← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Atizazul Mansoor, MD, Chair of the Heart and Vascular Institute at UPMC in Central Pennsylvania, and Samir Saba, MD, Professor of Medicine and Chief of Cardiology at the UPMC Heart and Vascular Institute
00:13:40
Loading summary
Transcript19 lines
- [00:01]
A
Welcome everyone to the Becker's Healthcare Cardiology and Heart Surgery podcast. I'm Mariah Taylor, Assistant Editor and I'm thrilled to be speaking with Azaz Mansoon, Chair of Heart and Vascular Institute at UPMC in Central Pennsylvania, and Samir Sabah, Chief of Cardiology and Co Director of UPMC Heart and Vascular Institute. Thank you both so much for joining me today. I'm really excited to hear about how you are using your cardiology workforce to help meet the needs of patients. But before we dive into that, I'd love for you to introduce yourselves and tell us a little bit about your background. Dr. Mansoor, how about we start with you?
- [00:40]
B
Sure. Yeah. So my name is Azaz Mansour. I'm a non invasive cardiologist here in UPMC of Central Pennsylvania, covering the Harrisburg region and beyond. I serve currently as the president of the Heart and Vascular Institute in this region and I have a focus on a couple different areas, but my real passion is in what's called structural heart valve valvular heart disease and preventive cardiology.
- [01:11]
A
Excellent. Dr. Saba, how about you tell us a little bit about you.
- [01:14]
C
Yeah. Sameer Sabah. I'm the co Director of the Heart and Vascular Institute at upmc. I'm the Division Chief of cardiology. I'm a cardiac electrophysiologist by training. I deal with the heart rhythm problems, do procedures. I've been in my leadership position since 2009. Most importantly, I've been in the Pittsburgh areas for the past 26 years and still enjoy all the aspects of my job besides leading, seeing patients, taking care of them, procedures and in the clinic, as well as teaching and doing research. Thank you for having us.
- [01:49]
A
Yes, thank you both for joining me. Now here at Beckers, we recently covered a report about how about 22 million Americans are lacking access to a cardiologist. And of course, staggering numbers. We all knew that there were cardiology deserts here and there, but it really puts that into perspective to see 22 million Americans. I'd love to hear how you all are reorganizing and deploying your cardiology workforce to help meet the needs of patients where they live and what have some of those results been.
- [02:22]
C
So maybe I can jump in first and say that at UPMC this is a top priority. We recognize the fact that the workforce is today not meeting all the needs of the community around us. Although here at upmc, as you probably know, we are so widespread in our presence in the community. So UPMC is not Pittsburgh based. The fact that Taz is with us here, he mentioned he's in central Pennsylvania. So our clinical operation is across the Commonwealth. It goes into areas of Maryland, New York, and most more recently into Ohio. So we're already present in the community. But the question is very timely, too, because patients expect us to see them where they are, and there is always more to be done on that front. We're constantly moving into the community, opening up new clinics so that the patients don't have to travel too far to see us. So we recognize, for example, in the Pittsburgh area that south of us, we have a little bit of a thin presence in the community east of us, and we continue opening up those clinics. In addition, we have, since COVID I would say, been leaning heavily on telehealth. And as much as patients have the ability to connect with us through video visits, we've been doing a lot of that.
- [03:50]
A
Excellent. Now, as I'm sure you're well aware, access isn't just about the location. Right. It's also about getting patients in a timely manner. So what are some of the strategies that are working to ensure that patients can see their cardiologists in a timely manner?
- [04:05]
B
Yeah, that's.
- [04:06]
C
This is a very important question, and it's at the forefront of what we're doing currently. So, as you know, when cardiologists are become very busy and they build a practice like myself over 26 years, you could fill up your clinic all the time with the return patients that need care and ongoing care. But that leaves a lot of patients who are new patients who need cardiac care unable to see new physicians. So we have a lot of initiatives on that front, and I'm just going to enumerate some of them. One of them is definitely making sure that in the template of any of our physicians, any of our cardiologists, the general cardiologist, as well as the subspecialist, there is a minimum number of slots that are reserved for new patients. New patients are, you know, they haven't had an evaluation. They need the care. They are very worried about potentially having a cardiac condition.
- [04:59]
B
And.
- [05:00]
C
And getting that evaluation is extremely important. Our expectation today is that any clinic would have no less than 20% new patient slots, and then the rest of it would go towards return patients. We're also making sure that we're in cardiology. We're not dealing with a skin rash or what have you. So the timeliness of seeing patients is very important. So the system has mandated that a patient who wants to see a cardiologist within seven days should be able to see that provider within seven Days. Now, it may not be their provider of choice. It may be whoever is available. We're deploying a lot of cardiologists, we're deploying a lot of light professionals, nurse practitioners, as well as PAs, to be able to meet the needs. But that is definitely a goal that we have set for ourselves. So this question uncovers a deeper problem, honestly, which is that the fact that we need more cardiologists, we need to train more cardiologists. And I don't want to jump ahead of ourselves, but we're doing a lot on that front also to make sure that the pipeline continues to build as a lot of cardiologists are later in their careers, are expected to be retiring. So the problem may become worse before it gets better.
- [06:27]
A
Absolutely. And I'm sure we all know the cardiologists are kind of on the decline. There's not a lot of people coming into the specialty. So it makes competition a lot harder, it makes recruitment harder. So, on the workforce side of things, how are you maintaining a strong recruitment pipeline to ensure that you can continue to serve all the patients that want to see you?
- [06:49]
B
I mean, I can jump in on that question for sure. You know, we started a cardiology fellowship here in Central Pennsylvania to augment the fellowship that already exists within the broader system in Pittsburgh. So we have six fellows per year being trained as cardiologists. These are internal medicine trained doctors. And so they're now going into their subspecialization. And already we've seen fruits of that effort where two of our new cardiologists that we hired this year actually came through this training program. And so we're able to basically have an internal pipeline in that way and also cross pollination. Now our fellows are going between campuses and learning from our colleagues at Pittsburgh and bringing that learning back here. And so we get better integration between the campuses and in terms of the cardiac care that our patients are receiving. And so having that internal pipeline, I believe UPMC in general is the biggest training program in the country. And when you encompass all subspecialties within medicine. And so we are kind of blessed with that abundance. And I know Dr. Saba is involved with training of the fellows over on our Pittsburgh campus. So I don't know, Sameer, if you wanted to add a little bit to that.
- [08:05]
C
Totally agree, Taz. I mean, this is, you know, a priority. You know, the cardiology fellowship in Central Pennsylvania has been a huge addition, and some of those fellows are coming to for subspecialty training in Pittsburgh, and we have they're some of the best. The other thing that I wanted to mention along the same lines is that we've augmented the size of our own fellowship here in Pittsburgh from 8 cardiology fellows per year to 10 cardiology fellows per year. This took an investment from UPMC because obviously that costs money. But that is a very important thing to build that, to build that pipeline, particularly that we've been very successful in returning our trainees to become our colleagues, to become the faculty that are going to be serving all of those communities and, you know, servicing the clinics that we're opening and the, and the hospitals that are in the community. But there are also things at a national level happening that, for example, in my specialty of cardiac electrophysiology is already happening, which is the shortening of the training, meaning that how can we get the physicians not to choose cardiology? A lot of them want to do cardiology, but sometimes the length of the training, three years of internal medicine and then three years of cardiology, and if you're doing a subspecialty like electrophysiology, that's an extra two years. How can we reduce a little bit that duration to get people to work? And some things have already happened. There is something called the two plus two, which means that, for example, people going into electrophysiology can short track with doing two instead of three years of general cardiology and then do two years of electrophysiology. And a lot of these things are happening in the field, including discussions at the national level as to whether we can even shorten a little bit the internal medicine training and, you know, short track physicians into or trainees into, into cardiology. So a lot is happening on that front.
- [10:03]
A
Absolutely. And there's a lot happening in cardiology across the board. And I know for some leaders it can be a little difficult to figure out, you know, where do I focus my attention, where do we focus our resources? So I'd love to hear from both of you, what's your next priority for improving cardiovascular care?
- [10:23]
B
I think, you know, I was thinking about what our goal should be as a system, as a department, and I, you know, we just finished talking about the topic of training fellows, which is an education goal. And I feel like as a physician, nevermind as a cardiologist, a big part of my job is education, whether it's educating the next generation, educating myself to keep up to date, or educating our patients and our primary care partners. So I think there's only so much load that any one provider is going to be able to handle. Because, you know, that's just a natural way of things. And so in a long winded way, I think one thing we can do is better educate our providers at large, our primary care providers, our allied health professionals, nurse practitioners, PAs in caring for and managing of these patients. It's a team effort, right? And so as we kind of started with the access issue with cardiologists, there's going to be only so many times and so many slots that you could ever see a patient as a specialist. And so a big load comes on the primary care providers, both physicians and allied health professionals. And so educating them, giving them the resources, fortifying their workforce will help the patients both cardiac wise and in a broader sense. What are your thoughts on that, Sameer?
- [11:43]
C
No, totally agree, Taz. I mean, again, the question could go in so many different directions, honestly. And I was thinking, well, you know what, Education is a big part of it. Providing excellent clinical care day in and day out and being able to retain your own trainees in a system especially like upmc, that is so wide and different hospitals are over a large geographic location creates that unity and that consistency in the quality of the care that one would be able to provide. Taz touched on something very, very important. We think that we train people and that they become physicians and that's it. Whatever they learn during training, that's it, what they're using. I can basically think back at when I was in training 26 years ago, 90% of what I do today I did not train on doing. It's learning, you know, as we go. And that is the beauty of medicine, that is the beauty of cardiology. And it's a necessary thing to be able to continue providing the best care for our patients. So I think that both Daz and I agree that education in that broad sense that Daz just, you know, explained is probably the top priority. Of course we can talk about research and about a lot of other things, but. But that if I had to be choosing one thing, that would be the top priority.
- [13:09]
A
Excellent. Well, this has been such an informative discussion. Thank you both for being here today and sharing your thoughts.
- [13:16]
C
Thank you for having.