Electrophysiology is the fastest-growing subspecialty in cardiology, and hospitals and ASCs are each racing to expand capacity for it.
But the physicians who perform ablations, implant devices and manage the heart’s electrical system are in short supply — and that shortage, more than reimbursement policy or square footage, may decide who captures the specialty’s shift outpatient.
“We’ve never been in this moment in electrophysiology before,” Usha Tedrow, MD, director of fellowship and the Clinical Cardiac Electrophysiology Program at Boston-based Brigham and Women’s Hospital, told Becker’s in the same report. “We’ve never had such a clear solution to a problem that so many people have. This is happening all over the world.”
CMS has approved electrophysiology ablation procedures for the ASC setting, positioning the subspecialty for the kind of site-of-care migration interventional cardiology underwent after CMS expanded ASC coverage for cardiac catheterization and percutaneous coronary intervention in 2020.
The number of single-specialty cardiology ASCs grew from 55 to 221 between 2018 and 2023, and cardiovascular procedure volume in ASCs is projected to grow another 15% between 2023 and 2028. Cardiac catheterization currently accounts for just 0.2% of ASC procedure volume, compared with 18% for cataract surgery — the closest available model for what a fully matured site-of-care shift can look like at scale.
“We’re seeing a move toward utilizing electrophysiology procedures, including ablation and insertion of some devices, in freestanding centers,” Richard Chazal, MD, medical director of heart health at Lee Heart Institute in Fort Myers, Fla., told Becker’s. “Some of these procedures have matured to the point where many of these can, and perhaps should be, done in these lower-cost, efficient outpatient centers that can provide really good care.”
That growth assumes a workforce that doesn’t currently exist at scale. Only 2,847 cardiac electrophysiologists practice in the U.S., out of roughly 35,700 cardiologists overall, according to a Medicus white paper. The broader cardiologist workforce is projected to become less adequate, not more, as demand accelerates: a study published in the Journal of the American Heart Association found supply will grow just 2% between 2025 and 2037, from 37,000 to 37,730 cardiologists, while demand grows 15.7%. That gap is projected to push overall workforce adequacy down from 92.2% in 2025 to 81.4% by 2037. A separate, earlier analysis projected a shortfall of 8,650 cardiologists by that same year.
Electrophysiology is already one of the hardest cardiology subspecialties for health systems to recruit. Leaders at Chillicothe, Ohio-based Adena Medical Group told Becker’s they’re having similar difficulty filling noninvasive cardiology and electrophysiology roles as they described for other subspecialized fields.
“Take urology — we certainly have the volume for general urologic services, but a lot of urologists coming out of training are not general urologists willing to take hospital call,” Brooke Burns, president of Adena Medical Group, said, describing the broader recruiting challenge that leaders say extends to electrophysiology. “They’re subspecialized, and that makes recruitment really challenging.”
Hospitals aren’t ceding the outpatient shift by default, either. So far in 2026, Jonesboro, Ark.-based St. Bernards Healthcare opened a new outpatient interventional cardiac, vascular and electrophysiology lab; Winston-Salem, N.C.-based Novant Health is adding a cardiac catheterization lab to a campus expansion; Tacoma, Wash.-based MultiCare Health System is renovating two cath suites as part of a $15 million investment; and Washington, Mo.-based Mercy opened an expanded catheterization lab, according to Becker’s tracking of 2026 cath lab projects.
ASCs are moving just as fast: ChristianaCare and Cardiovascular Physicians of Delaware formed a joint venture for a new cardiovascular ASC in Newark, Del., and Compass Surgical Partners opened a cardiovascular ASC in Panama City, Fla. Hospitals and ASCs are underwriting new capacity for the same subspecialty at the same time, drawing from the same small, hard-to-recruit pool of physicians to staff it. Outfitting a single cardiovascular ASC procedure room can cost more than $1.5 million, and about half of states still have certificate-of-need laws restricting complex cardiac interventions — real constraints, but ones that capital and time can eventually work around. A physician who spent a decade training in cardiac electrophysiology cannot be produced on the same timeline.
Some physicians are responding by building their own access points. Amanda Ryan, DO, an interventional cardiologist and CEO of Advanced Heart and Vascular Center of New Mexico in Carlsbad, N.M., brought electrophysiology services in-house in 2025 after patients had been traveling three to four hours for care, training for six months to offer atrial fibrillation and heart failure procedures herself.
“In the peripheral vascular and EP space, the revenue numbers can look high, but the costs are substantial,” Dr. Ryan told Becker’s. “You can find yourself in the negative on a case quickly if anything goes beyond routine. Even with standard equipment, you’re looking at profit margins around 15%, which is workable, but slim.”
For hospitals and ASCs alike, the site-of-care question that has dominated the electrophysiology conversation may increasingly give way to a talent question. Whichever one can recruit and retain the physicians to deliver that care — rather than whichever one builds the most square footage — may determine how much of the coming volume it actually captures.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.