Since I began working with cardiovascular program leaders over ten years ago, hospital employment has been a very common pathway for CV specialists, typically more so than for other specialties. There are a number of reasons for this. For one, CV treatment has historically been very inpatient and procedure-focused, meaning CV specialists spent much of their time at the hospital in the cath lab and operating room. CV also was targeted early on by health care reform efforts like the Hospital Readmissions Reduction Program and appropriate utilization scrutiny, which increased the need for non-RVU generating care management tasks.