This spring, discussions on how to build a workforce that better meets the needs of the heart failure population will begin in earnest.
The alarming number of unfilled fellowship spots for advanced heart failure and transplant cardiology (AHFTC) each year shows that the field is not enticing new trainees, despite the growing clinical need and advances in therapeutics. As recently as the 2023-2024 cycle, just 71 of the 127 AHFTC positions were filled, according to data from the National Resident Matching Program.
Meanwhile, the 1,100-plus fully fledged heart failure physicians in the U.S. are grossly outnumbered by the 6.2 million people living with heart failure. One estimate projects more than 8 million heart failure patients by the year 2030.
Initial efforts are already underway to overhaul the training pipeline for greater interest and efficiency in the heart failure field.
“Day in and day out, I’m so grateful to be a part of this field, which is increasing what it addresses and encompasses. I think innovation is moving at lightning speed. All fields of cardiovascular medicine are converging into heart failure, and it behooves those of us who are in this field to recognize the incredible excitement and fulfillment there is to be gained from entering the field,” said Anuradha Lala, MD, program director for the advanced heart failure & transplant fellowship at the Icahn School of Medicine at Mount Sinai in New York City.
Of note, the Heart Failure Society of America (HFSA) has assembled a task force to address the workforce issue.
John Barnes, CEO of the HFSA, told MedPage Today that the task force “will be organizing a consensus conference to develop strategies to increase the number of trainees interested in pursuing subspecialized training in heart failure through [AHFTC] programs. This will include assessing the current design of AHFTC fellowship programs, developing novel approaches that are more responsive to contemporary needs and of interest to potential trainees, and assessing the feasibility and value of AHFTC fellowship programs offering distinctions in addition to core training in [AHFTC].”
The group is expected to make its recommendations to the HFSA Board of Directors this spring, Barnes said.
For starters, there is a need for survey data from fellows and faculty to get an idea of what they think is motivating or deterring applicants, Lala told MedPage Today in an interview. “We are assuming a lot. We need to get that primary data,” she said.
Theories of why it is so difficult to recruit include inadequate exposure to AHFTC during the 3 years of cardiovascular disease fellowship, as many programs lack a heart transplant or left ventricular assist device (LVAD) component. Additionally, the designation of “AHFTC” itself fails to capture the widening scope of heart failure cardiology that now overlaps with critical care, some cardiomyopathies, cardio-oncology, cardio-obstetrics, and other disciplines.
Then there’s the reality of the limited job market at transplant and LVAD centers — and the relatively low compensation among those who do find jobs.
Some suggest that compensation models should be overhauled so that heart failure cardiologists are not penalized for spending more time in evaluation and management services and care coordination compared with other cardiovascular subspecialties. “The idea of one billing code [doesn’t capture] all the work put into our interactions and care,” Lala said.
Lala and colleagues recently published a proposed roadmap of next steps in the Journal of Cardiac Failure that discusses improvements in heart failure compensation models, among other suggestions for the field.
“The time to bridge the divide between the dearth of AHFTC fellowship applicants, exciting therapeutic advances, and an increasing need for a larger heart failure-specialized workforce is now,” the authors wrote.
“What to me is clear is we’ll require concerted efforts across organizations like CMS, professional societies, as well as education bodies to really recognize that this is a problem that needs attention. What we are proposing are not solutions but certainly suggestions to explore as a start,” Lala said.
AHFTC was introduced as a cardiovascular subspecialty in 2008 by the American Board of Internal Medicine. Its subspecialty requirements and scope of training were codified by the Accreditation Council for Graduate Medical Education in 2013.
As for advanced practice providers, the recently launched HFSA heart failure professional certification may be earned by registered nurses, pharmacists, physicians, and physician assistants who demonstrate the ability to provide heart failure services at an advanced level.
Lala and colleagues had no disclosures.
Journal of Cardiac Failure
Source Reference: Blumer V, et al “A roadmap to reinvigorating training pathways focused on the care of patients with heart failure: shifting from failure to function” J Card Fail 2023; DOI: 10.1016/j.cardfail.2022.12.009.