Over the past decade, employment trends for cardiologists have changed significantly. Today, approximately 85% of cardiologists work for hospitals or health systems—an increase from 40% a decade ago and a dramatic jump from 10% when many current practitioners began their careers. This shift has reshaped cardiovascular medicine and raises pressing questions about physician autonomy, patient care, and the financial sustainability of independent practices.

Why Are So Many Cardiologists Moving to Hospital Employment?

Several factors have contributed to this trend, making independent practice increasingly difficult:

• Financial Pressures: Higher overhead costs, declining reimbursements, and increased labor expenses have made private practice harder to maintain.
• Technological Challenges: Implementing and managing new medical technologies requires significant investment, making it difficult for smaller practices to compete with larger institutions.
• Regulatory Burdens: The growing complexity of compliance and reimbursement models has added another layer of difficulty for independent physicians.
• Operational Demands: Administrative tasks such as billing, contract negotiations, and compliance management take time away from patient care, contributing to burnout.

Faced with these obstacles, many cardiologists see hospital employment as a way to ensure financial stability and reduce administrative responsibilities. However, this transition often comes with reduced clinical autonomy, increased oversight, and protocols that may prioritize efficiency over individualized patient care.

The Deficit Reduction Act: A Turning Point for Independent Cardiology

A significant moment in the decline of independent cardiology came with the Deficit Reduction Act of 2005, which was implemented in 2007. This legislation cut office-based cardiac imaging reimbursements by approximately 20% and eliminated consultation codes, replacing them with Evaluation and Management (E&M) codes. Commercial payors quickly adopted these cuts, significantly reducing the profitability of private cardiology practices.

While the goal was to reduce overutilization, the result was different: independent cardiologists—who were already practicing conservative resource utilization—were disproportionately affected. This financial strain forced many to merge with or be acquired by larger health systems, accelerating the movement toward consolidation.

The Cost of Hospital-Based Employment in Cardiology

While hospital employment may offer stability, the consolidation of private practices into larger systems has not been shown to improve patient care outcomes. Research suggests that hospital-employed cardiologists generate higher costs for patients and the healthcare system. Some estimates indicate that consolidation can double the total cost of care, without clear improvements in quality.

Additionally, the decline of independent cardiology practices impacts the profession itself. Early-career cardiologists are overwhelmingly choosing hospital employment, meaning fewer physicians gain experience in running an independent practice. Without mentorship from established independent cardiologists, future generations may lack the knowledge needed to sustain private practices, reducing choices for both physicians and patients.

Supporting Independent Practice

Despite these challenges, independent cardiology remains essential for ensuring physician autonomy, patient-centered care, and cost-effective healthcare. To support private practice, healthcare leaders and policymakers should consider:

• Financial Incentives: Reimbursement structures that allow independent practices to remain competitive.
• Regulatory Adjustments: Reducing unnecessary administrative burdens that make private practice more difficult.
• Alternative Practice Models: Exploring new ways to sustain independent physicians, such as value-based care arrangements and strategic partnerships.

Atria Health: A New Path Forward

At Atria Health, we believe cardiologists should have the ability to practice independently and successfully. By providing capital, technology, and strategic expertise, we help cardiologists regain control over their work and build sustainable, physician-led practices. Our approach is designed to remove barriers so independent cardiologists can compete, innovate, and focus on delivering high-quality patient care.

The direction of cardiology should not be dictated solely by consolidation. Instead, there should be a healthcare system where independent physicians have the support they need to succeed. Now is the time to take action—because the best care happens when physicians lead.

Looking to regain control over your practice? Contact Atria Health today to explore how we can support your professional goals and the future of your practice.

‍