Electrophysiology is one of the fastest-growing subspecialties, but workforce pipelines are not keeping up with demand, hospital leaders told Becker’s.
Like many specialties, there are a limited number of fellowship training positions, but the electrophysiology fellowship also was extended from one to two years in 2017, deterring some candidates from pursuing it due to the added training time and medical school debt associated with it. The American College of Cardiology has piloted a “two plus two” model in which trainees complete two years of general cardiology fellowship followed by two years of EP, for a total of four years instead of five, but that is available at only about 20 programs right now, Paari Dominic, MD, director of electrophysiology at Iowa City, Iowa-based UI Health, told Becker’s.
Despite this, the specialty is seeing growth “unlike anything I’ve seen before,” Usha Tedrow, MD, director of fellowship and the Clinical Cardiac EP Program at Boston-based Brigham and Women’s Hospital, told Becker’s. Around 2015, it was difficult to find both academic and private practice jobs in EP, but now there are more opportunities.
“I have colleagues my age in other specialties who say, ‘If I had to do it again, I’d do electrophysiology,’ that’s how exciting the direction of the field is,” Dr. Tedrow said. “Attracting people isn’t that hard at the moment.”
This is partially due to procedural specialties being considered somewhat immune to AI disruptions, growing procedural technology and techniques, and an increased need for minimally invasive procedures.
Although there is growing demand for EP physicians, most hospitals and systems are still finding it difficult to attract physicians, nurses and APPs in the field.
Four leaders connected with Becker’s to discuss which recruitment strategies are working.
Note: Responses have been lightly edited for length and clarity.
Paari Dominic, MD. Director of Electrophysiology at UI Health (Iowa City): Recruiting a dedicated EP is probably the most difficult task right now for most institutions, including ours to some extent, and several factors are at play.
Location is one. We’re a large institution — 900 beds at our main hospital, plus a second and now a third campus — but we’re in a smaller city. The nearest major cities are Chicago at about three hours, Minneapolis and Kansas City at four hours. That’s a disadvantage when we’re competing for people who want to live in larger urban areas. Pay scale is another factor. As an academic institution, we’re not in a position to match what some private practices offer. There are organizations in our state offering $300,000 to $400,000 more than we can.
So we recruit on different values. One is a passion for education — we’re a training institution, and we attract people who genuinely want to train the next generation of physicians. Another is research. We do a significant amount of investigator-initiated and collaborative research, and that draws people who are passionate about publishing and advancing the field. We’re also a tertiary and quaternary referral center serving roughly a 300-mile radius, which means our faculty are working on some of the most complex cases in the region. If you’re a junior faculty member here, you develop a skill set you simply couldn’t build in most private practice settings, with senior faculty available to guide you on the difficult cases.
Work-life balance has also been a significant asset in recruitment. Because we’ve built the lab to run efficiently — start on time, end by 5:30 — our faculty go home at a reasonable hour without sacrificing case volume or productivity. They’re still doing enough cases to maintain their skills and meet productivity expectations, but they’re not sacrificing their personal lives to do it.
Olivia Fleming, MSN, RN. Corporate Vice President of Cardiovascular Service Line at LCMC Health (New Orleans): Recruiting electrophysiologists is highly competitive nationwide. Physicians are evaluating opportunities based on program maturity, access to advanced technology and research opportunities. Our recruitment strategy emphasizes investment in state-of-the-art technology, dedicated procedural time, multidisciplinary collaboration, APP support, and opportunities to participate in clinical research thanks to our academic partners LSU Health and Tulane School of Medicine.
At the same time, the bigger challenge is often the broader care team. Experienced EP nurses, technologists and APPs are in short supply, and building those teams takes ongoing investment in training, development and retention. That’s where we’re continuing to focus.
Jessica Hennessey, MD, PhD. Assistant Professor of Medicine at Columbia University Vagelos College of Physicians and Surgeons (New York City): In the New York metropolitan area we benefit from a relatively strong pool of highly trained EP physicians. Because of that, our focus is often on retention of staff. We need to make sure our physicians feel supported, engaged and able to build the kind of career they want here.
That starts with understanding what matters most to each individual physician. This is especially important in academic institutions. For some, that may mean research opportunities. For others, it may be the right balance of procedural time and clinical practice, or the ability to work across multiple sites in a way that aligns with their interests and strengths. We try to be thoughtful about creating an environment where electrophysiologists can grow professionally and build successful programs.
One of the biggest needs we see is in support infrastructure, specifically advanced practice providers, including nurse practitioners and physician assistants, as well as administrative and clinical support staff. As volumes continue to increase, those roles become even more essential.
Jeffrey Robinson, MD. Medical Director of the Pediatric Cardiac Electrophysiology and Cardiology at Children’s Nebraska (Omaha): We’re fortunate. We’re a freestanding children’s hospital with three pediatric electrophysiologists, and from what I can see in the market, fellows coming out of pediatric EP training have generally been able to find positions. That hasn’t been a significant issue recently.
That said, the number of training programs for pediatric electrophysiology is relatively small. In North America, roughly 10 fellows are trained in pediatric cardiology annually. I think that has been intentional in many ways — to protect the workforce and avoid overtraining people in a subspecialty where the patient population is finite.
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