Anthony DiGiorgio, DO, MHA

Cardiology Business

The Cardiologist Shortage and its Consequences

We all know there’s a growing cardiologist shortage, but American cardiovascular care might hit its breaking point, with a Medicus Healthcare Solutions analysis now projecting that the shortage will only get bigger, and will hit rural communities the hardest.

• CVD affects nearly half of U.S. adults with its prevalence expected to rise, driven by aging demographics and increasing CVD risk factors.
• The cardiology workforce itself is also aging, with 29% of cardiologists now over 65 years old and an average age of 58.

To quantify the problem, Medicus examined over 34k U.S. cardiologists (24.9k general, 5.2k interventional, 2.9k electrophysiologists) and created supply-demand projections through 2036 that revealed several bottlenecks.

First there’s a well known geographic hurdle:

• Nearly half of U.S. counties don’t have a single cardiologist.
• Rural counties face a 54% higher CVD mortality rate.
• Northeast states have double to triple the number of cardiologists per capita compared to the most rural states (14-16 vs. 5-7 per 100k).

Then there’s a fellowship training mismatch: 

• Cardiovascular disease programs saw 35.6% of applicants fail to match.
• Meanwhile interventional cardiology (23.1% unfilled) and advanced heart failure/transplant (40.2% unfilled) also faced insufficient applicant interest.

And even when a cardiologist is done training, recruitment is difficult:

• It takes 209 days on average to recruit a cardiologist even though they generate up to 7x their annual salary in revenue for hospitals.

Medicus offers some ideas on how to fix this, like:

• Advanced practice provider ratio expansions, which already increased 25% from 0.60 per cardiologist in 2020 to 0.75 in 2024.
• AI adoption in imaging analysis and clinical decision support.
• Locum tenens (temporary regional staffing, which Medicus provides) for coverage stabilization.

But the real, long term answer might not be AI or more APPs according to other industry giants like Johns Hopkins University; instead it’s making residency and fellowship training more accessible.

• For example the federal cap on Medicare-funded residency positions has remained largely unchanged since 1997.
• Furthermore, only 14% of residency slots are in rural locations.

The Takeaway

The cardiologist shortage is certainly going to get worse before it gets better. That said, Medicus’ analysis makes it clear that we need to overcome the inertia of opening more cardiology training opportunities while making it attractive for these physicians to practice in rural settings.

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The Wire

• The NOBLE Trial’s 10-Year Safety: Long-term results from the NOBLE trial confirmed that PCI is as safe as CABG for treating unprotected left main coronary artery disease in patients without complex lesions. Over a decade, all-cause mortality rates were 23% for PCI and 25% for CABG, showing no statistically significant difference (p = 0.56). This evidence provides heart teams with robust reassurance that PCI is a safe, effective alternative to surgery for appropriate candidates, which could help usher-in a more individualized approach to revascularization.

• Esperion’s Enbumyst Acquisition: Esperion Therapeutics acquired Corstasis Therapeutics and its FDA-approved nasal spray, Enbumyst, for $75M upfront and up to $180M in milestones. Enbumyst (intranasal bumetanide) is the first and only nasal loop diuretic designed to treat edema in congestive heart failure, CKD, and liver disease. This move could position Esperion to capture a significant share of the projected $4.6B U.S. diuretic market as part of its long-term growth strategy.

• Stereotaxis’ Synchrony FDA Clearance: Stereotaxis received FDA 510(k) clearance for its Synchrony system, a high-definition digital cockpit designed to modernize interventional cath labs. Centered around a 55” 4K UHD display, the system integrates separate video streams with ultra-low latency, decluttering the surgical environment. Paired with Stereotaxis’ SynX cloud app, Synchrony facilitates secure, HIPAA-compliant remote collaboration and real-time monitoring. This pairs well with Stereotaxis’ full portfolio of robotic catheter procedures.

• Anumana’s Cardiac Amyloidosis AI Clearance: Anumana secured FDA 510(k) clearance for the first AI algorithm designed to identify cardiac amyloidosis from standard 12-lead ECGs. Validated in a 25.5k patient study with 78.9% sensitivity and 91.2% specificity, the tool enables clinicians to flag “invisible” waveform patterns during a routine heart check. This milestone expands Anumana’s portfolio of ECG-AI solutions, transforming the 100-year-old ECG modality into a screening tool for CA which is often underdiagnosed due to symptoms that mimic more common forms of heart failure.

• Impella’s Class I Purge Recall: The FDA issued a Class I recall for J&J’s (Abiomed) Generation 1 Impella Purge Cassette, warning that leaks can cause sudden pump failure and patient death. By allowing blood into the motor, these leaks compromise vital hemodynamic support. Per the recall, facilities must immediately quarantine Gen 1 units and transition to Generation 2 components. If Gen 2 is unavailable, emergency Gen 1 use requires vigilant monitoring for “Purge Pressure Low” alarms.

• The RVU-AHF Mismatch: A recent review article in Circulation Heart Failure suggests that U.S. academic centers are swapping salaries for RVU-based pay, a move that prizes volume over the complex “cognitive work” required for Advanced Heart Failure. Since AHF involves grueling care coordination often invisible to billing codes, the RVU model fails to capture the specialist’s true effort. Since this undervaluation fuels burnout and scares off new trainees (see top story above) the authors argue we need compensation reform that reflects the multidisciplinary reality of HF care.

• VDYNE’s TRIVITA1 Trial Milestone: VDYNE received FDA Investigational Device Exemption (IDE) approval to launch TRIVITA1, its U.S. pivotal clinical trial for its transcatheter tricuspid valve replacement (TTVR) system. This minimally invasive, patient-tailored solution aims to provide a much-needed alternative for the 1.5M Americans suffering from severe tricuspid regurgitation  (which is associated with a 10% one-year mortality rate).

• Topaz TTVR Pivotal Study Cleared: The FDA also granted an IDE for TRiCares’ TRICURE pivotal trial of the Topaz TTVR system. TRiCares claims it stands out with a unique dual-stent architecture including an outer hourglass-shaped frame that flexes with the heartbeat for a superior seal, and an inner valve-hosting frame designed to steer clear of the heart’s electrical pathways. This IDE, alongside VDYNE’s IDE, points to the FDA’s acknowledgement of a lack of transcatheter technology for the tricuspid valve.

• J&J’s Varipulse Pro Launch: Johnson & Johnson MedTech launched the Varipulse Pro pulsed field ablation system in Europe following its CE mark approval. This next-generation platform features a refined pulse sequence that is five times faster than previous iterations while operating at a lower temperature profile. It’s also designed for seamless integration with J&J’s Carto 3 mapping system, and uses advanced tissue proximity indicators to ensure precise, consistent lesion delivery.

• Stalled Pandemic BP Recovery: A JAHA study of 1.5M patients showed that U.S. blood pressure control deteriorated over the course of the pandemic and still hasn’t recovered. The percentage of adults with controlled BP worsened from 65.3% in 2019 to 61.8% in 2020, recovering only to 62.6% by 2022. Non-Hispanic and Asian individuals saw the sharpest decline, dropping 4.47% points (68.4% to 63.9%), while Black patients (20% of the cohort) maintained stable rates, but consistently exhibited the lowest control levels across all groups.

• Cardiovascular Consultants Data Settlement: Cardiovascular Consultants finalized a $3.85M settlement to resolve a class action lawsuit following a massive 2023 data breach. The incident, which occurred during its tenure as a Fresenius Medical Care subsidiary, compromised the names, Social Security numbers, and medical records of roughly 500k patients. Now part of the Atria Heart network, Cardiovascular Consultants is utilizing the network’s fund to provide restitution for those affected, though they still deny any wrongdoing.

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The Resource Wire

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The Industry Wire

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9. Chapter’s $100M funding round for Medicare navigation.
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