SNOWMASS, COLO. — The pipeline of future cardiac surgeons is “essentially nonexistent,” which will have serious consequences not only for the surgical specialty but for cardiologists and all others who provide care for patients with heart disease.
“When I began my cardiac surgical training, there were roughly 10 applicants per available position. Today there are basically more positions than applicants. So anyone who has reasonable qualifications will be accepted by a program somewhere,” said Dr. Andrew S. Wechsler, professor of cardiothoracic surgery at Drexel University, Philadelphia.
Last year, there were only 97 applicants for the 130 U.S. training positions, and only 68 of whom were graduates of American medical schools. The quality of the applicants has dropped off, he said at a conference sponsored by the Society for Cardiovascular Angiography and Interventions.
The fall-off in the applicant pool began about 4 years ago. It's a trend of particular concern because of the projected increasing demand for cardiac surgical services as the population ages and the fact that one-half of practicing cardiac surgeons are above the age of 53 years. Many are contemplating retirement because of decreasing reimbursement, mounting malpractice insurance costs, and declining job satisfaction.
Reimbursement for cardiac surgery today is, in real dollars, about 30% of what it was 15 years ago. Cases have become more complex, with a huge increase in the number of reoperations. The average yearly cost of malpractice insurance for cardiac surgeons in Pennsylvania is $125,000. Surveys indicate only one-quarter of practicing cardiac surgeons would advise medical students to enter the field, Dr. Wechsler said at the conference, cosponsored by the American College of Cardiology.
Cardiac surgery is currently performed at more than 1,400 U.S. hospitals, many of which have small-volume programs. Dr. Wechsler predicted that one result of the looming shortage will be governmental pressure to reconsolidate cardiac surgical services to high-volume centers, with resultant closure of many smaller programs. Referring physicians are likely to find excellent-quality cardiac surgeons becoming less readily available.
Cardiac surgical educators have launched a number of initiatives to address the predicted shortage. Paid internships are being offered to medical students in an effort to capture their attention early in their education in the hope of steering them into this challenging field. New integrated training programs have been approved, including a 6-year program in cardiac surgery beginning right out of medical school. It is no longer required that trainees complete the chief resident year and take the board exam in general surgery before entering cardiac surgical training. And vascular surgery is now accepted as a pathway to cardiac surgical training, noted Dr. Wechsler.
Surveys indicate only one-quarter of practicing cardiac surgeons would advise medical students to enter the field. DR. WECHSLER