The surest sign that "times they are a’changin’ " is that job opportunities for our graduating fellows are not what they once were. Despite draconian predictions that we would be facing a cardiology manpower shortage, we may now be facing a glut, or so it would appear. To some degree, we should not be surprised. Could it be that all the statins and ACE inhibitors and yes, even stents, are finally paying off?
KeithBinns/iStockphoto.com
Maybe, but it’s highly unlikely that the depressed job market outlook is a phenomenon driven by an improvement in the nation’s overall cardiovascular health. After all, cardiac risk factors are rampant. Instead, other factors are probably in play. The 2008 economic meltdown has kept older cardiologists in the field longer than expected, and so-called vertical integration has increased economic uncertainty. Both impact strategic thinking and hiring decisions. Cardiologists are encountering lower reimbursement, potential Medicare RAC (Recovery Audit Contractor) audits, and other pocketbook threats. Loss of income is no longer imagined, it’s real.
The cardiology discipline is not immune from market forces (or the lack thereof, thanks to regulations). This quite seamlessly gets us back to our fellows.
There are job openings for graduates wishing to pursue heart failure and transplant (hooray!). The university hospital setting may no longer appear as the "black sheep of the family"; program directors will tell you that they get inquiries from private practice cardiologists all the time. Opportunities exist in many areas that were once relatively underserved. Fargo anyone? Why not! And indeed several graduates of my program are thriving there right now. But the big cities on the East or West Coast? Not a lot of hope there for meaningful employment inroads.
Here’s a joke, but one that sends a message: How do you find an interventional cardiologist in California? Just call out "Waiter!"
So, our senior fellows, I sympathize with you. It’s not the way it used to be. And in this case, it’s the exception that proves the rule made famous by former New York City Mayor Ed Koch when he was confronted at a campaign stop by an elderly woman. Part urban legend, part reality, the exchange went like this:
Lady: "Mr. Mayor, Mr. Mayor, why can’t you make things the way things used to be?"
Ed Koch: "Lady, things were never the way they used to be."
If any cardiology fellow thinks the clock will eventually turn back, he or she is mistaken. Opportunities exist but our professional well-being has been compromised, to say nothing of our autonomy. I’ll have more to say on this in another blog. But meantime, in July we’ll be bringing on board another enthusiastic group of first-years. Wish them luck!