Interventional cardiology manpower needs: how many of us are there? How many should there be? How many will we need in the future?

The manpower necessary to handle interventional procedures in the United States remains a subject of great uncertainty. The American College of Cardiology predicted a glut of cardiologists in a 1994 position statement [1], and Federal policy and budget decisions reduced financial support for cardiology training. As a result cardiology training programs were downsized [2]. Between 1990 and 1995 the total number of cardiology trainees increased from 2,310 to 2,633. Subsequently the number declined and by 2001 had decreased to 2,305. How many of us (invasive/interventional cardiologists) are there? In 1997 over 6,500 operators at 1,003 hospitals billed Medicare for PCI procedures [3]. This may be one of the best estimates of the number of practicing interventional physicians in the United States today. If we “do the math” and estimate 1,000,000 PCI procedures annually, each operator should be performing about 150 procedures each year. This represents a manageable load. However, the workload is unevenly distributed. It is clear that many operators have difficulty meeting the 75 case-per-year PCI guideline benchmark number. At the same time, there are certainly operators who perform many hundreds of procedures per year. There is clearly capacity for the current pool of interventional practitioners to do more. What is the demand for interventionalists in the community? From the number of letters I receive each week from headhunter companies, there seems to be an endless number of possible interventional positions around the United States. Each seems to offer a higher starting base salary than the next, along with tremendous benefits. They are all in family-friendly, university towns. Fellows tell me they receive daily phone calls with job offers. A recent New England Journal had almost sixty ads for interventional positions. We are not alone. Electrophysiology is clearly facing a shortage, accelerated by the recent trials demonstrating benefits for AICD therapy and biventricular pacing in large groups of patients, and by the growing applications