There can be little doubt that the lethal combination of aging baby boomers, the obesity epidemic, and the growing success of medical and interventional therapies for CV disease (resulting in more and more survivors of major events) is going to produce a flood of cardiovascular disease in the coming decades, and cardiologists in great numbers will be needed to care for these people.
However, that doesn’t mean that the message conveyed by the ACC report, concerning the impending cardiologist shortage, should be accepted without scrutiny. It is disturbing that the determination of a current shortage of cardiologists – and in particular, interventional cardiologists – was based on an assessment of the marketplace demand for interventional cardiologists. Employing the same logic it would be easy to conclude that there are “critical shortages” of cosmetic surgeons or, for that matter, drug dealers or malpractice lawyers.
Interventional cardiology, in particular, has been utilized as a seemingly endless font of revenue for many institutions, so it is hardly surprising that institutions compete to build interventional cardiology programs. But, as we learned from William Boden’s COURAGE trial, an aggressive use of interventions is not necessarily always in the best interest of either the patient or the healthcare system. Now if the ACC is acting in the capacity of a cardiologists “union” then it is appropriate for them to seek the most number of jobs at the highest possible salary for their members. But if the ACC is acting in the capacity of a “college” then it has a different responsibility.
The coming “flood” of cardiovascular disease threatens our entire future in much the same way hurricanes threatened New Orleans prior to Katrina. After Katrina flooded New Orleans, thousands of construction workers found work rebuilding the city. But surely it would have been far better if before Katrina the city had reinforced its levees and prevented the disaster in the first place. Similarly, prior to the flood of CV disease we should be devoting resources to prevention, primary care, and population-based efforts to fight obesity and diabetes. More interventional cardiologists may help relieve symptoms, but they will do nothing to prevent the flood from occurring.
Many years ago, when I still smoked, I asked a cardiologist friend if he minded if I had a cigarette during a meal. “Go right ahead,” he told me, “it’s good for business.” Similarly, the coming flood of CV disease might be perceived by some more cynical than myself as being “good for business.” The ACC, and other health organizations, should make every effort to combat that perception.
Larry Husten is a writer and editor of CardioBrief.org.
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