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Personal and Professional Characteristics of U.S. Dual-Boarded Critical Care Cardiologists in 2015

Blumenthal, Daniel M. MD, MBA1; Mikhael, Bassem MD, MBA2; Lawler, Patrick R. MD, MPH3; Yeh, Robert W. MD, MSc4; Metlay, Joshua P. MD, PhD2; Dudzinski, David M. MD, JD1

doi: 10.1097/CCM.0000000000002766
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Objectives: Evaluate the characteristics of U.S. physicians who are board certified in cardiology and critical care medicine (“dual-boarded cardiologists”).

Design: Retrospective cross-sectional study using a comprehensive database of licensed U.S. physicians linked to Medicare claims.

Setting: The United States.

Subjects: Dual-boarded cardiologists.

Measurements and Main Results: We used a comprehensive physician database to identify all physicians who were board certified in cardiology and critical care medicine before July 2015. We assessed physicians’ characteristics and compared dual-boarded cardiologists with and without active board certification in critical care medicine and estimated the maximum proportion of 2014 Medicare Cardiac ICU admissions treated by dual-boarded cardiologists. Among 473 dual-boarded cardiologists, 16 (3.4%) were women; 468 (99%) and 85 (18%) maintained active board certification in cardiology and critical care medicine, respectively. Overall, 98 dual-boarded cardiologists (21%) submitted 1,215 total claims for critical care services in 2014. Compared to dual-boarded cardiologists without active board certification in critical care medicine, those with active certification had more publications (median publications: 6.5 vs 3.0; p = 0.002), were more likely to be professors (22.3% vs 9.5%; p = 0.003), and were more likely to bill Medicare for critical care services (29% vs 17.8%; p = 0.002). We estimated that no more than 0.47% of all 2014 Medicare Cardiac ICU admissions were treated by a dual-boarded cardiologist.

Conclusions: Dual-boarded cardiologists appear to deliver a small proportion of all Cardiac ICU services received by Medicare beneficiaries. Optimizing the modern Cardiac ICU workforce will require greater efforts to promote and support the training of dual-boarded cardiologists.

1Division of Cardiology, Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA.

2Department of Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA.

3Division of Cardiology, Department of Medicine, University of Toronto School of Medicine, Toronto, ON, Canada.

4Susan A. and Richard F. Smith Center for Outcomes Research in Cardiology, and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA.

Drs. Blumenthal, Lawler, and Dudzinski contributed in conception and design; Drs. Blumenthal, Mikhael, Lawler, and Dudzinski contributed in analysis and interpretation; and Drs. Blumenthal, Mikhael, Lawler, Yeh, Metlay, and Dudzinski contributed in drafting the article for important intellectual content.

Dr. Blumenthal received funding from the John S. LaDue Memorial Fellowship at Harvard Medical School. Dr. Lawler received funding from the National Institutes of Health. Dr. Yeh’s institution received funding from Abiomed, and he received funding for consulting from Abbott Vascular and Boston Scientific. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: dblumenthal1@partners.org

Copyright © 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.