From HeartWire, Mar 15, 2002, "Critical shortage of cardiology specialists looms" Aging baby boomers with their increasingly failing hearts, plus the recent explosion in cardiovascular technical advances, equal a pressing need for more cardiovascular specialists. The shortage of cardiologists, particularly interventionalists and electrophysiologists, is not on the horizon; it is right at our front door, American College of Cardiology (ACC) president-elect Dr W Bruce Fye (Mayo Clinic) says. "Changing technology, epidemiology and demographic factors, the decrease in the number of people being trained as interventional and electrophysiology cardiology specialists, are all conspiring to increase the potential pool of patients who require highly specialized services," Fye told heartwire. Unfortunately, the supply is not keeping up with the demand. Fye predicts a "significant" shortage of cardiovascular specialists, which "isn't going to happen in 20 years. It's happening now. We are going to see evidence of it very quickly." In a recent report in Business First, staff writer Jennifer Gordon writes that the incidence of cardiovascular problems in the US is rising by 13% a year, but the number of cardiologists is not keeping pace with the demand. Over the next 5 years, the need for in-hospital cardiovascular services are expected to increase 44% more than other hospital services, according to a report by Solucient (Evanston, IL), a health care research and information company, Gordon writes. "The report is very accurate," she quotes Michael Esposito (Norton Healthcare Inc, Louisville, KY). Currently in the Louisville area, there are 70 adult and 16 pediatric cardiologists, but in the next few years, 16 additional cardiologists will be needed, both to meet increased demand and to replace physicians who retire or relocate, according to Business First. Increasingly rigorous training requirements as a result of new technological developments are a major obstacle to the production of new cardiovascular specialists, says Fye. Clinton health plan got it wrong "The electrophysiologists and NASPE [North American Society of Pacing and Electrophysiology] have articulated their thoughts about this. As in all of the technical areas of cardiology, there has been an extraordinary explosion of technical innovation and growth. The implantable cardioverter defibrillator, although it is not brand new, has certainly become the procedure of choice in a number of areas. This leaves us with the knowledge that the population that requires these specialized procedures is growing and also with the recognition that more and more, there are specific cardiovascular conditions - such as the risk for sudden death - where devices like ICDs are proven to reduce this risk," he said in an interview. Back in the mid-1990s, during the Clinton years, it was widely thought that there would be too many cardiovascular specialists within a few years. Such a surplus has not materialized, says Fye. "Back in 1994, as part of the Clinton health plan, there were many voices articulating such a view. But we are now seeing how the natural history of the intrusive and very heavy-handed managed care organizations, which were preaching fewer specialists and more family physicians, have been forced to modulate their rhetoric. Clearly, we are not all living under a heavily managed-care model, where there are very few specialists and many primary care physicians." The future is "problematic" if no action taken Fye told heartwire that one of his main goals as ACC president will be to persuade government and health officials to address this important issue. To this end, the ACC will be launching a formal work force study, which will be having its first meeting at the ACC annual meeting in Atlanta. "I would like to see us put together a compelling argument that makes it crystal clear that the future is problematic if we do not provide the American people with an increased number of cardiovascular specialists. Hopefully we will have the ear of health policy people and government official legislators." US President George W Bush "is very interested in these matters," adds Fye, who, with current ACC president Dr Douglas P Zipes, has already met the President to discuss the Patients' Bill of Rights legislation. "The meeting was supposed to last for 20 minutes and in fact lasted 45 minutes. Bush was very interested in the whole issue of whether patients are able to get access to specialty care."