Assessing Supply, Demand, and Adequacy of Cardiologists in the United States: Projecting a National Shortage

Abstract

Background

There is a paucity of contemporary studies on the projected supply and demand of cardiologists in the United States.

Methods

This was a cross‐sectional study of US‐based cardiologists using data from the Health Workforce Simulation Model. Demand and supply were defined as the number of full‐time equivalent physicians needed and working in cardiology, respectively. Adequacy was defined as the ratio of supply over demand. Cardiology workforce trends were calculated from 2025 to 2037.

Results

From 2025 to 2037, the supply of cardiologists was projected to increase from 37 000 to 37 730 (2.0% increase). Demand for cardiologists was projected to increase (40 110 to 46 390, 15.7% increase). As a result, the adequacy of the cardiologist workforce was projected to decrease from 92.2% to 81.4%. By 2037, nonmetropolitan areas were projected to have a less adequate supply than metropolitan areas (29.2% versus 88.9%). The West had the lowest adequacy relative to the Northeast (69.1% versus 117%). By 2037, the states with the lowest adequacy were Idaho (47.8%), Nevada (48.8%), and Alaska (50.0%). In 2025, cardiology ranked 14th out of 21 specialties for physician workforce adequacy, which increased to 12th by 2037.

Conclusions

Future workforce shortages are anticipated in cardiology, which are greatest in the West, certain US states, and nonmetropolitan areas. Future work is needed to implement strategies that improve the adequacy of the cardiologist workforce in the United States.

Nonstandard Abbreviations and Acronyms

APP

advanced practice provider

FTE

full‐time equivalent

HWSM

Health Workforce Simulation Model

SCAI

Society for Cardiovascular Angiography and Interventions

Clinical Perspective.

What Is New?

• From 2025 to 2037, growth in the demand for cardiologists is expected to exceed growth in the supply of cardiologists.

• Workforce adequacy of cardiologists is projected to decrease in the United States especially in the Midwest and nonmetropolitan areas.

What Are the Clinical Implications?

• Future efforts are needed to design and implement strategies that improve the adequacy of the cardiologist workforce in areas with identified deficiencies.

Preparing a sufficient number of cardiologists to meet the growing health care demands in the United States has become an increasingly important focus of research and attention. ¹ , ² , ³ , ⁴ The dual pressures of an aging patient population and a wave of physician retirements have strained the sufficiency of the cardiologist workforce. ⁵ , ⁶ , ⁷ , ⁸ , ⁹ , ¹⁰ Prior research has questioned whether the number of practicing cardiologists in the United States is adequate to meeting growing population needs. ¹¹ , ¹² , ¹³ , ¹⁴ , ¹⁵ Uneven geographic access to cardiologists has been documented across the United States especially affecting patients living in rural areas. ¹⁶ , ¹⁷ , ¹⁸ , ¹⁹ However, adequate access to cardiologists has been shown to promote clinical outcomes for patients suffering from cardiac diseases including heart failure, arrhythmias, and myocardial infarction. ²⁰ , ²¹ , ²² , ²³ , ²⁴ , ²⁵ , ²⁶ Inequities in access to cardiologists may lead to adverse health outcomes for an increasing number of patients living with heart disease in the United States. ²⁷

Shifting models of cardiac care delivery make it increasingly difficult to predict cardiology workforce needs with precision. ²⁸ Prior recommendations on the supply and demand for cardiologists in the United States offered conflicting recommendations ²⁹ with studies in the 1980s suggesting an overabundance of medical specialists in the United States. ³⁰ Recent reports have highlighted an emerging shortage in the number of cardiologists in the United States. ¹¹ , ¹² , ¹³ , ¹⁴ , ¹⁵ , ²⁸ , ²⁹ Yet, despite its importance to understanding effective cardiac care delivery in the United States, there is a paucity of contemporary literature on the adequacy of the emerging cardiologist workforce. Thus, the primary objectives of this study were to analyze the supply, demand, and adequacy of the cardiologist workforce in the United States.

METHODS

This was a cross‐sectional analysis of US‐based cardiologists using data from the Health Workforce Simulation Model (HWSM). The Health Resources and Service Administration developed the HWSM in 2016 to inform policy makers on workforce issues that affect health care delivery in the United States. Assumptions in the HWSM are derived from multiple real‐world data sources including but not limited to the US Census, the American Medical Association, and the Healthcare Cost and Utilization Project. The HWSM uses a microsimulation approach to model supply and demand behavior for health care services in the United States. Methods employed by the Health Resources and Service Administration to construct the HWSM have been described in detail ³¹ and are summarized herein. All projected years from the HWSM were extracted on January 1, 2025, which included the years 2025 to 2037. All workforce projections in the HWSM are deterministic scenario estimates and are designed to be interpreted accordingly. Due to the lack of patient information, this study qualified for review exemption status based on the policies of the institutional review board. The data that support the findings of this study are available from the corresponding author upon reasonable request.

The HWSM uses a microsimulation approach to model the supply and demand for cardiologists in the United States. Supply of cardiologists is derived from physician workforce behavior including their movement, work hours, and career duration and demand for cardiologists is derived from patient behavior including health care usage patterns. The HWSM simulates the behavior of 1 individual within a larger, statistically representative cohort of physicians and patients across the United States. Assumptions in the HWSM are derived by integrating US population data, health care usage trends, and physician workforce characteristics across multiple sources. ³¹

The primary outcomes in this study were supply, demand, and adequacy of the cardiologist workforce. Supply was defined as the number of full‐time equivalent (FTE) cardiologists in the United States. In the HWSM, annual supply is calculated as a dynamic figure that incorporates both workforce addition and attrition. Data from the American Association of Medical Colleges National Sample Survey of Physicians indicate that most cardiologists work >40 hours per week. As such, FTE supply assumptions are often higher than the count of active physicians in a particular specialty to account for this difference. To model supply, the HWSM integrates certification and licensing data from multiple sources including the Accreditation Council for Graduate Medical Education and the American Medical Association. Accreditation Council for Graduate Medical Education data indicated that 1216 new annual entrants were expected in the cardiologist workforce based on current cardiovascular disease fellowship training capacity. The sex distribution of cardiologists was integrated from the American Medical Association Physician Professional Data. Assumptions for career duration and workforce attrition in cardiology were obtained from the American Association of Medical Colleges National Sample Survey of Physicians. In addition, state‐level administrative records were used to model new entrants into the physician workforce as well as attrition due to retirement, mortality, and career changes. Patterns of physician migration were also sourced from the National Plan and Provider Enumeration System to account for workforce attrition. For the purposes of this study, all supply assumptions for the cardiologist workforce from the HWSM were preserved.

Demand was defined as the number of cardiologist FTEs needed to meet US health care needs under the status quo scenario. To forecast demand, the HWSM incorporates real‐world data from multiple sources including US population demographics, health insurance coverages, and health care claims data from authoritative sources including the Medical Expenditure Panel Survey and the Medical Group Management Association. Demand assumptions captured geographic variabilities in demographics, disease prevalence, insurance coverage, and household income. The HWSM created a population file for each US county and integrated prediction equations in the demand for health care services while normalizing expected demand with physician staffing ratios. For cardiology, the following health care administrative codes were used to model demand from International Classification of Diseases, Ninth Revision (ICD‐9) diagnosis (390–459, diseases of the circulatory system; 745–747, congenital anomalies of the circulatory system; 785, symptoms involving the cardiovascular system) and Tenth Revision (ICD‐10) diagnosis (I00–I99, diseases of the circulatory system; Q20, congenital heart malformations; Q22, congenital malformations of pulmonary and tricuspid valves; Q25, congenital malformations of great arteries; R00–R03, symptoms involving the circulatory and respiratory systems; R57, cardiogenic shock; R59, enlarged lymph nodes) codes. Growth in the demand for cardiologists was also modeled based on anticipated visits in the outpatient, inpatient, and emergency room settings. Population growth estimates were obtained from the US census and health care prediction equations were sourced from Medical Expenditure Panel Survey. Physician staffing ratios were derived from the Medical Group Management Association survey.

Sensitivity analyses for cardiologist workforce projections were also extracted from the HWSM. These included national cardiologist supply projections under the fewer graduates, more graduates, early retirement, and late retirement scenarios. The fewer graduates scenario was defined as 10% fewer new graduates entering the workforce and the more graduates scenario was defined as 10% more new graduates entering the workforce. The early retirement scenario was defined as cardiologists retiring 2 years earlier on average and the late retirement scenario was defined as later retirement by 2 years. Sensitivity analyses for national cardiologist demand projections included urban effect, insurance effect, race effect, and improved access scenarios. The urban effect scenario was defined as the entire population achieving health care usage rates equivalent to people living in metropolitan areas. The insurance effect scenario was defined as the entire population achieving health care usage rates equivalent to people with insurance. The race effect was defined as the entire population achieving health care usage rates equivalent to the non‐Hispanic White population. The improved access scenario was defined as the combination of all 3 urban, insurance, and race effects.

Statistical Analysis

Adequacy was defined as the ratio of supply over demand, which was calculated at the national and state levels. Physician workforce adequacy was also calculated for 20 additional medical specialties, which were selected based on the greatest number of active physicians. For visual representation of state‐level disparities, the following thresholds for cardiologist adequacy were created: ≥100%, 90% to 99%, 80% to 89%, 70% to 79%, and <70%. Percentage changes were calculated for outcomes of interest and descriptive statistics were employed to analyze workforce trends and geographical differences from 2025 through 2037. Average change per year was calculated for all outcomes of interest as final value in 2037 minus initial value in 2025 divided by the number of years.

RESULTS

Trends in Supply, Demand, and Adequacy of Cardiologists in the United States

In 2025, the supply of cardiologists was 37 000 FTEs, which was projected to increase to 37 740 FTEs by 2037 (2.0% increase, 0.2% increase per year, Figure 1). Over the same period, demand for cardiologists was projected to increase from 40 110 to 46 390 (15.7% increase, 1.2% increase per year). As a result, the adequacy of the cardiologist workforce was expected to decrease from 92.2% to 81.4% (10.9% decrease, −0.8% decrease per year).

Figure 1. Annual trends in the supply and demand for cardiologists in the United States.

Sensitivity analyses of cardiologist workforce projections under different scenarios are presented in Table 1 providing bounded plausible ranges. In 2025, cardiologist workforce adequacy projections ranged between 83.8% to 94.0%. By 2037, cardiologist workforce adequacy projections were projected to range between 72.2% and 83.8%.

Table 1.

Sensitivity Analyses for Supply and Demand Projections for the US Cardiologist Workforce

Y	Cardiologist workforce projections (full‐time equivalents)										Cardiologist workforce adequacy, range
	Supply					Demand
	Fewer graduates	More graduates	Early retirement	Late retirement	Status quo	Urban effect	Insurance effect	Race effect	Improved access	Status quo
2025	36 630	37 450	36 400	37 700	37 000	40 790	40 630	42 020	43 420	40 110	83.8%–94.0%
2026	36 230	37 410	35 990	37 720	36 810	41 470	41 240	42 630	44 130	40 730	81.6%–92.6%
2027	36 090	37 460	35 670	37 710	36 770	42 090	41 880	43 350	44 780	41 330	79.7%–91.2%
2028	35 900	37 590	35 610	37 840	36 730	42 740	42 500	44 000	45 470	41 960	78.3%–90.2%
2029	35 760	37 690	35 490	37 890	36 740	43 320	43 070	44 650	46 070	42 540	77.0%–89.1%
2030	35 680	37 900	35 520	37 980	36 800	43 860	43 710	45 270	46 720	43 090	76.0%–88.1%
2031	35 630	38 060	35 550	38 030	36 780	44 440	44 150	45 800	47 300	43 670	75.2%–87.1%
2032	35 600	38 280	35 580	38 110	36 890	44 900	44 680	46 370	47 920	44 150	74.2%–86.3%
2033	35 600	38 590	35 790	38 260	37 020	45 380	45 210	46 980	48 440	44 630	73.9%–85.7%
2034	35 670	38 870	35 910	38 430	37 270	45 890	45 720	47 510	48 980	45 160	73.3%–85.1%
2035	35 680	39 110	36 060	38 620	37 440	46 360	46 200	48 050	49 500	45 640	72.8%–84.6%
2036	35 720	39 380	36 280	38 800	37 550	46 720	46 570	48 420	49 930	45 990	72.7%–84.4%
2037	35 770	39 710	36 420	38 880	37 740	47 120	47 010	48 920	50 420	46 390	72.2%–83.8%

Cardiologist Workforce Adequacy by US Metropolitan Status

The adequacy of the cardiologist workforce was lower in nonmetropolitan areas when compared with metropolitan areas (Figure 2). In metropolitan areas, the adequacy of the cardiologist workforce was projected to decrease from 102% to 88.9% (13.5% decrease, −1.0% decrease per year). In nonmetropolitan areas, the adequacy of the cardiologist workforce was projected to decrease from 30.5% to 29.2% (1.3% decrease, −0.1% decrease per year).

Figure 2. Comparison of cardiologist workforce adequacy by metropolitan status.

Comparison of Cardiologist Workforce Adequacy by US Region

There were additional disparities in the adequacy of the cardiologist workforce by geographic region (Figure 3). In 2025, the Northeast had the highest cardiologist workforce adequacy (129%) and the West had the lowest (80.0%). By 2037, the Northeast was projected to have the highest cardiologist workforce adequacy (117%) and the West was projected to have the lowest (69.1%).

Figure 3. Adequacy of cardiologists in the United States by geographic region.

Disparities in Cardiologist Workforce Adequacy by State

There were disparities in the adequacy of the cardiologist workforce by state. In 2025, there were 8 states where cardiologist workforce adequacy was <70% (Figure 4). By 2037, there were 17 states where cardiologist workforce adequacy was projected to be <70% (Figure 5). In 2025, the states and districts with the highest cardiologist workforce adequacy were the District of Columbia (383%), Massachusetts (175%), and New York (146%). The states with the lowest cardiologist workforce adequacy were North Dakota (50.0%), New Mexico (61.9%), and Oklahoma (62.7%). By 2037, the states with the lowest cardiologist workforce adequacy were projected to be Idaho (47.8%), Nevada (48.8%), and Alaska (50.0%) (Table 2).

Figure 4. Cardiologist workforce adequacy by state in 2025.

Figure 5. Cardiologist workforce adequacy by state in 2037.

Table 2.

Geographic Disparities in the Supply, Demand, and Adequacy of the Cardiologist Workforce

	State or district	Cardiologist workforce projections (full‐time equivalents)						Change
		2025			2037
		Demand	Supply	Adequacy	Demand	Supply	Adequacy
Decrease	District of Columbia	60	230	383%	70	250	357%	−26.2%
	Maine	190	180	94.7%	240	170	70.8%	−23.9%
	New Jersey	1180	1260	107%	1340	1130	84.3%	−22.5%
	Alaska	70	50	71.4%	80	40	50.0%	−21.4%
	Idaho	190	130	68.4%	230	110	47.8%	−20.6%
	Delaware	150	120	80.0%	180	110	61.1%	−18.9%
	Florida	3360	2560	76.2%	4180	2410	57.7%	−18.5%
	North Carolina	1370	1150	83.9%	1720	1150	66.9%	−17.1%
	Nevada	370	240	64.9%	430	210	48.8%	−16.0%
	Arizona	920	720	78.3%	1180	740	62.7%	−15.5%
	Utah	280	250	89.3%	400	300	75.0%	−14.3%
	Hawaii	130	120	92.3%	140	110	78.6%	−13.7%
	Texas	3200	2690	84.1%	4050	2850	70.4%	−13.7%
	Washington	890	660	74.2%	1180	720	61.0%	−13.1%
	South Carolina	690	530	76.8%	800	510	63.8%	−13.1%
	Maryland	790	730	92.4%	930	740	79.6%	−12.8%
	New Hampshire	180	170	94.4%	220	180	81.8%	−12.6%
	Rhode Island	150	150	100%	160	140	87.5%	−12.5%
	Colorado	580	550	94.8%	740	610	82.4%	−12.4%
	South Dakota	100	70	70.0%	120	70	58.3%	−11.7%
	Minnesota	610	750	123%	690	770	112%	−11.4%
	Indiana	770	680	88.3%	830	640	77.1%	−11.2%
	Massachusetts	800	1400	175%	920	1510	164%	−10.9%
	Tennessee	950	810	85.3%	1090	820	75.2%	−10.0%
	New York	2220	3240	146%	2380	3240	136%	−9.8%
	Kansas	350	250	71.4%	420	260	61.9%	−9.5%
	Alabama	620	460	74.2%	680	440	64.7%	−9.5%
	Pennsylvania	1780	1970	111%	1980	2010	102%	−9.2%
	Virginia	1090	880	80.7%	1240	890	71.8%	−9.0%
	California	4200	3490	83.1%	4940	3680	74.5%	−8.6%
	Iowa	350	290	82.9%	390	290	74.4%	−8.5%
	New Mexico	210	130	61.9%	240	130	54.2%	−7.7%
	Oregon	540	380	70.4%	670	420	62.7%	−7.7%
	Mississippi	330	230	69.7%	370	230	62.2%	−7.5%
	Michigan	1330	1170	88.0%	1490	1210	81.2%	−6.8%
	Georgia	1240	1060	85.5%	1390	1100	79.1%	−6.3%
	Montana	130	100	76.9%	140	100	71.4%	−5.5%
	Louisiana	600	540	90.0%	650	550	84.6%	−5.4%
	Oklahoma	510	320	62.7%	570	330	57.9%	−4.9%
	Kentucky	630	480	76.2%	680	490	72.1%	−4.1%
	Connecticut	420	590	141%	430	590	137%	−3.3%
	Illinois	1500	1480	98.7%	1560	1510	96.8%	−1.9%
	Wisconsin	640	630	98.4%	690	670	97.1%	−1.3%
	Missouri	830	790	95.2%	900	850	94.4%	−0.7%
‐‐‐	Vermont	60	60	100%	60	60	100%	0
	Wyoming	60	40	66.7%	60	40	66.7%	0
Increase	Ohio	1610	1500	93.2%	1630	1540	94.5%	1.3%
	Nebraska	190	210	111%	210	240	114%	3.8%
	Arkansas	350	290	82.9%	370	330	89.2%	6.3%
	West Virginia	260	180	69.2%	250	190	76.0%	6.8%
	North Dakota	80	40	50.0%	80	60	75.0%	25.0%

Comparison of Physician Workforce Adequacy in Cardiology and Other Medical Specialties

In 2025, the cardiologist workforce ranked 14th most adequate out of 21 medical specialties (Table 3). By 2037, the cardiologist workforce ranked 12th most adequate. In 2025, physician workforce adequacy was observed to be highest in emergency medicine (103%), critical care medicine and pulmonology (99.5%), and endocrinology (97.7%). Physician workforce adequacy was observed to be lowest in adult psychiatry (66.4%), family medicine (76.5%), and general internal medicine (83.2%). By 2037, physician workforce adequacy was projected to remain highest in emergency medicine (116%), critical care medicine and pulmonology (110%), and endocrinology (102%). By 2037, physician workforce adequacy was projected to be lowest in adult psychiatry (42.8%), ophthalmology (68.2%), and family medicine (72.9%).

Table 3.

Comparison of Cardiologist Workforce Adequacy With 20 Other Medical Specialties

	Specialty	Physician workforce adequacy (supply/demand)
		2025	2037
1	Emergency medicine	103% (64 770/63 110)	116% (78 420/67 820)
2	Critical care medicine and pulmonology	99.5% (26 910/27 050)	110% (32 990/30 100)
3	Endocrinology	97.7% (12 070/12 350)	102% (13 710/13 440)
4	Gastroenterology	96.5% (20 730/21 490)	94.0% (21 790/23 180)
5	Hematology and oncology	96.2% (23 030/23 950)	92.5% (24 630/26 620)
6	Dermatology	96.4% (14 480/15 020)	94.1% (15 260/16 220)
7	General surgery	96.3% (34 530/35 850)	98.8% (37 980/38 440)
8	Orthopedic surgery	94.9% (31 890/33 690)	85.4% (30 620/35 850)
9	Anesthesiology	95.0% (53 840/56 680)	86.1% (52 310/60 760)
10	Obstetrics and gynecology	93.4% (49 170/52 620)	81.7% (44 130/54 020)
11	Pathology	91.9% (17 670/19 220)	80.3% (17 290/21 520)
12	Infectious diseases	92.8% (13 070/14 090)	85.0% (13 500/15 890)
13	Nephrology	92.5% (14 600/15 780)	78.5% (14 810/18 860)
14	Cardiology	92.2% (37 000/40 110)	81.4% (37 740/46 390)
15	Pediatrics	92.2% (62 250/67 540)	81.2% (55 840/68 770)
16	Ophthalmology	89.5% (20 400/22 800)	68.2% (17 560/25 760)
17	Hospital medicine	88.3% (39 980/45 290)	76.5% (38 700/50 600)
18	Neurology	88.4% (21 090/23 850)	91.2% (23 310/25 560)
19	General internal medicine	83.2% (88 490/106 320)	76.0% (91 570/120 460)
20	Family medicine	76.5% (111 990/146 300)	72.9% (116 330/159 550)
21	Adult psychiatry	66.4% (36 450/54 870)	42.8% (32 660/76 320)

DISCUSSION

Projected increases in the demand for cardiologists are expected to outpace the supply of cardiologists in the United States. Accordingly, the adequacy of the cardiologist workforce is expected to decrease. Shortages in the cardiologist workforce were concentrated in certain regions including nonmetropolitan areas, the West, and certain states like Idaho, Nevada, and Alaska. As a specialty, cardiology ranked towards the median in terms of physician workforce adequacy when compared with 20 additional medical specialties. Collectively, these results highlight impending shortages of cardiologists, which may have public policy in the United States. Future research is required to develop and implement strategies that increase the supply of cardiologists in areas with identified deficiencies.

Recommendations to Improve Cardiologist Workforce Adequacy

Analyzing projected changes in the supply and demand of cardiologists in the United States can help guide future recommendations for the field. First, decisions about expanding cardiovascular disease fellowships and training slots should be made thoughtfully, taking into account the rising demand for cardiologists highlighted in this study. Cardiovascular disease fellowship training is among the most competitive internal medicine subspecialties, and an increasing number of qualified applicants go unmatched each year. ³² Furthermore, more cardiologists are pursuing subspecialized training after fellowship, which serves to further fragment the cardiologist workforce. ³³ Physician organizations in the specialty including the American College of Cardiology, the Heart Failure Society of America, Heart Rhythm Society, and Society for Cardiovascular Angiography and Interventions should routinely monitor supply and demand projections for future cardiologists. Second, there is a growing need to attract cardiologists to regions with identified deficiencies including nonmetropolitan areas. ¹⁶ , ¹⁷ , ¹⁸ , ¹⁹ Creation of new cardiovascular disease fellowship programs in areas with identified deficiencies may help improve the local supply of cardiologists in these areas. However, further research is needed to identify additional funding mechanisms to support US graduate medical education in cardiology. The creation of regional training consortia may help provide cardiology fellows with enough case volumes and exposure to diverse pathologies in areas with identified deficiencies of cardiologists. In this study, there were several states that demonstrated the lowest adequacy of cardiologists including Idaho, Nevada, and Alaska. State governments facing cardiologist shortages can consider augmenting physician recruitment strategies including expansion of student loan forgiveness, physician work visas, and other financial incentives.

Health Care Trends That May Influence Cardiologist Workforce Projections

Several trends in US health care may affect the underlying assumptions of the HWSM and alter future supply and demand forces for cardiologists. Declining reimbursement rates from state and federal health insurance programs are expected to create growing financial strain on cardiology practices in the years ahead. ³⁴ , ³⁵ Broader expansion of state Medicaid programs could also drive greater demand for cardiologists as additional patients gain access to care for chronic cardiovascular conditions. ³⁶ , ³⁷ Notably, the growing diversity within the incoming cardiology workforce may affect future assumptions regarding the FTE capacity assumptions of practicing cardiologists. ³⁸ , ³⁹ Younger cardiologists have unique work preferences including a greater predilection for part‐time work. ⁴⁰ , ⁴¹ Additionally, rising rates of early career burnout and workforce attrition has been described in cardiology, which may increase with rising administrative burdens. ⁴² , ⁴³ , ⁴⁴ Future interventions may be needed to help retain cardiologists in the workforce. Professional societies in cardiology including the American College of Cardiology, Heart Failure Society of America, Heart Rhythm Society, and Society for Cardiovascular Angiography and Interventions should increasingly offer physician support services during all career stages including transition to later career stages.

Impact of Digital and Telehealth in Cardiology

Advances in digital health and telemedicine have the potential to significantly enhance the cardiologist workforce by improving efficiency, expanding reach, and redistributing clinical tasks. ⁴⁵ , ⁴⁶ , ⁴⁷ Remote monitoring technologies such as wearable sensors, implantable devices, and app‐based symptom tracking can enable continuous cardiovascular assessment without requiring in‐person patient visits, thereby allowing cardiologists to focus on complex decision making rather than routine symptom surveillance. ⁴⁵ Telehealth clinics can help mitigate geographic disparities by extending access to cardiologists in rural and underserved areas. ⁴⁶ These digital tools may help reduce unnecessary hospitalizations and emergency room visitations by enabling earlier detection of decompensation in chronic diseases like heart failure. ⁴⁷ Digital health tools may support more efficient interdisciplinary care by enabling nurses, care coordinators, and other team members to manage stable patients while triaging higher complexity cases to cardiologists. ⁴⁷ However, further adoption of digital health solutions in cardiology will require robust data infrastructures, thoughtful reimbursement models, and attention to clinician fatigue related to disparate digital health data streams. ⁴⁷ Overall, however, digital and telehealth solutions have the potential to augment the cardiologist workforce by amplifying physician time and improving system‐wide productivity.

Role of Advanced Practice Providers in Cardiology

Incorporating advanced practice providers (APPs) into cardiology care teams represents a practical approach to mitigating shortages in the cardiologist workforce. As cardiologists take on more complex cases and have less available time, APPs will increasingly be needed to handle routine follow‐up visits, support patient education, manage chronic cardiac conditions, and assist with diagnostic and therapeutic decisions under appropriate supervision. Prior literature has demonstrated that interdisciplinary cardiovascular teams that integrate nurse practitioners and physician assistants can improve access to care, reduce wait times, and enhance clinical outcomes. ⁴⁸ Data from the American Community Survey and the National Sample Survey of Registered Nurses suggest that physician assistants and nurse practitioners will increase by annual growth rates of 4.3% and 6.8% from 2016 to 2030, respectively. ⁴⁹ These figures exceed anticipated annual growth rates for physicians, which were at 1.1% over the same period. Further successful integration of APPs into cardiovascular care teams will require clearly defined scopes of practice, standardized training pathways, supportive institutional cultures, and collaborative care protocols. ⁴⁸ , ⁴⁹

Study Limitations

This study had several limitations. This was a microsimulation of cardiologists in the United States, which used specific assumptions inherent to the HWSM. Accordingly, results from this study represent a cardiology‐focused synthesis and interpretation of a well‐established workforce model rather than the creation of a novel modeling framework. Assumptions in the HWSM were triangulated across multiple real‐world data sets. Assumptions for supply and demand of the cardiologist workforce were susceptible to multiple unforeseen policy shifts in US health care. Additionally, the demographic composition and work preferences of the cardiologist workforce are rapidly evolving. Currently, the Health Resources and Service Administration models the cardiologist workforce as a single specialty and additional assumptions for cardiovascular subspecialties including heart failure, electrophysiology, and interventional cardiology were not available. Further fragmentation of the cardiologist workforce can be expected due to increasing pursuit and adoption of subspecialized training across cardiovascular subspecialties. Unique supply and demand dynamics exist in each cardiology subspecialty, which should be the focus of future investigation. Additional studies are needed that coordinate with respective subspecialty boards to understand the current supply of cardiology subspecialists. Physician associations in cardiology should continuously monitor potential shifts in cardiovascular care delivery including potential clinical and technological advancements. Lastly, this study analyzed cardiologists and excluded physician assistants and nurse practitioners. The increasing prevalence of APPs in cardiovascular care delivery especially within states that have passed legislation for autonomous practice of APPs is an important topic worthy of future investigation. ⁴⁹

CONCLUSIONS

In conclusion, the demand for cardiologists is expected to outpace future supply. As such, cardiologist workforce adequacy is expected to decrease in the United States. Deficiencies in the cardiologist workforce appear greatest in nonmetropolitan areas, the West, and certain states like Idaho, Nevada, and Alaska. Compared with other medical specialties, cardiology ranked among the median for physician workforce adequacy. Collectively, these results highlight an impending shortage of cardiologists, which may have profound implications on public health policy in the United States. Future efforts are needed to develop strategies that increase the supply of cardiologists in regions with identified deficiencies.

Sources of Funding

None.

Disclosures

None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

Supporting information

STROBE Statement—Checklist