiology field?
John Arnold, MD. Cardiothoracic Surgeon at Blessing Hospital (Quincy, Ill.): I think the competition for available work within a region, and within practices where remuneration is solely [relative value unit] based, leads to a significant lack of "sharing" of cases and experience, especially with younger cardiologists, resulting in a significant deficit in practical positive mentoring for recent program graduates. This translates into there being about five years after training before interventional, and sometimes even the purely diagnostic cardiologists, have the necessary experience, exposure and skills to be able to produce consistently excellent quality work. Clinical cardiologists I think are generally too dependent on pharmacologic interventions, and add and tweak meds with a belief that they can somehow get the right mix of stuff and all will be well, when lifestyle modification generally is more likely to be efficacious.
Karan Bhalla, MD. Cardiologist at Orion Medical (Houston): There are a few challenges. First is that current U.S. healthcare is geared toward treatment rather than prevention. The majority of cardiovascular disease can be prevented, but payers do not pay due to paucity of valid data. We are incentivized to treat diseases, not prevent them. Second is that we need to be able to get reimbursed for acute outpatient care to prevent hospitalization for patients who can be treated in a cardiac urgent care model. Finally, cardiologists, especially hospital-employed, need to see the value to migration of site of care from most cardiac procedures from hospital outpatient to ASC.
Mary Branch, MD. Cardiologist at Cone Health (Greensboro, N.C.): There are many challenges in medicine in general. However, there are many aspects of cardiology that make it particularly challenging. For one, receive a multitude of consults. There are lower thresholds to consult cardiology, which has led to an increased patient population to manage without cardiac disease. With the lack of PCP access, we are managing cardiovascular risk factors and at times other conditions. Further, with increased anxiety and depression, patients are challenged with their symptoms, but they don't require cardiac intervention. This is frustrating on both sides. Also, the patient population has a high burden of cardiovascular disease risk factors; these risks are increasing in younger populations. There is a high burden of obesity and hypertension as well as atrial fibrillation. The baby boomers are a large portion of the population, and they are aging, which contributes to this burden of disease. Finally, many cardiologists are choosing to retire. COVID has made a significant negative impact on the healthcare system. This leaves early career cardiologists with this enormous burden to manage when they start practicing without much guidance. It can be demoralizing. The requirements for certification are also numerous with the expectations of many board exams. In particular, for a woman without dedicated family support, it is almost impossible to be a mother and cardiologist. Relationships are strained with this profession as well. It has become more difficult to appreciate the return on investment in medicine in general without much relief of these issues. Systematic changes are desperately needed, which likely will include AI support.
Danny Chu, MD. Director of Cardiac Surgery of VA Pittsburgh Healthcare System: Decreasing reimbursement and increasing overhead in cardiology and cardiac surgery procedures. The corporatization of healthcare and its unintended negative consequences on research, innovation and education. Value-based bundle payment for treatment of cardiology and cardiac surgery diseases.
Khagendra Dahal, MD. Cardiologist at Bergan Mercy Medical Center (Omaha, Neb.): There are several challenges. Burnout is a real issue. Especially now, we are experiencing difficulty filling the vacant spots from retiring cardiologists. It is causing stress among the cardiologists. Decreasing reimbursement is another issue. For some specialities like structural, finding a job in a place of interest is limited due to lack of new openings.
Vishal Kapur, MD. Interventional Cardiologist and Endovascular Specialist at Mount Sinai Hospital (New York City): The biggest challenge facing cardiologists today is to find a right balance between practicing medicine and dealing with bureaucracy such as insurance companies and other entities without compromising on providing best care to the patient. The practice of medicine nowadays warrants more time and energy to be spent on dealing with issues such as completing paperwork and working on authorizations rather than diagnosing and treating diseases itself.
German Larrain, MD. Medical Director of Aspirus Heart Care (Wausau, Wis.): There are so many challenges in cardiology. The white tsunami as baby boomers that are aging and require more and more cardiology services; the ongoing challenges with the EHR. The government has put the pieces in place to decrease the documentation burden, but physicians are already used to templates and continue to produce bloated and difficult-to-read notes. As a consequence, care continues to be suboptimal; too much emphasis on metrics and the payment associated with them. The metrics chosen may not always be the most important or clinically relevant; a new generation that doesn't want to work as hard as the older generation did. I am not saying that they are wrong, but it will take more than one new cardiologist to replace an old cardiologist. The obsolete training pathway for cardiologists: Interventional cardiologists and electrophysiologists need to undergo three years of internal medicine and three years of general cardiology before they can start to subspecialize. This is a leftover from when the disciplines were not too different, but things have markedly changed now. Training just takes too long. The lack of GME funding so that more can go to medical school then specialize.
Lookman Lawal, MD. President of SouthWestern Cardiac Arrhythmia Institute (El Paso, Texas): The biggest challenges facing cardiologists and cardiology groups are dwindling reimbursements and high overheads, which is making it difficult to sustain a private practice; private equity acquisition of cardiology practices and ASCs; and high burnout rates.
Devin Mehta, MD. Advanced Heart Failure Cardiologist at Endeavor Health Medical Group (Mount Prospect, Ill.): One of the largest challenges facing cardiologists is how we participate in innovative payment models to lead the transition of specialty care from fee-for-service to value-based care. Cardiologists, health systems and practices will need to align incentives and compensation models to the changing landscape of cardiology care.
Saraschandra Vallabhajosyula, MD. Interventional and Critical Cardiologist at Lifespan Cardiovascular Institute (Providence, R.I.): The biggest challenge in cardiology is our aging population and the high comorbidity burden in our patients. Due to our ability to manage chronic illnesses with excellent medical, percutaneous and surgical therapies, our patients are living longer and accrue more comorbidities over time. These comorbidities, advanced age and frailty, make their care very complex and challenging during an acute hospitalization. This frequently necessitates multidisciplinary collaboration, teamwork and personalization of care for such individuals.
Sreekanth Vemulapalli, MD. Cardiologist at Duke Health (Durham, N.C.): As baby boomers age, cardiology and cardiologists are facing a graying population with increased needs for cardiovascular care. This increasing demand for cardiovascular care and cardiovascular services is occurring when, for the first time since the 1950s, we are seeing an increase in cardiovascular mortality in the U.S., we face increasing financial pressures at both the national and health system level, and we have disrupting forces such as AI in healthcare and the entry of technology and retail companies into healthcare delivery. Concurrently, we've also had major advances in the fields of cardiovascular prevention, heart failure and structural heart disease, to name a few. Despite these advances, we are often failing to deliver them, with examples ranging from poor blood pressure control in cardiovascular clinics; to failure to achieve [guideline-directed medical therapy] in heart failure patients; to undertreatment of severe, symptomatic aortic stenosis. So, over these next several years, cardiologist and cardiovascular service lines are going to be faced with the challenge of harnessing and delivering cardiovascular breakthroughs via increasingly personalized and nuanced care while needing to become substantially more efficient and effective in doing so. This means that cardiologists and cardiovascular service lines will need to view themselves as both a coach and a player on a team of cardiovascular providers delivering care, which include MDs/DOs, PAs, NPs, nurses, pharmacists, AI and algorithms. Put simply, for most cardiologists currently in practice, this type of care delivery looks nothing like what we were taught in medical school, residency or fellowship.
Andrew Zurick, MD. Cardiologist at Ascension St. Thomas Heart (Nashville, Tenn.): I would say currently, the biggest challenges facing the field of cardiology are: How do we thoughtfully incorporate AI into patient care in a way that helps clinicians and is well received by patients? How do we continue to introduce new medical therapies into our care of patients in a way that is fiscally responsible? How do we transition to a CCTA-first approach to the management of patients with chest pain? Will medical therapy to reduce Lp(a) result in meaningful reduction in major adverse cardiology events or even development of valvular heart disease? Will AI-based CCTA plaque analysis serve as the new gold standard to demonstrate stability or progression of atherosclerotic cardiovascular disease? The challenges in the field are always changing.