Group Warns of Looming Thoracic Surgeon Shortage
By John Gever
http://www.medpagetoday.com
CHICAGO, June 13 — A five-year shortfall in applicants for cardiothoracic surgery training positions threatens to create a shortage of physicians qualified to perform open-heart surgeries, lung resections, and other major procedures, according to the Society of Thoracic Surgeons.
Only 94 applicants applied for the 118 positions available in the National Residency Match Program for the upcoming year, according to results released this week.
The association noted that this is the fifth consecutive year in which there were fewer applicants than open positions.
The number of positions is down as well, from a peak of about 145 in 1995.
The number of coronary artery bypass grafts, the specialty’s bread and butter, declined by 15% from 1998 to 2003, as patients with coronary artery disease received percutaneous and medical treatments, leading some observers to declare an oversupply of the specialists.
But with half of currently practicing cardiothoracic surgeons expected to retire in the next 10 years, the specialty society is now warning of “a brain drain of increasingly dangerous proportions” and “compromised patient care in the very near future.”
The average age of practicing heart and lung surgeons is more than 55, according to the STS.
The group also noted that the aging of the population as a whole is likely to boost the need for cardiothoracic surgeries.
“It’s a prescription for disaster,” said Douglas Mathisen, M.D., a thoracic surgeon at Massachusetts General Hospital in Boston and a spokesman for the society.
He estimated that there could be 1,500 to 2,000 fewer thoracic surgeons in 15 years than the approximately 4,500 practicing today.
Kendall Reed, D.O., a surgeon at Des Moines University in Iowa and a member of the Council on Graduate Medical Education, said he shared the group’s concern about inadequate numbers of cardiothoracic surgeons in the future.
He called it a “misperception” that advances in medical and percutaneous therapies are reducing the need for cardiothoracic surgery.
Dr. Mathisen said recent studies casting doubt on the long-term performance of angioplasties and stents may prompt “a migration back to surgery.”
He also pointed to a 2004 study based on Medicare statistics that found bypass graft surgeries declining, but overall cardiovascular surgeries increasing.
Another discouragement to budding cardiothoracic surgeons may be harder to counter.
Dr. Reed said the specialty is simply less appealing to today’s medical graduates. “It’s long hours and a difficult job,” he said.
He said it was becoming more difficult precisely because of the inroads made by interventional cardiologists and other specialties. The cases they treat are what would have been the simpler surgeries. The surgical caseload now tends to be more complicated and carry the most risk, he said.
Medical graduates are aware of that, and “they don’t want that stress,” Dr. Reed said.
David Cornett, regional vice president for Cejka Search in St. Louis, a physician recruitment firm, agreed that new graduates are deliberately choosing other specialties.
“Surgery [in general] is not viewed favorably by young people,” he said.
He said students today are risk-averse. “When [they] have questions about what cardiovascular surgery is going to look like in the future,” they are inclined to choose other specialties with surer prospects, he said.
Dr. Reed agreed, saying that medical graduates now perceive that the need for cardiothoracic surgeons is not as critical as it once was.
Cornett and Reed both said higher reimbursements or salaries would not make much difference.
Average physician salary data compiled by Cejka Search indicate that, at $460,000, cardiothoracic surgery is the third highest-paid specialty among more than 70 listed (after neurosurgery and spinal surgery). The firm lists the average starting salary for cardiothoracic surgeons at $350,000, the second highest.
“I don’t know how much more money can have an effect,” Cornett said.
Dr. Reed agreed. “I don’t think money is going to solve it.”
Nevertheless, the solutions advanced by the Society of Thoracic Surgeons focus on money.
The group is calling on Congress to stop the implementation of scheduled Medicare cuts in reimbursements.
It also wants a bill passed that would allow trainees to defer repayment of student loans until they begin practicing.
Currently, the eight-year training program for thoracic surgery after medical school means that student loans start to come due well before physicians finish their residencies.
Dr. Mathisen said part of the reason for focusing on these issues is that federal policy is something the society can hope to influence.
