Several cardiology leaders joined Becker’s Oct. 16 at the 31st Annual Business and Operations of ASCs Meeting in Chicago to discuss how health systems and independent groups can recruit and retain top cardiovascular talent — and what cultural, regulatory and workforce dynamics will shape the next decade of growth.
Culture, values and shifting expectations
For large systems, effective recruitment begins with understanding a rapidly changing landscape, said Maan Fares, MD, staff physician in clinical cardiology and chairman of global patient services at Cleveland Clinic.
“Times are changing, and the interest and the value in everything that’s driving people toward cardiology or toward choosing an employment model is really shifting very rapidly,” he said.
The pandemic, he added, accelerated the shift.
He noted that Cleveland Clinic recruits heavily from its own training programs but also leverages its international network, especially Cleveland Clinic Abu Dhabi, where U.S.-trained cardiologists often return stateside for family reasons or career opportunities.
Chicago-based Northwestern Medicine faces similar dynamics, said Jim Flaherty, MD, an interventional cardiologist and associate professor of medicine who serves as medical director of the coronary care unit at Northwestern Memorial Hospital.
Chicago’s metropolitan draw helps entry-level recruitment, but senior-level hiring is more difficult.
“You can run through 10 candidates for one position,” he said. “That’s the bigger challenge.”
Retention, the panelists agreed, hinges on culture far more than dollars — and leadership sets the tone.
“If the leader does not foster the right culture in an organization, then you can kiss that organization goodbye,” Dr. Fares said.
Why cardiologists stay — or leave
Jon George, MD, an interventional cardiologist at Philadelphia-based ReVamp Heart & Vascular Institute, said burnout in hospital settings often stems from misaligned priorities.
“It’s really important to consider the culture and remember the priorities of the physicians that are part of your team,” he said.
Loss of focus on patient care, rising administrative burden and unchecked productivity pressure all contribute to attrition.
He emphasized the importance of personalization in retention. Understanding what each clinician wants, academically, procedurally or lifestyle-wise, is essential for keeping teams intact.
Dr. Flaherty added that academic retention depends on ensuring clear promotion pathways and leadership opportunities.
“You want to avoid frequent massive turnover,” he said, noting the long replacement timelines in cardiology.
ASC expansion and new compensation realities
As cardiovascular care shifts outpatient, systems must evaluate how culture and compensation translate to ASC models. Cleveland Clinic, Dr. Fares said, anticipates running its cardiology ASCs through system ownership, but entering new markets may require more flexible structures.
“We have to be more open-minded,” he said, adding that private-practice physicians may join in hybrid roles that differ from Cleveland Clinic’s traditional employed model.
Dr. George underscored that ASC economics are still evolving. Many general cardiologists cannot yet participate financially in cardiac ASCs because certain procedures, such as transesophageal echocardiogram and cardioversion, are not approved for the setting, but he foresees expansion.
“This is very early,” he said. “I don’t anticipate things staying the way they are right now.”
Workforce pressures and the future of the field
The demand for cardiovascular care continues to rise, but physician supply is not keeping pace. Dr. Flaherty said systems will increasingly rely on advanced practice clinicians.
“The number of physicians really is not rising to a rate that’s going to meet the need,” he said.
Dr. Fares is optimistic that technology, particularly AI, will reduce administrative burden and improve efficiency.
“The introduction of AI has been nothing but transformative for us,” he said.
ASC migration is also affecting the flow of certain cardiology specialties, moving them out of the hospital setting. Electrophysiology and interventional cardiology will likely follow different trajectories, Dr. George noted.
Interventional cardiologists still require significant hospital time for urgent cases, he said.
“If you took that hospital piece of procedures away from me right now, I wouldn’t be happy with my career.”
Recruiting the next generation — especially for ASCs
One audience member asked how independent cardiology groups can recruit early-career talent into ASC-centric practices. Dr. George said trainees’ lack of exposure to independent or ASC models during fellowship contributes to the challenge.
“It took me 15 years to get out into this space,” he said. “Anyone coming out of training has not been exposed to that at all.”
Establishing clear expectations is key, he said. The worst outcome is recruiting a physician who later discovers the environment is a poor fit.
New physicians want to practice the skills they just learned — and strong mentorship, Dr. Flaherty added. Practices that offer both will have a recruiting advantage.
Integration, rotation and maintaining quality
Amid outpatient migration, cardiology needs hybrid practice models that balance ASC efficiency with hospital-level complexity.
Dr. Fares and Dr. Flaherty both stressed the importance of rotating physicians between settings to maintain procedural skills and ensure safety.
“If you only practice in a lower-acuity setting with a healthier patient population, then what do you do when you have surprises?” Dr. Fares said.
They also reiterated that ASC cardiology will remain deeply interconnected with hospitals.
“There’s still a big chunk of cardiology that’s going to be done in the hospital setting,” Dr. Flaherty said.
Looking ahead
Despite persistent workforce challenges, compensation complexities and regulatory limitations, panelists agreed the field’s trajectory is strong.
“Cardiology is super exciting,” Dr. Fares said. “It is ever-changing.”
