Adult cardiovascular physician resources and needs assessment: Report of the 1992 and 1993 American College of Cardiology surveys on physician training and resource requirements

Training for procedures will remain an important issue. At the present time, primary care physicians principally perform exercise tests and interpret ECGs among cardiovascular procedures, and their training is supplemental to their routine program. If more cardiovascular procedures are to be performed by primary care physicians, some additional formal training will be necessary to provide skills equivalent to those attained by cardiovascular specialists in the course of their training. However, risk factors are frequently managed by the primary care physician without cardiovascular support. The surveys indicate sufficiency in the perceived number of cardiologists and perceived oversupply of invasive cardiologists. Cardiologists provide significant proportion of primary care for their patients with cardiologic diagnoses, and primary care physicians provide considerable proportion of routine cardiovascular care, particularly involving risk modification. As care models change in the future, it will be important to continue to examine the referral patterns and relative provision of cardiovascular care by both primary care physicians and cardiologists. Future cardiovascular physician requirements will reflect changing needs relating to geography, technical expertise and the use of advanced practice nursing and physician assistants. Adequate procedure experience remains concern for cardiologists because the procedure volumes frequently fall below recommended minimal standards. All these issues will continue to have an impact on the need for additional cardiovascular practitioners.