Cardiovascular disease remains the leading cause of death in the U.S., but the workforce charged with treating it is aging, growing too slowly to keep pace with the population and leaning more heavily on international medical graduates to fill gaps left by U.S. training programs, according to a study published Aug. 19 in JACC: Advances.
Researchers analyzed American Medical Association Physician Masterfile data for 10 reporting years between 2005 and 2023 to track how the U.S. cardiology workforce has shifted in size, age, sex and training background. The findings, part of a brief report titled “Who Will Care for the Heart?: Structural Changes in the U.S. Cardiology Workforce, 2005-2023,” add new evidence to warnings cardiology leaders have raised for years about a looming shortage.
Here are 8 findings from the study.
1. Cardiologist density is falling, even as raw numbers grow. The number of active cardiologists in the U.S. increased modestly, from 21,117 in 2005 to 22,843 in 2023. But population growth outpaced that gain, so the number of cardiologists per 100,000 Americans declined over the same period, from about 7.10 to 6.78.
2. The decline accelerated after 2013. Using a statistical model anchored to the Affordable Care Act’s graduate medical education expansion, researchers found the rate of decline in cardiologists per 100,000 population steepened after 2013 — suggesting the GME expansion did not reverse the downward trend.
3. Nearly two-thirds of cardiologists are now 55 or older. The share of cardiologists age 55 and up climbed from about 37% in 2005 to nearly 65% by 2021, flipping the field from a younger-skewing workforce to one nearing retirement age.
4. The pipeline meant to replace them has stalled. The ratio of younger to older cardiologists shifted from youth predominance toward near-equilibrium, and the study’s authors warn the training pipeline may not be big enough to absorb the coming wave of retirements.
5. National projections point to a shortfall of about 7,900 cardiologists by 2036. That means every additional retirement now represents an outsize loss of clinical capacity, according to projections cited in the study.
6. Women still make up less than 17% of the field. Female representation grew from 9% in 2005 to 16.7% in 2023 — real progress, but slow. At that pace, the study’s authors project women won’t reach a quarter of the cardiology workforce until around 2040. The male-to-female ratio narrowed from 10.1-to-1 to 5-to-1 over the study period.
7. International medical graduates are increasingly propping up the workforce. IMGs grew from 28% to 32.3% of practicing cardiologists, even as the share of U.S. allopathic medical graduates fell from 68% to 63.4% — a shift the authors say makes visa and GME funding policy directly relevant to workforce adequacy.
8. Osteopathic physicians remain a small — and the slowest-growing — share of cardiologists. Doctors of osteopathic medicine reached just 4.3% of the workforce by 2023, growing more slowly than any other training pathway tracked in the study.
The study relies on headcount data from the AMA Physician Masterfile, which doesn’t capture clinical full-time status, patient volume or hours worked — meaning actual strain on cardiology capacity could be worse than the topline numbers suggest. The authors also did not examine geographic or subspecialty variation, which they flagged as an area for future research.
To offset the shortage, the study’s authors called for expanding fellowship training positions, reducing barriers for underrepresented groups entering cardiology, sustaining policy support for international medical graduates, and integrating more advanced practice providers, primary care physicians and pharmacists into cardiovascular care. They cited prior research finding no difference in the quality of outpatient care delivered by advanced practice providers compared with cardiologists.
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