3 Cardiology Employment Trends Post-Reform

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The need for coordinated care, lower costs and higher quality has left all but large physician practices nearly untenable. Cardiologists have been moving en masse to hospital employment for the last few years, with a spike about two and a half years ago when their reimbursement was cut 40 percent. Now that healthcare reform has been upheld by the Supreme Court, what are some major trends in cardiologist employment, and how do they affect hospitals?

Jerome Hines, MD, PhD, chair of the American College of Cardiology's Council on Clinical Practice, says the Supreme Court decision has not made an impact on cardiologist employment. "What's affecting that direction more is the change in healthcare anyway — the pressures on the insurers, the pressure insurers are putting on patients, physicians and hospitals — that's what's really affecting what we see in the trenches more than the Affordable Care Act, which at least at this point, has just guaranteed that more [people will be] insured; it hasn't impacted what really needs to be impacted in terms of good reform to hold down costs. " he says.

1. More hospital employment. Cardiologists are continuing to turn to hospital employment or other hospital relationships rather than small private practices. A recent ACC report found only 35 percent of cardiovascular practitioners are in private practice, down from 59 percent in 2007. One of the reasons for this continued trend is cardiologists' need for capital to acquire the technology needed to drive higher efficiencies and quality. "The ability to put in place an electronic health record or an infrastructure that is going to be able to take advantage of some of the different payment models and value-based purchasing can really only be afforded by large groups, either large private practices or large integrated groups with hospitals or academic medical centers," Dr. Hines says.

2. Business savvy needed.
As cardiologists become integrated with hospitals, they are holding new leadership positions that require knowledge of business. "The demands of the marketplace are affecting the way we practice," Dr. Hines says. "Everyone is being pushed in the same direction to show outcomes, show appropriate use. More and more, we're being forced to pay attention to the business aspects of these things."

The demand for business-savvy physicians may drive a change in medical education. "We're hearing in the college that [training in business] is something fellows are wanting more and more," Dr. Hines says. "Fellows should be given more training in the business aspects of cardiology. We're the ones with the pen, and we're the ones with the ability to bring down the number of stents per case. No one else is."

3. Growing demand for mid-level providers.
Cardiologists may have more competition in employment as hospitals turn to mid-level providers to trim costs. "There will be pressure to replace ourselves with mid-level providers and not with younger cardiologists. Fellows coming out of training will face a much more difficult job market going forward," Dr. Hines says. "There'll be fewer and fewer opportunities in competitive areas; rural areas will continue to be the one area [where] potentially jobs will exist, but even in those areas there'll be pressure to use mid-level providers because of the cost constraints." To help connect cardiologists and employers, the ACC recently launched the ACC Cardiology Careers page using HEALTHeCAREERS Network, according to Dr. Hines. Enhanced communication between cardiologists and hospitals can help ease this potential increase in competition for jobs.

More Articles on Hospital Cardiology:

Report: Only 35% of Cardiovascular Practitioners Work in Private Practice
Deborah Heart and Lung Center CEO Calls on Hospital to Partner Instead of Seeking Cardiac Surgery CON

IU Health, IU School of Medicine to Offer Cardiovascular Genetics Program

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