Clinical Scorecard: A Nationwide Assessment of Earnings and Work Efficiency in Advanced Heart Failure and Transplant Cardiology

At a Glance

Key Highlights

• Among 183 respondents, 49% received salary-only compensation, 6.6% received productivity-only compensation, and 44% received a combination.

• Estimated median compensation was lower among university-based than community-based respondents ($450,000 vs $550,000; P < .01).

• Median wRVU production adjusted for clinical effort was lower in university settings (8,600 vs 11,100; P < .01).

• Compensation correlated with unadjusted and clinical effort–adjusted wRVU productivity across the cohort. Compensation per wRVU for clinical work did not differ significantly between settings after adjustment for clinical effort.

• Women in community settings reported lower compensation than men despite no significant difference in wRVU productivity.

Guideline-Based Recommendations

Diagnosis

• This workforce survey does not evaluate diagnostic practices or provide diagnostic recommendations.

Management

• The authors discuss previously proposed compensation strategies, including higher base salaries and wRVU conversion rates, compensation for different call responsibilities, and recognition of program growth and outcomes. These are workforce proposals rather than clinical guideline recommendations.

Monitoring & Follow-up

• The authors recommend regular compensation and work-life balance surveys to improve transparency and inform advocacy.

• Organizations conducting compensation surveys should distinguish AHFTC as a separate specialty.

Risks

• Clinical productivity measures may inadequately capture education, research, and other work that does not generate wRVUs.

• Lower compensation among women in community settings warrants further investigation.

• Self-reported metrics, missing productivity data, and broad response categories limit the precision of the findings.

Patient & Prescribing Data

The study includes 183 AHFTC physicians: 127 in university settings and 56 in community settings. Both groups reported a median of 60 work hours per week. University-based respondents allocated less time to clinical work and more to education and research. Compensation and productivity data reflect 2024. The survey does not report patient-level outcomes or prescribing data.

Clinical Best Practices

• Assess compensation findings in the context of clinical effort, productivity, and nonclinical responsibilities.

• Recognize the limitations of wRVU-based compensation in a specialty with substantial work that does not generate wRVUs.

• Further investigate the observed compensation differences between women and men in community settings.

Related Resources & Content

Perceptions of careers in advanced heart failure and transplant cardiology: results of a national survey of advanced heart failure and transplant cardiologists — Patel PA, Seals AL, Chien C, et al — Journal of Cardiac Failure — July 20, 2026.

Compensating heart failure cardiologists: is the RVU model the right model? — Uriel N, Elad B, Brailovsky Y, et al — Circulation: Heart Failure — 2026.

Interest in advanced heart failure and transplant cardiology fellowship: a national survey of cardiology fellows — Gilbert O, Patel P, Ponir C, et al — JACC: Heart Failure — 2024.

The HFSA Advanced Heart Failure and Transplant Cardiology Fellowship Consensus Conference — Drazner MH, Ambardekar AV, Berlacher K, et al — Journal of Cardiac Failure — 2024.

A roadmap to reinvigorating training pathways focused on the care of patients with heart failure: shifting from failure to function — Blumer V, Kittleson MM, Teerlink JR, et al — Journal of Cardiac Failure — 2023.

2025 cardiovascular provider compensation and production survey report — MedAxiom — MedAxiom — October 2025.

HFSA president’s update: November 2025: building the future heart failure workforce—together — Margulies KB — Heart Failure Society of America — November 2025.