Cardiovascular Manpower The Looming Crisis

Less than 10 years ago, conventional wisdom taughtthat there was an oversupply of specialists in amanaged care environment and that the majority of needs in cardiovascular prevention and care could be pro-vided by generalists. Healthcare planners called for a reduc-tion in specialty training,1–4 and a number of cardiovascular training programs went through a period of downsizing. The demand for subspecialty care has not diminished and, with the continued needs for cardiovascular practitioners in the community and in academic medical centers, most training programs that downsized in the early 1990s have reversed the trend and increased the number of trainees. We agree with others5–7 that despite these changes, the current number of training positions is inadequate to meet the future demand for cardiovascular care and that a manpower crisis is imminent. Manpower needs in the treatment of cardiovascular disease are driven by three fundamental factors, as follows: (1) th