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How Cardiology Practice Is Changing with the Times

By Debra Wood, RN, contributor

Cardiologist jobs have evolved over time as diagnostic and treatment advances have occurred, new technologies entered the field and, in certain areas, subspecialization has proliferated.

“There are all kinds of changes,” said Douglas P. Zipes, MD, a past president of the American College of Cardiology. 

“There are advances in heart rhythm areas with new technology to treat heart rhythm problems and sudden death,” Zipes explained. “There are advances in valve dysfunction with new technology to replace heart valves with a catheter rather than open chest.”

In addition, researchers have identified different types of heart failure with new treatments. New concepts in genetics exist, allowing cardiologists to understand the genetic role in inherited heart problems.

“The list is almost endless,” Zipes said. “It’s very exciting progress, but it comes at a toll for young doctors having to learn a lot more information if they wish to become cardiologists. The demands on their time have escalated.”

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Regenerative Changes

As in other areas of medicine, cardiology researchers are investigating stem cells’ regenerative properties to treat heart failure and after a myocardial infarction. In August 2018, Peter V. Johnston, MD, a cardiologist at Johns Hopkins University School of Medicine in Baltimore, and colleagues reported in Circulation Research about the use of stem cells to manage chronic heart failure in certain patients most likely to benefit. Patients receiving the therapy showed improvement in walking distance and heart failure class after six months compared to baseline.

The authors concluded, “We believe that trials offering more specific, patient-centered and ‘personalized’ approaches to regenerative medicine will generate the robust and effective therapies needed to address CHF and other conditions.”

BioCardia, based in San Carlos, California, supported the study. The company has developed CardiAMP, a device that will enable interventional cardiologists to deliver the patients’ stem cells to the heart muscle to regrow damaged heart tissue.

Technological Changes

Diagnostics and treatments have changed dramatically during the past few years. Handheld echocardiology devices enable a cardiologist to perform the test in an office or clinic setting.

“That is gaining momentum, and that is fascinating,” Zipes said. “When I was in training, we spent so much time learning to listen to heart sounds and murmurs, so I could make a diagnosis after examining a patient. But young people today are rebelling, claiming, ‘Why listen when we can do a hand-held echo?’ There’s a bit of truth in that.”

However, Zipes said understanding heart sounds shows that a physician understands heart physiology.

Even how cardiologists learn about new technologies is changing to electronic books and journals. Cardiologists can look up information while with a patient.

However, Zipes called the mandatory use of electronic health records a “dual-edged sword.” While the systems collect and allow reports on a tremendous amount of data from large numbers of patients, they also take up considerable amounts of a cardiologist’s time. Some practices have hired scribes, so the physician can spend uninterrupted time with the patient.

Cardiology practices have shifted from single practices to hospital-based practices, with an emphasis on generating clinical dollars, by seeing more patients and doing more procedures, while research and education are taking hits, Zipes said.

“There are changes in the young people who want to become cardiologists,” Zipes said. “Young people today are more interested in quality of life than being married to medicine and cardiology.”

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Among more seasoned cardiologists, Zipes reports more burnout.

Depending on location, cardiology jobs are becoming more specialized with demand high for both permanent and locum tenens noninvasive cardiologists, interventional cardiologists and cardiovascular surgeons. Other cardiologists specialize in cardiac electrophysiology, adult congenital abnormalities, prevention, or heart failure and transplant cardiology.

“Subspecialization depends on where you are,” Zipes said. “If you are in a remote area and the only cardiologist, you have to have a broad base of information.”

However, in larger cities, such as New York or Los Angeles, cardiologists can become expert in a specific area of cardiology.

The Bureau of Labor Statistics estimates the number of cardiology jobs will increase in the coming years, as the population ages and the risk of heart disease increases.

In 2013, Timothy M. Dall, managing director for health care and pharma at IHS Inc., in Washington, D.C., and colleagues published a study in Health Affairs projecting a 20 percent increase in demand for cardiologists by 2025. 

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