Cardiology leaders are familiar with the common challenges across healthcare with staffing, pay issues and patient access being among the most pressing. But recently leaders are highlighting other areas that are contributing to the complex network of challenges.
Staffing
It begins with a longstanding issue: There are fewer young people going into residency.
"It used to be that there were so many applicants you could cast a wide net and be confident that what you pulled in would be pretty good, and you didn't worry too much about it; But now, with a smaller pool, the same number of programs, and more selectivity on the part of trainees and junior faculty regarding what they want, things have changed," Leonard Girardi, MD, chair of the cardiothoracic surgery department at Weill Cornell Medicine and chief of cardiothoracic surgery NewYork-Presbyterian/Weill Cornell Medical Center in New York City, told Becker's.
The issue is more concerning as experienced physicians retire. About 20% to 25% of all physicians are older than 60. At the current rate of replacement with respect to cardiology, for every two physicians retiring, systems are replacing only one, John Mignone, MD, PhD, medical director at Seattle-based Providence Swedish Heart & Vascular Institute, told Becker's.
"As the workforce ages, we have to navigate the transfer of knowledge between seasoned providers and providers entering the marketplace," Martina Schmidt, BSN, RN, director of the cardiovascular service line at the Norfolk, Va.-based Bon Secours Hampton Roads market, said.
And if that were not enough challenges around staffing, there is also the issue of burnout and pay.
"This situation coincides with many physicians being compensated based on fair market value, or fair market compensation, which is essentially a form of price fixing for salaries," Dr. Mignone said. "As a result, many physicians are experiencing burnout because they have been working so hard without a pay raise for over 15 years."
Technology
As staffing challenges abound, more systems are turning to technology to ease workloads and allow staff to work smarter.
"I've been involved in basic science for years at a leading research institution, so I've seen disruptive technologies throughout my career. AI seems to be the latest trend," Dr. Mignone said. "Adopting these advancements will be challenging, especially when most hospitals are financially struggling. Given the way American healthcare operates, with hospital-based and interest-based care, adopting new technology will be slow."
Xuanya "Bill" Zhang, senior director of operations for Providence Swedish Heart & Vascular Institute, told Becker's its system is testing ways for technologies to increase work and patient capacities with their limited staff levels, "but these solutions come with costs, effort and investment in implementation, and it will take time to refine their optimal use."
Part of what makes technology adaptation slow can be how divided data is.
"In cardiology alone, we have probably 10 different technology platforms managing patient data, imaging, monitoring and more," Mr. Zhang said. "These platforms are spread across various companies' databases — some are in Epic, some are connected to Epic — but there's no single-point solution. Our caregivers and physicians have to navigate multiple systems to access the data, and these systems don't necessarily communicate with each other."
He said one way to improve technology and staff experience using it is to effectively integrate data from all systems. But "this is another challenge we're facing right now."
Patient access
One aspect of the job makes the staff and technology challenges more pressing: patient demand.
"As baby boomers are aging, this also adds to the burden of disease and the need for additional access in the inpatient and outpatient cardiology fields," Ms. Schmidt said. "The greatest challenge we are currently facing in cardiology is access."
Shortages in other specialties
Patients are usually first seen by primary care providers before receiving specialized care such as cardiology, but like other specialties, primary care is facing staff shortages.
"The imbalance between primary care and subspecialty medicine continues to adversely affect patients," Mitchell Weinberg, MD, chair of the cardiology department at Staten Island University Hospital in New York City, told Becker's. "The shortage of primary care providers leaves patients to navigate a complex array of sub-specialists without an invaluable quarterback, creating confusion and inefficiency. We bolstered talent acquisition investments to grow the pool of general providers, but these efforts are only sluggishly repleting the ranks. This year (and I suspect for many years to come), we will be exploring a variety of new models and digital enablers to fill the gap."