The United States Cardiovascular Care Deficit

Abstract

A life so short, a craft so long to learn — Hippocrates, Aphorisms As we move into the new millennium, the deficit of able and willing cardiovascular physician providers widens. In 1980, the Graduate Medical Education National Advisory Committee (GMENAC) predicted an “oversupply of 145 000 physicians in the US by the year 2000.”1 Subsequently, in the early 1990’s, physician workforce analysts used physician staffing patterns at closed panel Health Maintenance Organizations (HMO’s) to predict the number of physicians required per 100,000 population. Based on the HMO model, the predicted physician surplus would exceed 150,000 by the year 2000.2 National major medical organizations responded to these predictions by reducing the number of physician training positions available, particularly in subspecialities such as cardiology, where 12% of fellowship training positions were eliminated between 1995 to 2001.3–5 However, cardiovascular diseases are more prevalent with age, and the US population is growing older. In a recent census, the most rapidly growing decade on a relative basis was that in excess of 80 years old. As older people need more cardiovascular care, who will provide it? Through enhancements in technology and care processes, the mortality due to cardiovascular disease has progressively declined over the past 20 years. This success has allowed the survival of many individuals with chronic cardiovascular disease who require extended care. Remarkably, as the overall burden from cardiovascular disease increases, the supply of qualified individuals to provide care has diminished and threatens to limit access to health care unless remedies are found.6–9 A number of factors contributing to this “cardiovascular care deficit” are eloquently defined and analyzed by Drs W. Bruce Fye, Robert Bonow, and Sidney Smith,10,11 in this issue of Circulation . Their consensus opinion is that the US cardiovascular care deficit will continue to widen …