Specialty Profile

Cardiology GENERAL INFORMATION (Source: Pathway Evaluation Program and RCPSC) The study and practice of cardiology involves a wide range of patient care activities including: basic physical examinations; preventive health; and the diagnosis and management of cardiovascular disease through non-invasive treatment modalities or sophisticated interventions. They often see patients in a consultative role but most of their patient involvement is long-term and ongoing. Cardiologists are highly specialized practitioners in a dynamic field who place a premium on mastery and competence. They use their hands for invasive procedures and other manual tasks, but they also apply cognitive skills to the physical exam and other diagnostic procedures. Their daily tasks are diverse. With the pace of new developments (both in medical technology and in broader treatment trends), a high level of challenge and diversity, as well as significant intellectual demands are associated with this specialty. Cardiologists are expected to act as consultants in cardiovascular disease to all branches of medicine and pediatrics. They must be proficient in the management of acute coronary care problems, participate in the medical and surgical therapy of coronary artery disease and deal with the pre- and post-operative evaluation of cardiac surgical cases. This specialist must deal with cardiovascular problems associated with hypertensive, rheumatic and congenital heart disease and with cardiomyopathies. A physician may choose if they will specialize in adult or pediatric cardiology. Upon completion of medical school, to become certified in adult cardiology requires an additional 6-7 years of RCPSC-approved residency training. This training includes:

• RCPSC certification in internal medicine (4 years) • 3 years of RCPSC-approved adult cardiology training that must include rotations

in: a clinical residency (acute cardiac care, clinical cardiology, including cardiology CTU and consultation); ambulatory cardiology (may be done longitudinally); pediatric cardiology (which may include adult and congenital heart disease); and a laboratory-based residency (cardiac catheterization, echocardiography, electrophysiology/pacemaker, ECG/ambulatory ECG monitoring/exercise stress testing, nuclear cardiology and an additional elective)

• research (clinical and/or basic) For more detailed training requirements for adult cardiology go to: http://rcpsc.medical.org/residency/certification/training/cardadu_e.html Pediatric cardiology is the branch of medicine concerned with the study of congenital and acquired heart disease in the fetus, newborn, child and young adult. Upon completion of medical school, to become certified in pediatric cardiology requires an additional 6-7 years of RCPSC-approved residency training. This training includes:

• RCPSC certification in pediatrics (4 years) • 3 years of RCPSC-approved pediatric cardiology training that must include

rotations in: ambulatory (out-patient cardiology); pediatric cardiac intensive care unit; clinical cardiology (involving the clinical care of children of all ages with

heart disease); adult cardiology (including adult congenital heart disease); clinical laboratory training which must include: cardiac catheterization; echocardiography; electrophysiology (pacemaker; electrocardiography); cardiac pathology; and additional approved training, which may include basic or clinical research and electives.

For more detailed training requirements for pediatric cardiology go to: http://rcpsc.medical.org/residency/certification/training/cardpeds_e.html There are currently 1,078 cardiologists practicing in Canada. Of these, 5% are under the age of 35, 61% are 35-54 and 33% are 55 and older. Most practicing cardiologists are male (84%) and 16% are female. (Source: 2008 CMA Masterfile). DETAILED INFORMATION The remainder of the data contained in this specialty profile has been extracted from the 2007 National Physician Survey (NPS), unless otherwise stated. All percentages are for respondents only. A total of 221 cardiologists responded (for a response rate of 23%). Complete data tables for cardiology from the 2007 NPS are available at: http://www.nationalphysiciansurvey.ca/nps/2007_Survey/Results/physician3.2_sp-e.asp For an index to all specialties, go to: http://www.nationalphysiciansurvey.ca/nps/2007_Survey/2007results-e.asp Choosing cardiology (2004 NPS Data) In 2004, more than half of cardiologists (53%) reported that they decided on this specialty as a career choice during their residency, while many others (21%) during their clerkship year (i.e., the last year of medical school). The most frequently cited reason for deciding to become a cardiologist was for the intellectual stimulation/challenge this specialty provides (88%). Also cited as factors were the quality of the doctor-patient relationship (56%) and the influence of a mentor (50%). From these factors, intellectual stimulation/challenge was identified as the single most important career decision-making factor (58%). Practice Setting For most cardiologists (60%) the main work setting is an academic health sciences centre, while 58% work mainly in a private office/clinic, 34% are in a community hospital and 34% work in a university/faculty of medicine. Cardiologists see patients in a variety of settings, with academic health science centres being the main patient care setting for about half (49%), followed by a private office/clinic (27%). Liking the area was the major influence (59%) on cardiologists’ selection of their current practice location, but the availability of a medical support system/resources (52%), the

availability of a practice opportunity (45%) and the opportunity for affiliation with a university (43%) were also cited as important influences. Practice Profile More than half of cardiologists (51%) work in a group practice where on-call duties, equipment, office space and/or staff are shared amongst the physicians, while 31% are in a solo practice and 17% work in an interprofessional practice setting where physicians and other health professionals have their own caseloads. In their main patient care setting, 77% of cardiologists share patient care with many other types of health care providers, including:

• family physicians (94%) • nurses (70%); • pharmacists (66%);

Nearly all cardiologists (97%) feel that this collaboration improves the care that their patients receive and 96% feel it enhances the care that they can deliver. During a typical week, a cardiologist will see approximately 63 patients. The majority of cardiologists (63%) serve mainly an urban/suburban population. Cardiologists work an average of 58 hours per week on professional activities (excluding on-call). The majority of this time (36 hours per week) is devoted to direct patient care, with or without a teaching component. An additional 6 hours per week is spent on indirect patient care, such as making appointments with specialists, charting, meeting a patient’s family, etc. The remainder of the time is spent on CME/CPD, research and/or teaching. Most cardiologists (80%) make themselves available to their patients (i.e., on-call) outside of their regularly scheduled hours. Because of the nature and primary location of their practice, the majority of cardiologists (98%) provide on-call for hospital in-patients, but a fair number of cardiologists (67%) also provide emergency room on-call, while 35% make themselves available to non-hospitalized patients either by telephone or seeing the patient if required. Of those who do on-call, the majority (71%) tend to spend up to 120 hours per month on-call for their patients, while 13% put in between 121 and 180 hours per month and 10% spend more than 180 hours per month on-call. On average, a cardiologist spends 107 hours per month on-call. During the time that cardiologists are on-call each month, they spend an average of 43 hours on direct patient care and see an average of 50 patients. Income The majority of cardiologists (68%) receive 90+% of their income from fee-for-service and 19% receive 90% or more through a blended source (i.e., made up of a combination of 2 or more payment methods like fee-for-service, salary, capitation, sessional, contract, benefits/pensions, on-call remuneration or some other form). When asked their preferred method of remuneration, the majority (54%) of cardiologists prefer some form of blended remuneration, while 32% would prefer fee-for-service only.

According to the Canadian Institute for Health Information’s Average Gross Fee-for-Service Payment Report 2005-2006, the average gross fee-for-service payment per internist (of which cardiology is a subspecialty) in 2005-06 was $297,563. Note that this is gross billings and does not take into account deductions for overhead expenses, taxes, etc. To protect their income, physicians take out medical liability coverage in the event that a patient is harmed in a medical misadventure. According to The Canadian Medical Protective Association’s Fee Schedule for 2009, the annual cost for insurance for a cardiologist is:

Quebec Ontario Rest of Canada $ 4,029 $ 4,884 $ 1,968

Satisfaction Most cardiologists (79%) report that they are very or somewhat satisfied with their current professional life. Nearly all (91%) are very or somewhat satisfied with their relationship with their patients, their relationship with other specialist physicians (83%) and with their relationship with family physicians (82%). Cardiologists are less likely to be very or somewhat satisfied with finding a balance between personal and professional commitments (56%), with their net revenue per hour compared to other cardiologists (61%) and with their net revenue per hour compared to other specialists (54%). ADDITIONAL INFORMATION Additional information on this specialty can be found from the: Canadian Cardiovascular Society: http://www.ccs.ca/home/index_e.aspx