Well as a practicing electrophysiologist, we don't all work at specialized heart centers. We do work at hospitals with open heart surgery programs and hospitals with cardiac catheterization labs as that is where we do our electrophysiology studies. Here in Santa Barbara, I work in two hospitals 30 - 40 miles south and 1 hospital 70 miles north as well as Cottage Hospital here in Santa Barbara. You need about 10-14 cardiologists to support one electrophysiologist. So, it is true that we tend to hang around bigger cities.
Regarding EKG interpretation, I would find it very hard to program a computer to pick up subtle nuances of electrical rhythmn. If you look at computer interpretations, the rhythm seems to be the most inaccurate. But, I would not say you need to be an electrophysiologist to interpret heart rhythms, but since it is what I do day in and day out... I have gotten pretty good and feel more comfortable calling the rhythmn. But there are definitely times where a wide comlex tachycardia is a wide complex tachycardia and I can't be more specific than that. Then, I resort to the electrophysiology study to confirm the diagnosis.
But remember, there is more to EKG interpretation than just rhythmn.
Cardiac Electrophysiology is a great field because we see the healthy indivduals with supraventricular tachycardia, cure them and allow them to live a normal life, we see our defibrillator patients on a continual basis and develop the personal relationship that long term patients and their doctors develop.
Certainly some of the academic electrophysiologist will deal with the engineers that design these devices, but most of us are pretty involved with day to day pateint care. But my hat is off to those engineers and physicians who have taken the field of electrophysiology to the state of the art it is today.