Workforce Planning for a Sustainable Cardiac Physiology Profession
An Open Letter to Australian Employers, Healthcare Leaders and Stakeholders in Cardiac Care from Professionals in Cardiac Sciences Australia (www.picsa.org.au)
Health leaders (including ministers, senior cardiologists, and department managers) hold significant power in shaping the future of the Cardiac Physiology workforce, with the potential to either strengthen or undermine its development. Your support is essential to building and maintaining skilled and well-supported teams, ensuring high-quality patient care.
Here are five key ways to strengthen the Cardiac Physiology profession:
1. Use Our Name
In Australia, “Cardiac Physiologist” has replaced the term “Cardiac Technician” (1). This is a professional title, like the title “Doctor” or “Nurse.” The term “Tech” is considered outdated and has contributed to misclassification and pay disparity, with some individuals still on the same award as gardeners. Today, Cardiac Physiologists are degree-qualified professionals with specialised expertise in the diagnosis and treatment of heart disease. Using the correct title and classifying them appropriately acknowledges their role and supports the workforce.
2. Support the Regulation of Practising Cardiac Physiologists
Currently, there is no legal safeguard against unqualified individuals programming pacemakers or conducting many other cardiac tests. Only one of the five Cardiac Physiology modalities -Echocardiography/Cardiac Sonography – requires registration, and even that falls outside of AHPRA (2).
Employers must stop using unqualified staff (e.g., cleaners and receptionists) to perform cardiac tests. Instead, hire individuals with suitable tertiary backgrounds and support their further training, accreditation, and registration. A properly regulated workforce ensures safety, quality, and accountability in patient care. See the the “Australian Guidelines for Entry and Practice in the Field of Cardiac Physiology” which can be downloaded from https://picsa.org.au/about/#core-documents).
3. Invest in Professional Development
Addressing clinical placement challenges for students is essential for workforce development. Workplaces should be supported in hosting students more easily, with structured pathways for students to receive payment during placements.
Centres of excellence should also provide CPD opportunities and training allowances for all Cardiac Physiology staff. Ongoing education is crucial for maintaining high healthcare standards and strengthening the profession. However, if Cardiac Physiologists are not employed under a suitable award agreement, they may be ineligible for professional development allowances.
Employers can also support professional growth by funding advanced qualifications, conference attendance, research, and teaching roles. Cardiologists can also mentor junior staff, fostering a culture of continuous learning and development.
4. Employ Actual Cardiac Physiologists
Does your area of jurisdiction support each of the five Cardiac Physiology roles? Are staff adequately trained and authorised to fulfill their full scope of practice?
Australia is facing a shortage of radiographers and nurses, but there is an abundance of medical science graduates. Yet, many employers fill Cardiac Physiology roles with staff from nursing or radiography, rather than supporting Cardiac Physiology as a distinct profession.
a) Junior Roles (ECG/non-invasive, and Cath Lab)
We recommend recruiting medical science graduates as Cardiac Physiologists to perform key scientific roles in cardiac cath lab procedures and non-invasive cardiac testing (e.g., ECGs, stress tests, tilt table tests, Holter monitoring, and ambulatory blood pressure monitoring). With structured training, these professionals can develop expert-level procedural and interpretive skills, reducing the burden on medical practitioners.
There is significant potential to expand these roles further. For example, Canada integrates cardiac scientists into emergency departments, recognising their expertise in ECG interpretation. In the cath lab, the role extends beyond haemodynamic monitoring (3) to include immediate arrhythmia intervention, assisting with intravascular imaging, prosthesis sizing, and the setup and optimisation of equipment (such as intra-aortic balloon pumps).
Investing in Cardiac Physiologists in these areas creates a focused, expert workforce, and establishes a pipeline of skilled professionals primed for more advanced roles. As their baseline qualification is less transferable to other sectors, Cardiac Physiologists are also more likely to remain in cardiology, ensuring long-term workforce stability.
Just as a strong junior league sustains a successful senior football league, the future of cardiac care depends on nurturing junior roles today. This long-term strategy builds a clear professional pathway, ensuring a steady supply of expertise and the specialised care patients will need for years to come.
b) Advanced Roles (Echo, Cardiac Devices, and Electrophysiology)
Where possible, hospitals should support workplace training and employ their own advanced Cardiac Physiologists. This is more cost-effective [see recent government correspondence about cardiac implantable electronic device (CIED) service delivery] builds local expertise and ensures continuity of care.
While locums and company representatives can be a suitable option for temporary staffing needs or when alternatives are unavailable, relying on them long-term can have drawbacks and, in some cases, may be considered unethical. Company representatives are intended to support rather than replace direct employees, and there are limitations on their scope of practice (4).
There is significant potential for these roles to evolve and expand, with advanced Cardiac Physiologists developing highly specialised expertise in certain areas. In many cases, cardiologists consult with cardiac physiologists as subject matter experts, particularly in areas such as cardiac device programming, and advanced imaging. Hospitals and clinics should consider local needs and invest in building strong, in-house multidisciplinary teams that leverage this expertise.
5. Manage Workload and Injury Risks
The well-being of Cardiac Physiologists must be a priority. Long hours, high-stress environments, heavy PPE, and repetitive tasks contribute to burnout and injury. Rotating duties may be useful to reduce injury risk, keep work engaging, and improve workforce flexibility. Employers can also help by offering flexible working arrangements, promoting work-life balance, allocating appropriate time for tasks, and supporting ongoing professional development (including establishing research, educator, and manager roles).
To meet current and future demands, expanding the cardiac physiologist workforce is crucial. Demand for services across all modalities of cardiac physiology are growing steadily, and shortages in several areas of specialisation (e.g., Echo) have recently been highlighted (5,6). Staffing calculators, such as those from the Heart Rhythm Society, provide valuable guidance in workforce planning. For instance, approximately 3.3 FTEs per 1,000 patients (7,8) are needed for cardiac device management (note this calculation is adjusted for Australia’s 38-hour workweek and includes implant and admin support).
PiCSA: Supporting Your Workforce
Professionals in Cardiac Sciences Australia (PiCSA) is committed to education, professional development, and advocacy for Cardiac Physiologists. We provide training resources, practice guidelines, and advocacy tools to help employers build a strong workforce.
Conclusion
The long-term sustainability of the Cardiac Physiology profession depends on proactive workforce planning. Employers and healthcare leaders must recognise the unique contributions of Cardiac Physiologists, invest in their professional development, and ensure they are employed under appropriate conditions to address staffing challenges and future demands.
Collaboration between cardiologists, administrators, and Cardiac Physiologists is essential to building a workforce capable of delivering high-quality patient care. PiCSA is committed to partnering with employers and stakeholders to drive the growth of a well-supported profession.
To strengthen the future of Cardiac Physiology, health leaders should:
✅ Use the correct professional title
✅ Support regulation
✅ Invest in education and continuing professional development (CPD)
✅ Employ Cardiac Physiologists across junior and advanced roles
✅ Manage workload and injury risks
By working together, we can ensure a resilient profession that continues to provide exceptional cardiac care. Let’s invest in the future of Cardiac Physiology—because patients deserve nothing less.
References:
1. Professionals in Cardiac Sciences Australia (PiCSA). (2020). PiCSA National Title Statement (updated August 2020). https://picsa.org.au/wp-content/uploads/2022/12/PiCSA-National-Title-updated-August-2020.pdf
2. Professionals in Cardiac Sciences Australia. (2024, August). Australian guidelines for entry and practice in the field of cardiac physiology (adult and paediatric) (Version 2.1). https://picsa.org.au/wp-content/uploads/2024/09/Career-Pathway-Position-Statement-2024-2.1-August-2024.pdf
3. Professionals in Cardiac Sciences Australia. (2023, June). Cardiac catheterisation laboratory competency (Version 1). https://picsa.org.au/wp-content/uploads/2023/07/PiCSA-Cardiac-Catherisation-Laboratory-Competency-V1-2023.pdf
4. Heart Rhythm Society. (2023). HRS Policy Statement Update: Recommendations on the role of industry-employed allied professionals. https://www.heartrhythmjournal.com/article/S1547-5271(22)02377-3/fulltext
5. Bureau of Labor Statistics, U.S. Department of Labor. (2024). Occupational Outlook Handbook: Diagnostic Medical Sonographers and Cardiovascular Technologists and Technicians. https://www.bls.gov/ooh/healthcare/diagnostic-medical-sonographers.htm
6. Australasian Sonographers Association (ASA). (2024). Skills Priority List 2024 – Sonography: Australasian Sonographers Association Feedback. https://www.sonographers.org/publicassets/2e501af8-1ae0-ee11-912b-0050568796d8/skills-priority-list-2024—sonography—australasian-sonographers-association-feedback.pdf
7. Heart Rhythm Society. (2023). CIED Remote Monitoring Clinic Staffing Calculator. https://www.hrsonline.org/guidance/CIED-RemoteMonitoringStaffCalculator
8. Heart Rhythm Society. (2023). 2023 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic. https://www.hrsonline.org/guidance/clinical-resources/2023-hrsehraaphrslahrs-expert-consensus-statement-practical-management-remote-device-clinic
