Author + information
- Joseph E. Marine, MD* ()
- ↵*Department of Medicine/Cardiology, Johns Hopkins University, Division of Cardiology, A-1 East, 4940 Eastern Avenue, Baltimore, Maryland 21224
While providing a detailed overview of the demographics of the cardiovascular (CV) specialist community in the U.S. today, the American College of Cardiology (ACC) Workforce Task Force Report relies on limited evidence to support its conclusion that there is a critical and growing shortage of CV specialists in the U.S. (1). In addition, the report did not address dissenting expert opinion and published data indicating that, to the contrary, there may exist now a surplus of physician specialists (including CV specialists) and that this surplus is a major driver of excessive health care spending in the U.S. (2,3).
According to reports from the Dartmouth Atlas of Health Care (4–6):
1. Specialist physicians tend to live and work in areas where they want to live and near where they trained, not in areas of greatest need or highest prevalence of disease.
2. Concentration of specialist physicians varies widely (as much as 300%) across the U.S.
3. Regions of the country with the highest specialist physician concentration have higher health care costs, yet patients have no better health care outcomes than those in regions of lowest concentration.
4. Patients living in the regions of lowest specialty physician concentration self-report the same high level of satisfaction with access to care as patients living in the regions of highest concentration.
These data make a reasonable case that the U.S. would have lower costs without significant impact on quality of care or patient access with a lower overall concentration of specialist physicians.
The ACC Workforce Report also did not address concerns that a large proportion of care provided in the U.S. today represents overuse, and this excess care provides no added value to the patient or to the health system (7). The ACC has acknowledged this concern and has supported efforts to reduce overuse of CV care (8,9). Yet the ACC Workforce Report does not factor in the impact of this reduction into its work force estimation. If these efforts are even partially achieved, U.S. cardiologists may have less productive work to do, rather than more, in the years ahead.
There has been no public outcry indicating a CV workforce crisis in the U.S. Unsustainable growth in health care costs and health insurance premiums are the critical concerns of the public. Before advocating growth in the number of CV specialists in the U.S., the ACC should consider all the evidence in this field and the impact of this growth on the national crisis in health care costs.
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