Image by Myriams-Fotos from PixabayAmbulatory surgery centers (ASCs) specializing in cardiology may see higher compensation levels for key members of the clinical team, as cardiovascular provider pay reached record levels in 2024, despite decreased productivity and more limited access to care.
That’s based on MedAxiom’s 2025 Cardiovascular Provider Compensation and Production Survey, which analyzed data from 232 cardiovascular programs involving 6,830 providers nationwide.
Overall, the report painted a more complex picture of rising salaries, expanding patient panels and increasing workforce shortages.
“These findings demonstrate how data can help anticipate challenges and guide strategic decisions, from workforce planning to patient access, enabling health systems to adapt to evolving demands,” Dr. Gerald Blackwell, MedAxiom president and CEO, said.
Compensation is high but private practice is lagging
Median annual compensation for full-time cardiologists hit a record high of $694,954 in 2024, continuing a multi-year upward trend.
Yet a widening gap emerged between different employment models: Hospital- or health system-employed cardiologists earned over $700,000, while private practice physicians made $588,479. This marks the largest difference in more than five years, according to the report.
Electrophysiology specialists led earnings among integrated physicians at $804,129, followed by interventional cardiologists at $788,083. In contrast, private interventional cardiologists earned $625,000. Despite gains in compensation, median work relative value units (wRVUs), a key indicator of physician productivity, declined slightly across most subspecialties.
Cardiac surgeons experienced modest compensation growth, rising 1.6% to $942,700, even as wRVUs declined 1.2%, according to the report.
Vascular surgeons’ compensation remained near record highs at $649,200, despite an 11% drop in productivity. The report attributes this disconnect to market demand, call burdens and workforce constraints outweighing production metrics.
For ASCs, this could be either positive or negative depending on various factors, according to Joel Sauer, MedAxiom’s executive vice president and report author.
“If I am an interventional cardiologist performing procedures at the hospital, my enthusiasm for referring patients to that ASC might depend on its location and whether I have a set of cases there,” Sauer told ASC News. “Most employed cardiologists are paid based on wRVUs, which are completely independent of where the case is performed. From the physician’s perspective, I prefer to do procedures where it’s most efficient for me. The situation changes if I own part of the ASC because then I have a different financial incentive.”
Advanced practice providers (APPs), such as nurse practitioners and physician assistants, continue to fill crucial workforce gaps, the report found. Cardiology programs increased their APP-to-physician ratio to 0.75, while surgical programs saw declines. Cardiology APP productivity rose by 8% to a median of 1,987 wRVUs, with private practice APPs surpassing their integrated peers by nearly 50%.
Median APP pay also increased — 6.7% in cardiology to $131,883, 12% in cardiac surgery to $171,314, and 8.6% in vascular surgery to $144,891.
“Programs are evolving by expanding APP roles and optimizing care teams, but data indicates this alone won’t resolve the access crisis,” Blackwell said. “Our insights assist cardiovascular leaders in preparing for an era where compensation growth, productivity pressures and patient demand intersect.”
Signs of stress are evident across the system. Median patient panels have reached nearly 2,000 per full-time cardiologist, while new patient visits have declined for the first time in years, making up 15.4% of all visits. Activity in the catheterization lab also continues to decline, with median PCI rates dropping nearly one-third since 2017.
“The number of new patients remains very high compared to history,” Sauer explained. “Cath lab volumes are decreasing on a per-1,000-patient basis. We’re seeing that we don’t use cath labs as often for diagnosis as we used to, because we have other options like cardiac CT and new, cost-effective, non-invasive technologies. We’re becoming very good at sending only patients who need intervention to the lab. So, in a positive way, we’re witnessing those volumes decline.”
The report also indicated that one in four cardiologists is now over 61 years old, and nearly half report experiencing burnout. With only about 1,150 new fellows entering the workforce each year, MedAxiom forecasts a net shortage of nearly 500 cardiologists annually, underscoring growing concerns about sustainability.
“Demand for cardiac services has increased by approximately 8% to 10%,” Sauer noted. “That puts a significant strain on our systems. We’re not graduating fewer fellows; we’re just not graduating enough to meet that rise in demand. Additionally, many older cardiologists are at the end of their careers, either retiring or slowing down. So, that imbalance is even more pronounced.”
Sauer said that, in response, health systems and ASCs will have no choice but to innovate and encourage staff to work at the top of their licenses to increase the number of patients each physician can manage.
But when it comes to adapting to managing an increasing caseload with fewer cardiologists, Sauer said ASCs will have no issues because they are adaptable by design.
“ASCs are focused; they know what their patient population is and isn’t,” Sauer said. “They are perfectly adapted to where patients want care delivered and where payers are pushing us to provide care.”
