Data Show CV Steering Into Deeper Subspecialization

Illustration: Lee Sauer

The 2023 Cardiovascular Provider Compensation and Production Survey Report, which published right before CV Transforum Fall’23, provided much needed reassurance that the field of cardiology has entered a more stable path after years of turmoil surrounding the pandemic and the “Great Resignation.” Creating the report is a massive team effort and the entire MedAxiom team was relieved to see that metrics across all of cardiology were relatively stable between 2021 and 2022 – a welcome state of being after so much change.

While the report did show some normalization, the data also revealed the continued shift toward deep subspecialization in the field of cardiology, particularly for advanced heart failure (HF), structural heart and advanced imaging physicians, as well as advanced practice providers (APPs). The definition of subspecialty roles has critical valuation implications when conducting peer comparisons within the larger buckets of interventional cardiology, cardiovascular imaging and general cardiology for compensation and production expectations.

For instance, nearly half of all advanced heart failure fellowship positions in the United States go unfilled. This is certainly not because the demand for these services is waning, as every analysis points to increasing prevalence and growing populations – reaching 8 million by 2030. While there are likely myriad reasons that these fellowships go unfilled, one logical factor may be compensation as compared to the other cardiology subspecialties. That’s why it’s critical that the MedAxiom survey goes deeper than simply reporting compensation and work relative value units (wRVU) and tells a more complete story for the critical provider resources.

This blog will highlight just some of these subspecialty details. You’ll have another opportunity to drill into the subspecialty data with me and my co-author, Karen Wilson, MHA, Vice President of Member Services at MedAxiom, during a webinar on Thursday, Oct. 26, 2023 at 1 p.m. ET with my. Register for the webinar now.

Resources:

• Download the Full 2023 Report
• Register for the 2023 Compensation and production Survey Webinar (Takes Place Oct. 26, 2023 at 1 p.m. ET)
• Read the Trending Story for 2023 Report Highlights
• Learn More About MedAxcess and Submit Your Data
• Consult With the Care Transformation Services Team to Translate Business Intelligence Into Practical Strategies

Advanced HF: An Outlier in Compensation and Production Trends

When examining the variation in earnings within the field of cardiology, we can observe distinct patterns among subspecialties. In Figure 1, electrophysiology (EP) and interventional cardiologists emerge as the highest earners, boasting median annual incomes that are nearly identical at $714,976 and $709,714, respectively. On the other end of the earnings spectrum, median total compensation figures for advanced HF specialists ($575,000) and general/non-invasive cardiologists ($585,8490) are also nearly indistinguishable, differing by less than 2%.

The 2022 data reaffirms a strong correlation between median production levels for each subspecialty and their corresponding total compensation (Figure 2). With only one exception, the rank of median total compensation per full-time physician aligns with the order of median work relative value unit (wRVU) production. Notably, advanced HF physicians represent an exception to this pattern, as they earn within 2% of the total compensation received by general/non-invasive cardiologists, despite having 32% lower median wRVU production per full-time physician.

Structural Heart Emerges as Heterogenous Super Subspecialty

The 2022 data painted a nuanced portrait of the structural heart “super subspecialty” – a subset of interventional cardiology that has been gaining distinction in the MedAxiom community. Individuals in this super subspecialty spend their time filling a variety of roles – performing structural heart work, cardiac interventions, imaging, and office work. This same heterogeneity is found within in the population of interventional cardiologists as a whole.

MedAxiom is often asked “should structural heart physicians earn more than interventional operators?” The answer from the survey data is quite elusive. Simply defining a structural heart physician is challenging when comparing rankings of structural heart wRVUs to total wRVUs (Figure 3) where at the median of total wRVU production coming from structural heart procedures is just 10%. What we do know from the data is that physicians who perform structural heart procedures have earnings similar to their interventional colleagues but generate fewer wRVUs.

Advanced Imaging Cardiologists: Another Growing Subspecialty 

The 2022 data reveals another diverse group: the growing subspecialty of advanced imaging cardiologists who perform cardiac PET, cardiac CTA and cardiac MRI. Physicians generating only 9% of their annual total wRVUs from advanced imaging interpretations can rank among the top 10% of all cardiologists involved in advanced imaging procedures. Curiously, this top decile also includes physicians whose advanced imaging services make up over half of their total annual wRVUs - so a range from 9% to over half. This highlights the considerable variation within the group.

Drilling deeper, those in the upper half of advanced imaging production reported median total wRVU production of 9,742 per full-time physician, while those in the lower half showed a median of 11,312 total wRVUs per full-time physician, representing an inverse relationship between the focus on advanced imaging and total wRVU production. This contrast is emphasized in the context of total compensation. Physicians in the upper half of advanced imaging production earned a median of $478,001 per full-time cardiologist, while those in the lower half earned $638,577.

APP Subspecialization

Along with the rise of APP inclusion on care teams within cardiology programs – from a median of 0.50 APP FTEs per physician in 2018 to 0.62 APP FTEs in 2022 – has been the increase in subspecialization amongst APPs. While the majority of APPs fall within the general cardiology category, APPs tend to specialize based on the subspecialty of the cardiologists with whom they work, and MedAxiom data show an increase in the number of APPs working in EP and HF. What’s also interesting is that the APP to physician ratios for these subspecialties are higher than the norm for cardiology as a whole. Compared to the 0.62 ratio just mentioned, the median APP to physician ratio for EP APPs working with EP physicians is 0.80 and for HF it is 1:1.  The distinct role of the APP on the cardiovascular care team will be the focus of the 2023 Cardiovascular APP Compensation and Utilization Report, which will be published toward the end of 2023.

Data to Drive Your Practice

Discerning a pattern of deep subspecialization in cardiology would not be possible without the power of MedAxcess, the cardiovascular industry’s leading business intelligence application and proprietary database. This resource will undergo enhancements in the coming year to make the user interface easier for leaders to drill down into the data for “like” comparisons to propel their practices forward. You can learn more about how to submit data and use MedAxcess through your member services representative (Membership@medaxiom.com) or by contacting our Care Transformation Services team (CareTransformationServices@MedAxiom.com).