Profile The following information reflects responses from 59 cardiologists who completed the 2003 Pathway Physician's Survey.

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1 CARDIOLOGY Cardiology is a board-certified subspecialty of internal medicine concerned with diseases of the heart, lungs and blood vessels. Cardiology involves the prevention, diagnosis, and management of disorders of the cardiovascular system, including ischemic heart disease, cardiac dysrhythmias, cardiomyopathies, valvular heart disease, pericarditis and myocarditis, endocarditis, congenital heart disease in adults, hypertension, and disorders of the veins, arteries, and pulmonary circulation. Management of risk factors for disease and early diagnosis and intervention for established disease are elements of the specialty. The specialty is relatively high-tech in its approach to diagnosis and treatment and is also on the cutting edge in preventive health and noninvasive treatment modalities. Two areas of specialization include interventional cardiology, the discipline responsible for catheter-based interventions in the management of ischemic heart disease, congenital heart disease, and acquired valvular disease; and clinical electrophysiology, the discipline that manages complex cardiac arrhythmias with the use of implantable pacemakers and cardioverter defibrillators, as well as the application of other interventional techniques and treatments. Cardiologists deal primarily with adults, many of whom are elderly. They manage complex cardiac conditions such as heart attacks and arrhythmias, perform complicated diagnostic procedures, and consult with surgeons on heart surgery. The practice involves a wide scope of patient care activities, ranging from basic physical exams to sophisticated interventions in lifeand-death emergencies. 1

2 Profile The following information reflects responses from 59 cardiologists who completed the 2003 Pathway Physician's Survey. A. Respondents by types of areas Rural 11.86% Large City 13.56% B. Respondents by gender Female 8.62% Small City 35.59% Metropolitan City 38.98% Male 91.38% C. Respondents by years in practice Number of Responses yrs 6-10 yrs yrs yrs yrs More than 30 yrs Perspectives A. Respondents' satisfaction with current specialty/area of work Number of Responses satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied dissatisfied

3 B. Would you choose this specialty again? Not Sure 3.45% No 5.17% Yes 91.38% C. Respondents by practice environment Number of Responses Academic instution Affiliated w/group Business/industry Hospital Community Acdemic med ctr Hospital other Managed care HMO IPA PPO Mgr care other Solo practitioner Practice other D. Respondents' satisfaction with practice environment Number of Responses satisfied Somewhat satisfied Neither statisfied nor dissatisfied Somewhat dissatisfied dissatisfied

4 and of Critical Factors Critical Factors represent significant aspects of physicians experiences in their practices. The rating represents their assessment of their current practice characteristics, while the weighting represents the importance of each factor to physicians. A. Caring for patients: How much time do you spend directly seeing and caring for patients? 8.3 σ = 1.81 No time at all Most of my time σ = B. Continuity of care: How much continuity of care do you have with patients, (i.e., the length of patient relationships)? σ = Short Term Long Term σ = C. Autonomy: To what extent do you have the final word on the treatment of your patients? σ = limited autonomy Great deal of autonomy σ =

5 D. Diversity: How much routine (similar work) or diversity (different tasks/activities) is involved in your work? σ = Great deal of routine Great deal of diversity σ = E. Personal time: Does your work allow you to control the scheduling and amount of time you spend on personal activities, (i.e., family, leisure)? σ = little flexibility A great deal of flexibility σ = F. Expertise: How broad is the scope of your work? σ = Narrow expertise Broad Expertise σ =

6 G. Income satisfaction: Compared to all physicians, do you feel you are fairly compensated for the amount of time and effort you spend? σ = dissatisfied Highly satisfied σ = H. Creativity: To what extent does your work provide opportunity for creativity? σ = Little opportunity Great deal of opportunity σ = I. Certainty of outcomes: How much certainty of clinical outcomes does your work provide? σ = little, often "wait and see" A great deal, outcomes usually clear σ =

7 J. Clinical decision-making: On what basis are your clinical decisions made? σ = Application of theory to a situation Based on prior evidence of clinical outcomes σ = K. Patient decision-making: To what extent do your patients have input into decisions about their health care? σ = Little opportunity Great deal of opportunity σ = L. Interacting with other physicians/members of health-care team: To what extent does your work provide opportunities for you to interact with other physicians/ members of a health-care team? σ = little A great deal σ =

8 M. Manual/mechanical activities: How often do you use manual/mechanical activities for highly skilled tasks (i.e., following procedures, performing operations)? σ = Never Most of the time σ = N. Pressure: How much pressure do you have in your work (i.e., dealing with clinical crises, need for immediate decisions about patients, dealing with multiple patients simultaneously). σ = Minimal pressure High pressure σ = O. Responsibility: How much responsibility do you assume for patient outcomes in your work? σ = Limited responsibility Sole responsibility σ =

9 P. Schedule: What type of schedule do you have in your work? σ = Regular hours Irregular and unpredictable hours σ = Q. Security: How much professional security do you have in your position, (i.e., know where you stand and are certain of your future professionally, will there be a need for your services in the future)? σ = Little security Great deal of security σ = R. Sense of accomplishment: To what extent does your work provide the opportunity to see end results? σ = Little opportunity Great deal of opportunity σ =

10 Weekly distribution of time According to the survey, cardiologists spend their week as follows: Activity Patient care activities On-call(in contact) On-call(available) Administrative Professional travel Continuing education Community service Research Other professional Average Hours per week (may overlap) Patient profile A. Patient encounters per week Number of Patients Ambulatory Inpatient Nursing Home Telelphone Terminally Ill Other Encounters B. Patient characteristics By age Infants(0-2 yrs) Children(3-18 yrs) Adults(19-64 yrs) Older adults(65+ yrs) By race Underrepresented minority (URM) Non-URM % % By type of insurance % Medicaid/Medicare Uninsured Other Percentage of patient encounters that deal with: % Routine check-ups Acute illness Chronic illness Terminal illness 6.31 Percentage of time per patient encounter devoted to: Acute conditions Chronic conditions Preventitive health % C. Five types of illnesses/conditions most frequently encountered Number of responses Coronary artery disease/angina 49 Congestive heart disease 48 Hypertension 46 Arrythmias 32 Hyperlipidemias 30

11 Specialty: Cardiology Total survey responses: 59 Summary of comments for question: List up to three other factors, if any, you would advise students to consider carefully before selecting your specialty? Physicians who completed the Pathway Physician s Survey, 2003, submitted the following comments. The majority of comments are categorized by the Critical Factors that are rated and weighted in another section. Numbers in parentheses indicate the total number of responses for a particular comment. 1. Caring for Patients Provide excellent care Respect your patients Importance of personal contact Listen to patient carefully Like patient care 2. Continuity of Care 3. Autonomy Less autonomy 4. Diversity Ever changing 5. Personal Time Lifestyle (5) Time away from family/home taking care of patients (2) Personal time Denial of personal life Effect on family life (2) Ready to make personal and family sacrifices, not look for financial rewards 6. Expertise Need to like science and mystery Cardiology is developing into a very sub-specialized field with narrow focus for individual cardiologists Advancement in technology, non static specialty Dilution of specialty by general internal medicine work Referral specialty 7. Income Satisfaction Decreasing income/reimbursement (3) Income satisfaction leads to better sense of self worth, less anger with medicine and less pressure

12 as financial needs increase with a family Relative importance of income versus personal time and stress level Future compensation likely to change adversely 8. Creativity 9. Certainty of Outcomes Ability to accept poor outcomes 10. Clinical Decision Making Incorporating many pieces of data/tests in decision-making 11. Patient Decision Making 12. Interacting with Other Physicians/Members of Health-care Team Quality of partners 13. Manual /Mechanical Activities 14. Pressure Accept pressure Overwhelming work demands Ability to handle rapidly evolving crisis Great reward but hard work (2) Ready to accept stress and carry out rules, regulations of hospital, state, and federal 15. Responsibility Ability to assume responsibility in jointly managed patients Accept final responsibility for patient care 16. Schedule Time commitment (8) Not a fixed schedule of time off Schedule/time/busy/lengthy hours (4) Willingness to work hard with long hours and call (2) Schedule demands, many late nights, holidays, and weekends (2) Call schedule/ night time call (2) Accept off-hour emergencies easily 17. Security Job Availability/Competition (2) 18. Sense of Accomplishment

13 19. Patient Characteristics 20. Types of Illnesses Do you like dealing with the chronic diseases mot prevalent in the specialty 21. Practice Environment Need for cardiology specialist in desired location of practice Malpractice (2) Insurance reimbursement Availability of work in desired geographical area Location of practice (2) 22. Health Care Environment 23. Personality/Temperament Willingness to teach (2) Don t be arrogant Curiosity Energy level Be a good listener Pride Self motivation Aptitude Practice style Motivation for being a physician Surgical mentality Willingness to work hard Dedication to the work (2) Endurance Being open minded, looking to the person not to the disease Love for patient contact 24. Miscellaneous Comments Practice style Surgical mentality Continuing education Enjoyment/satisfaction of job (5) Years of residency/length of training (4) Interests (3) Competition Academic affiliation Emergencies

14 Vocation Type of call Do not ever assume anything Fun Need flexible spouse Will you still want to do that in 25 years? What is your goal in life? Age Are you willing to keep learning daily? No hobby Clinical and administrative support