Cardiologists Saw Rising Incomes but Additional Pressures in 2024: MedAxiom

Pay for cardiologists in the United States continued its upward trajectory amid mostly steady workloads in the year 2024, according to new survey data from MedAxiom. Invasive cardiologists led the pack for annual earnings, followed by interventional cardiologists and electrophysiologists.

Yet these aren’t the only noteworthy trends. At a time when access to care remains a challenge, due to the aging patient population, advanced practice providers (APPs) have an increasingly important role to play in addressing demand. Additionally, the widespread use of advanced imaging to guide treatment decisions has led to a decline in cath lab volumes.

“The two big things that everybody wants to know are the compensation and productivity, but our report is a lot deeper than that,” said Joel Sauer, MBA, executive vice president of consulting for MedAxiom and co-author of the report.

Healthcare administrators, Sauer told TCTMD, are curious to hear specific details, asking questions such as, “How do my interventional cardiologists compare to others in terms of how much time they spend doing E&M [evaluation and management] visits?” Their dataset can supply the answer in peer comparison across more than 200 programs, he noted.

But Sauer added that the information gathered by MedAxiom, an American College of Cardiology company, isn’t just aimed at clinicians. Proceduralists, for instance, are often eager to hear others’ volumes, he noted. They might say: “I want to know that I’m going to be able to perform enough cases to stay proficient and be comparable to my peers.” More generally, physicians want to know how much they should get paid and what the expectations are for productivity, he added.

For the 2025 survey—which reflected 2024 data—a record high of 232 programs responded. Among the 6,830 cardiovascular providers in these programs, 47% were full-time cardiovascular physicians and 35% were full-time cardiovascular APPs. Part-time providers also were part of the mix, though in the minority. The increases in survey participation, the report says, reflect ongoing trends indicating “a measured return to physician hiring and continued reliance on APPs to support care team efficiency and patient access.”

Most (85%) worked in cardiology, 10% in cardiac surgery, and 5% in vascular surgery. Fifty-seven percent practiced in programs with 10 or fewer CV physicians, disproportionately higher than the prevalence of small practices in the real world.

Compensation and Productivity

At the top of the best-paid list were invasive cardiologists, who earned a median of $826,280 in private practice and $764,200 in integrated groups. Also high on the list were interventional cardiologists ($625,000 private and $788,083 integrated) and electrophysiologists ($623,134 and $804,129, respectively). General/noninterventional cardiologists earned $525,000 in private practice and $662,870 in integrated groups, whereas advance heart failure specialists earned $652,000 in integrated groups (no data were reported for private practice).

Looking at regional patterns, the South “retains its perennial perch in the number-one position,” the report notes. Cardiologists residing there had a median compensation of $701,000, whereas in the Northeast, the lowest-paid region, cardiologists earned a median of $654,347.

Productivity, measured in work relative value units (wRVUs), continued to hold steady for all physician subspecialties as it had in prior years. The two top-producing subspecialties were electrophysiology and interventional. APPs, on the other hand, saw an 8% increase in productivity with a median wRVU of 1,987; private-practice APPs came out ahead of those in integrated groups.

Earnings were, for the most part, similar to those seen in earlier surveys. However, there were some differences. In particular, the compensation divide between cardiologists at private versus integrated groups was the largest in 5 years. Additionally, the report notes, “cardiac surgeons experienced a modest compensation increase despite declining productivity, while vascular surgeons maintained near-peak compensation levels despite a steep drop in wRVUs.”

Median total compensation was higher for men than for women ($704,377 vs $615,595), as were median wRVUs (11,380 vs 8,503). Male and female cardiologists received a median of $64.73 and $69.47 per wRVU, respectively. Full call participation was 83% for men versus 85% for women.

Trends and What’s to Come

One big shift in recent years, said Sauer, is the rise in advanced imaging. The MedAxiom survey tracks cardiac CT (excluding calcium scoring), as well as cardiac PET CT and MRI.

“Advanced imaging is one of those transformational shifts because not only has it dramatically changed patient care in terms of what we’re using for patient care, it’s had significant impact on our cath lab volumes, on our procedure volumes, and on the way we distribute work within our practices,” he explained.

In 2024, the ratio of total advanced imaging studies to total catheterizations averaged 62% (up from 58% in 2023), with a median of 49% (up from 41%). “After considerable fluctuation over the past 10-plus years, 2024 marked a watershed high for the median at 27 advanced imaging studies per 1,000 active patients,” the report notes. Most common among them was CT and least common was MRI.

As a downstream effect, cath labs are seeing lower volumes. The median numbers of total catheterizations and PCI were 60 and 22 per 1,000 patients in 2024.

“To bring this decline into perspective, a group with 25,000 active cardiology patients would have likely performed around 1,925 total catheterizations in 2017,” according to the report. “This group with a similar panel size would have done approximately 1,500 total catheterizations in 2024—a difference of 425 catheterizations. Such changes over time have a profound impact on workforce needs.”

Interestingly, the ratio of PCIs to catheterizations has dropped to its lowest point—35%—in 2024, the authors add. “To some extent, this is surprising and counter to the expectation that this ratio would increase with the adoption of advanced imaging, which provides more definitive assessments of functional flow and other important clinical indications.”

Change has also come as the field attempts to meet rising need. “We have increasing demand for cardiovascular services because of the age distribution in the United States, and unfortunately our population is getting less healthy, not more healthy,” Sauer commented.

In 2024, each cardiologist had nearly 2,000 patients under their purview, but at the same time, the percentage of new patient visits to total office visits dropped to the lowest in 5 years: 15.4%. This may be attributed, at least in part, to the 12% decrease in the cardiologist workforce over the past 4 years, the MedAxiom data indicate.

Going forward, Sauer expects a growth in telehealth to match supply with demand, as well as growth in chronic care management as a way to enhance value-based care.