Cardiology Workforce Research Articles

Retraction to: Diversity, Inclusion, and Equity: Evolution of Race and Ethnicity Considerations for the Cardiology Workforce in the United States of America From 1969 to 2019.

For the article "Diversity, Inclusion, and Equity: Evolution of Race and Ethnicity Considerations for the Cardiology Workforce in the United States of America From 1969 to 2019" by Norman C. Wang (1), the American Heart Association became aware of serious concerns after publication.The author's institution, the University of Pittsburgh Medical Center (UPMC), has notified the Editor-in-Chief that the article contains many misconceptions and misquotes and that together those inaccuracies, misstatements, and selective misreading of source materials strip the paper of its scientific validity. JAHA will be publishing a detailed rebuttal. This retraction notice will be updated with a link to the rebuttal when it publishes. The Editor-in-Chief deeply regrets publishing the article and offers his apologies. The American Heart Association and the Editor-in-Chief have determined that the best interest of the public and the research community will be served by issuing this notice of retraction.The author does not agree to the retraction. The Editors and the American Heart Association retract the article from publication in Journal of the American Heart Association. Reference 1. J Am Heart Assoc. 2020;9:e015959. https://doi.org/10.1161/JAHA.120.015959.

Cascading Effects of COVID-19 on Women in Cardiology.

Cascading Effects of COVID-19 on Women in Cardiology.

Diversity, Inclusion, and Equity: Evolution of Race and Ethnicity Considerations for the Cardiology Workforce in the United States of America From 1969 to 2019.

Since 1969, racial and ethnic preferences have existed throughout the American medical academy. The primary purpose has been to increase the number of blacks and Hispanics within the physician workforce as they were deemed to be “underrepresented in medicine.” To this day, the goal continues to be population parity or proportional representation. These affirmative action programs were traditionally voluntary, created and implemented at the state or institutional level, limited to the premedical and medical school stages, and intended to be temporary. Despite these efforts, numerical targets for underrepresented minorities set by the Association of American Medical Colleges have consistently fallen short. Failures have largely been attributable to the limited qualified applicant pool and legal challenges to the use of race and ethnicity in admissions to institutions of higher education. In response, programs under the appellation of diversity, inclusion, and equity have recently been created to increase the number of blacks and Hispanics as medical school students, internal medicine trainees, cardiovascular disease trainees, and cardiovascular disease faculty. These new diversity programs are mandatory, created and implemented at the national level, imposed throughout all stages of academic medicine and cardiology, and intended to be permanent. The purpose of this white paper is to provide an overview of policies that have been created to impact the racial and ethnic composition of the cardiology workforce, to consider the evolution of racial and ethnic preferences in legal and medical spheres, to critically assess current paradigms, and to consider potential solutions to anticipated challenges.

How Do Asians Fit Into the American College of Cardiology’s Diversity and Inclusion Initiative?

The American College of Cardiology (ACC), a nonprofit medical association, is intricately involved in shaping the cardiology workforce. Because training physicians is funded largely by the federal government of the United States, the ACC has the responsibility to assist in the use of these funds to

DIVERSITY AND INCLUSION IN LEADERSHIP POSITIONS OF AMERICAN COLLEGE OF CARDIOLOGY: HOW DO THE INTERNATIONAL MEDICAL GRADUATES (IMGS) FARE?

Improving diversity and inclusion is a strategic priority for ACC. International Medical Graduates (IMGs- physicians who received medical degrees outside U.S.) constitute 29.4% of cardiology workforce in US (AAMC data 2014). We set out to evaluate whether IMGs practicing in US are adequately

Career Preferences and Perceptions of Cardiology Among US Internal Medicine Trainees

Few data exist on internal medicine trainees' selection of cardiology training, although this is important for meeting future cardiology workforce needs. To discover trainees' professional development preferences and perceptions of cardiology, and their relationship to trainees' career choice. We surveyed trainees to discover their professional development preferences and perceptions of cardiology and the influence of those perceptions and preferences on the trainees' career choices. Participants rated 38 professional development needs and 19 perceptions of cardiology. Data collection took place from February 2009, through January 2010. Data analysis was conducted from May 2017 to December 2017. Multivariable models were used to determine the association of demographics and survey responses with prospective career choice. A total of 4850 trainees were contacted, and 1123 trainees (of whom 625 [55.7%] were men) in 198 residency programs completed surveys (23.1% response; mean [SD] age, 29.4 [3.5] years). Principal component analysis of survey responses resulted in 8-factor and 6-factor models. Professional development preferences in descending order of significance were stable hours, family friendliness, female friendliness, the availability of positive role models, financial benefits, professional challenges, patient focus, and the opportunity to have a stimulating career. The top perceptions of cardiology in descending order of significance were adverse job conditions, interference with family life, and a lack of diversity. Women and future noncardiologists valued work-life balance more highly and had more negative perceptions of cardiology than men or future cardiologists, who emphasized the professional advantages available in cardiology. Professional development factors and cardiology perceptions were strongly associated with a decision to pursue or avoid a career in cardiology in both men and women. Alignment of cardiology culture with trainees' preferences and perceptions may assist efforts to ensure the continued attractiveness of cardiology careers and increase the diversity of the cardiology workforce.

Telemedicine Helps Cardiologists Extend Their Reach.

During a recent set of telemedicine consultations, Joaquin E. Cigarroa, MD, a cardiologist at Oregon Health & Science University in Portland, was able to establish relationships with 4 new patients and their families, conduct a physical examination using an electronic stethoscope, review the patients’ laboratory results, and develop a care plan. The best part was that the patients, who all live in coastal Lincoln City, Oregon, were able to skip the 3-hour drive to Portland through traffic and often fog. Figure 1. A mock telecardiology consult. Increasingly, cardiologists across the country are leveraging technology to provide remote care, whether through virtual visits and exams, consultations, or continuous monitoring using a growing array of implantable or wearable devices. “Patients love it,” said Cigarroa. They only need to make the trek to Portland when they need advanced diagnostics or procedures. For Cigarroa and his colleagues at Oregon Health & Science University, providing such off-site care is “critical to providing patient-centered care,” he said. He explained that ≈60% of the patients admitted to the cardiovascular service line at Oregon Health & Science University’s hospital are from outside of the Portland metro area, and many are from rural regions of the state. He and his colleagues have increasingly made use of Oregon Health & Science University’s telemedicine portals, which can even be used to perform echocardiograms, to care for patients closer to their homes. “It’s compassionate to the patient and their family to maintain them in their community and only transfer them if they need procedural or …

The United States pediatric cardiology 2015 workforce assessment: A survey of current training and employment patterns: A Report of the American College of Cardiology, American Heart Association, American Academy of Pediatrics Section on Cardiology and Cardiac Surgery, and Society for Pediatric Cardiology Training Program Directors

The number of pediatric cardiology trainees in the United States doubled between 2004 and 2015, but there is a lack of information on the current pediatric cardiology workforce. Therefore, a survey was administered to members of the American Academy of Pediatrics Section on Cardiology and Cardiac Surgery and to nonduplicative board-certified or -eligible pediatric cardiologists. Of 2897 individuals contacted, 823 completed the survey (28%), with a higher response rate among program directors (87%) and division chiefs (71%). Program directors reported that in the academic years of 2013/2014 and 2014/2015, 140 of the 237 (59%) fellows completing the 3-year core training program went on to additional subspecialty training, and of these, 125 (89%) accepted academic positions. The other 97 graduates accepted positions after the 3-year core fellowship; 51 (53%) of these went into academic settings, whereas 46 (36%) joined a private practice. The most difficult fields in which to find jobs were cardiac catheterization, electrophysiology, and general cardiology. The easiest fields in which to find positions were critical care cardiology, heart failure/transplant, and adult congenital cardiology. Imaging positions were in the middle range of ease of getting a position. No graduates left the field within this time range. On the basis of the responses from the division chiefs, 135 job openings per year are anticipated over the next 2years, while the number of fellowship match positions has increased steadily to the current number of 141 openings per year. These graduates will be competing for open positions with faculty who are changing institutions, who have filled 25% of these positions in the past 2years. In conclusion, the field of pediatric cardiology is very competitive currently, and training programs should consider suspending any increase in fellowship training positions until the next survey is performed. Continued close monitoring at least every 2years will be crucial to adapt appropriately to workforce fluctuations and needs as they arise.

A survey of national cardiology workforce in China

Cardiologists provided specialized care for patients with various cardiac conditions. The qualification system of subspecialty as cardiologist is well established in developed countries. However, there is no standardized national training programmes and common board certification for cardiovascular professionals in China. We launched a survey of national cardiology workforce to assess general characteristics of cardiovascular care providers in China. This survey includes licensed physicians who are currently working as cardiovascular care givers in tertiary or secondary hospitals in mainland China (Taiwan, Hongkong, and Macau were not included). A total of 25 240 physicians from 31 provinces responded to survey, achieving an estimated response rate at 76.5%. Data on demographic information, work characteristics, educational background, and professional skills of the physicians were collected. Results showed that cardiologist to population ratio is 1.9 per 100 000 and the number of cardiologist per 100 000 population over age of 65 is 21.3. Average age of respondents is 38.22 ± 8.19 and average time of medical practice after receiving medical certification is 12.1 ± 8.5 years. By gender and educational background, 58.5% of subjects are male and 33.3% had postgraduate degree. 25.9% of surveyed cardiologists were actively practicing interventional cardiology, but only 39.4% of them were licensed with interventional cardiology certification. Proportion of cardiologists worked on cardiac pacing, ablation of arrhythmia, and interventional treatment of congenital heart disease is 24.2, 14.1, and 9%, respectively, accordingly only 17.4, 36.5, and 25.6% of them had received specialty certifications. Physicians in eastern and middle regions had better educational background and training opportunities than those in western regions. This current survey is the most comprehensive investigation on cardiology workforce in China. The comparative study indicated a scarcity of cardiologists in China. This survey also helps greatly to guide authorities on decision making to improve training and specialty certification system of Cardiologist in China.

Women in Cardiology

Lean In ,1 the book by Facebook’s chief operating officer, Sheryl Sandberg, has sparked a debate on the issue of women in the workplace that has spread like wildfire throughout the country. In the book, she highlights the large discrepancy between the number of men and women in positions of power and leadership. She suggests that in addition to external barriers, internal barriers, such as lack of self-confidence and anticipation of future family obligations, are hindering women from being successful. Through this book, she is petitioning for women to close the gender gap by leaning in to their careers, sitting at the main table, and being part of the discussion to promote change. Although her experiences and thoughts are predominantly about the business sector, the discussion is applicable to every field, including our own. Her book should prompt introspection to understand why even in the 21st century there is such an under-representation of women in cardiology, particularly within leadership positions, and what can be done to change this. According to the American College of Cardiology (ACC) Survey: Addressing the Cardiology Workforce Crisis, which was published in 2009, women comprise a small fraction of all cardiologists (Figure 1).2 Only ≈12% of general cardiologists and 5 years later, suggests that only 10% of Full Physician Members from the United States are women. The data are more promising for fellows-in-training because women currently make up 22% of all ACC fellows-in-training members from the United States and 27% internationally (ACC membership profile data, unpublished data, 2013). However, this proportion is still strikingly low, especially considering that 30% …

US Cardiologist Workforce From 1995 To 2007: Modest Growth, Lasting Geographic Maldistribution Especially In Rural Areas

A sufficient cardiology workforce is necessary to ensure access to cardiovascular care. Specifically, access to cardiologists is important in the management and treatment of chronic cardiovascular disease. Given this, we examined the supply and distribution of the cardiologist workforce. In doing so, we mapped the ratios of cardiologists, primary care physicians, and total physicians to the population age sixty-five or older within different Hospital Referral Regions from the years 1995 and 2007. We found that within the twelve-year span of our study, the cardiology workforce grew modestly compared with the primary care physician and total physician workforces. Also, despite increases in the number of cardiologists, there was a persistent geographic maldistribution of the workforce. For example, approximately 60 percent of the elderly population had access to only 38 percent of the cardiologists. Our results suggest that large segments of the US population, specifically in rural and socioeconomically disadvantaged areas, continue to have a lower concentration of cardiologists. This maldistribution could be addressed through a variety of strategies, including the use of telemedicine and economic incentives.

From Numbers to Guidelines

Advances in pediatric cardiology and cardiac surgery have resulted in a change in the mortality, prevalence, and age distribution of patients with congenital heart disease (CHD). In this chapter, we review the changing epidemiology of CHD and the impact of these trends on health services utilization and delivery in this population. We demonstrate not only that adult CHD (ACHD) patients have high utilization rates but also that care gaps exist where disease is expected to be lifelong. We outline the components of quality improvement for the care of ACHD patients. We review the newly published guidelines for the management of CHD conditions in adults, anchoring them to structure, process, and outcome indexes of quality of care. We highlight the manpower needs and the importance of an appropriately trained cardiology workforce to provide ACHD care. Finally, we review recommended health care systems ideally suited to deliver care to this population.

Projecting the General Cardiology Workforce Shortage

• From the Division of Electrophysiology, Cardiovascular Institute, University of Pittsburgh, PA • Address for correspondence: Jeffrey L. Williams, MD, MS, PUH B535, Division of Electrophysiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213; e-mail: williamsJL4@upmc.edu www.lejacq.com ID: 7171 A model was developed to project the need for general cardiologists from 2005 through 2050 with Matlab (Mathworks, Inc, Natick, MA). The growth in need for general cardiologists was estimated by incorporating the effect of retirement, prevalence of heart disease, and patient per physician load. At the peak demand in 2038, the projected need is for 62,452 general cardiologists. Current training durations would result in 29,043 and fast-tracking would result in 32,533 general cardiologists, meeting only 46.5% of the projected need in 2038. This situation may result from a complex cascade of declining numbers of US medical graduates and of those matching in internal medicine residencies, combined with patients presenting with increasingly complex cardiovascular disease that require the care of multiple, distinct cardiovascular specialists. The American Association of Medical Colleges Center for Workforce Studies has reported on the growing evidence that the United States will face a physician shortage over the next 10 to 20 years and recommends a 15% increase in the number of US medical school graduates by 2015.1 Since 1987, the number of US medical school graduates matching in internal medicine residencies has dramatically declined: 26.5% of US medical school graduates matched in internal medicine in 19872 vs 19.0% in 2006.3 The 35th Bethesda Conference4 predicted an impending shortage of general cardiologists. However, the conference document did not make projections as to the degree or duration of the shortage. In this article, the author models the projected need for general cardiologists from 2005 through 2050 with current training program durations compared with that of a fast-track program for electrophysiology (EP) and interventional subspecialty fellowships.

Metabolic Syndrome and Cardiovascular Disease: Challenges and Opportunities

Metabolic syndrome (MetS) has been defined in different ways. However, key components common to most definitions are a constellation of risk factors including abdominal adiposity, impaired fasting glucose, hypertension, and dyslipidemia. A major mediator of MetS appears to be insulin resistance, which relates to the development of the vascular and metabolic dysfunctions that precede overt cardiovascular disease and type 2 diabetes. Evidence suggests that the mechanisms underlying the elevated cardiovascular risk associated with MetS begin with subclinical organ damage. Therapy for MetS targets individual components of the syndrome and includes lifestyle interventions, lipid-modifying therapy, and antihypertensive agents, particularly those that inhibit the renin-angiotensin system. Results of trials of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have demonstrated reductions in new-onset diabetes and cardiovascular events in a wide range of patients. Clinical trials to investigate further the role of these drugs in the primary prevention of type 2 diabetes in patients with MetS are currently under way. The purpose of this paper is to review the MetS from the perspective of the cardiology workforce with the hope that a better understanding of the links between MetS and cardiovascular disease could lead to improved management of persons at risk.

Working group 4: International medical graduates and the cardiology workforce

International medical graduates (IMGs) are physicians in practice or in post-graduate training in the U.S. who graduated from medical school outside the U.S., Puerto Rico, or Canada. Although many IMGs are foreign-born and are here on special visas (e.g., J-1 or H), a significant number are U.S.-born citizens and permanent residents who graduated from medical school in another country. Over the years, IMGs have been very important contributors to the science and practice of medicine in the U.S. During the past quarter-century they have filled the large gap between the number of U.S. medical graduates and the number of residency positions and subsequent opportunities in private practice and academic medicine. Several changes in licensing examinations and immigration laws have occurred over the past few years, however, that have potential impact on the contribution of IMGs to our nation's physician workforce. The present document examines the current status and future prospects of IMGs in cardiology training and practice in the U.S.

Cardiology's workforce shortage: implications for patient care and research.

The common wisdom at the end of the 20th century was that the United States was training too many specialists, including cardiologists.1 By 2001, however, there was increasing evidence that the supply of cardiologists was not meeting the growing demand. That year, as president-elect of the American College of Cardiology (ACC), I appointed a task force to evaluate cardiology workforce. The task force undertook a 2-year process of literature review, hypothesis generation, research design, data acquisition, and analysis. This intense effort included a Bethesda Conference at which consensus was achieved on a report that will be published in the Journal of the American College of Cardiology . Based on various types of information and data, the ACC task force concluded that the United States is facing a shortage of cardiologists. This will reduce access to specialty care of proven benefit and will undermine our nation’s vital cardiovascular research effort. The Bethesda Conference report includes 8 working group documents that recommend several short- and intermediate-term strategies to help narrow the growing demand-supply gap for cardiologists (see Table 1). Some recommendations can be implemented at a local practice or institution level. Others will require a series of complex and coordinated actions at a national level. Hopefully, the report will catalyze actions by academic medical centers, regulatory organizations, federal policymakers, professional societies, and others that influence the output of cardiovascular specialists. View this table: TABLE 1. Working Groups of the ACC Task Force on Workforce Several things continue to drive demand for cardiologists. Elsewhere, I have argued that various scientific, social, and demographic “demand catalysts” outweigh factors that might decrease demand for cardiologists during the next decade2 (see Table 2). Although the relative influence of each demand factor will change over time, one thing is certain: the cardiovascular disease burden in the United States …

Cardiology workforce: a shortage, not a surplus.

The United States faces a serious shortage of cardiologists as our population ages and the burden of heart disease grows. The problem is compounded by a cutback in the number of cardiology training positions a decade ago. Dramatic scientific, technological, and procedural advances fueled the growth of cardiology during the second half of the twentieth century. Patients benefited from access to specialists who transformed new knowledge into longer and better lives. Demand for cardiologists is strong and growing. An adequate supply of highly trained cardiologists is necessary to promote discovery and innovation and to help deliver state-of-the-art care to a growing number of cardiac patients.

Downsizing cardiology. Getting the process started.

HomeCirculationVol. 90, No. 2Downsizing cardiology. Getting the process started. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBDownsizing cardiology. Getting the process started. L O Langdon and M D Cheitlin L O LangdonL O Langdon Search for more papers by this author and M D CheitlinM D Cheitlin Search for more papers by this author Originally published1 Aug 1994https://doi.org/10.1161/01.CIR.90.2.1101Circulation. 1994;90:1101–1102"Downsizing cardiology. Getting the process started.." Circulation, 90(2), pp. 1101–1102 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Myerburg R (2009) Training in clinical cardiac electrophysiology at the crossroads, Heart Rhythm, 10.1016/j.hrthm.2009.08.027, 6:11, (1613-1615), Online publication date: 1-Nov-2009. Fye W (2004) Introduction: the origins and implications of a growing shortage of cardiologists, Journal of the American College of Cardiology, 10.1016/j.jacc.2004.05.019, 44:2, (221-232), Online publication date: 1-Jul-2004. Feldman T (2002) Interventional cardiology manpower needs: How many of us are there? how many should there be? how many will we need in the future?, Catheterization and Cardiovascular Interventions, 10.1002/ccd.10429, 58:1, (137-138), Online publication date: 1-Jan-2003. Fye W (2002) Cardiology workforce: there’s already a shortage, and it’s getting worse!, Journal of the American College of Cardiology, 10.1016/S0735-1097(02)01935-6, 39:12, (2077-2079), Online publication date: 1-Jun-2002. Schelbert H (2002) Myocardial Blood Flow and Perfusion: Radionuclide Techniques Pan Vascular Medicine, 10.1007/978-3-642-56225-9_38, (555-577), . Kassirer J (1994) Access to Specialty Care, New England Journal of Medicine, 10.1056/NEJM199410273311709, 331:17, (1151-1153), Online publication date: 27-Oct-1994. Casscells W and Willerson J (1994) Medicare's support of academic medical centers., Circulation, 90:5, (2554-2555), Online publication date: 1-Nov-1994. August 1, 1994Vol 90, Issue 2 Advertisement Article InformationMetrics Copyright © 1994 by American Heart Associationhttps://doi.org/10.1161/01.CIR.90.2.1101 Originally publishedAugust 1, 1994 PDF download Advertisement