Cardiothoracic Surgeon Shortage Likely By 2020, Study Predicts

July 28, 2009 (Washington, DC) — The United States faces a severe shortage of cardiothoracic surgeons within 10 years if entry into the profession keeps declining while the patient population ages, a study predicts. [1]

By 2025, even if CABG procedures are no longer performed--an extreme scenario--the US will lack at least 1500 cardiothoracic surgeons, the research estimates.

The study highlights the need for more surgeons despite the drop in CABG procedures and the rise in interventions such as angioplasty, senior author Dr Irving Kron (University of Virginia, Charlottesville) told heartwire .

"It turns out that even though angioplasty is a perfectly good therapy for a lot of people, many people have recurrence, and a significant number of patients still need coronary bypass and certainly other cardiac surgical operations," he said.

"We need to start to do a better job of recruiting individuals into our specialty, or I think patients are going to suffer," Kron cautioned.

The study is published online July 27 in Circulation.

Unfilled Residency Spots

In 2003, for the first time in 20 years, the number of practicing cardiothoracic surgeons dropped.

Half of the currently active cardiothoracic surgeons are older than 55 years and expected to retire soon. Meanwhile, one third of new cardiothoracic residency spots remain vacant, Kron said.

The shortage of applicants for residency spots began about eight years ago, when there was a lack of jobs for new surgeons, largely prompted by evolving cardiology technology, he noted.

From 1997 to 2004, the rate of CABG operations, "a mainstay of the specialty," decreased by 28%, and the rate of coronary stent placement during angioplasty increased by 121%, the authors write.

To determine future requirements for cardiothoracic surgeons in light of this decline in CABG surgery, the American Association for Thoracic Surgery and the Society of Thoracic Surgeons commissioned a study of projected supply and demand for these professionals through 2025.

Decrease in CABG, Increase in Other Surgeries

Based on the number of current active practitioners, anticipated retirements, and new recruits, the study's statistical model predicted that, by 2025, the supply of cardiothoracic surgeons would decrease by 21%.

Meanwhile, based on current patterns of healthcare use and projections of a growing elderly population, demand for cardiothoracic surgery--including valve procedures, other open heart procedures, and lung operations--could rise by 46%.

According to Kron, the job shortage for new cardiothoracic surgeons has reversed itself; there is an evolving need for surgeries other than CABG. Although some established surgeons are retraining in more leading-edge techniques, they are not dropping their surgical skills, he added.

"The change in technology is a good thing," he said. His institution's training program is emphasizing some interventional skills for fixing aneurysms, and minimally invasive or transcatheter valve procedures are becoming part of a surgeon's repertoire.

This study calls attention to the need for an immediate response to the looming expected shortage of cardiothoracic surgeons, Kron said.

One potential response might be to reduce the training time after medical school from eight years to six years, he added.

Alarming Specialist Shortage Predicted

"The alarm that we feel is that, although there seems to be less interest in cardiac surgery today because of changes in the number of coronary bypass surgeries that are being done, this doesn’t portend well for the future when the number of patients requiring other types of cardiac surgery--valve replacement, repair of aneurysms, and other surgery for advanced heart failure--will be increasing," Dr Timothy J Gardner (Christiana Care Health System, Newark, DE), immediate past president of the American Heart Association, told heartwire .

The drop-off in the number of surgeons reflects the growing number of procedures that are being done as interventional treatments, Gardner concurs. Some surgeons are training to perform catheter treatment of aortic aneurysms and aortic valve replacements--an area where there is some overlap between cardiologists and cardiac surgeons, he noted. The trend in surgery is to perform less-invasive procedures--such as off-pump coronary bypass grafting--and to use smaller incisions for valve replacement, which allows surgeons to deal with more challenging heart valve problems, he said.

"You hear a lot of talk about the need to increase our workforce in primary care in the United States, but we better be very careful that we're not overemphasizing that and [ignoring] the projected need for specialists in cardiac surgery and even in cardiology," Gardner cautioned.

"I think that this paper provides a bit of a warning or wakeup call in that regard," he said.

The study was supported by the American Association for Thoracic Surgery and the Society of Thoracic Surgeons. The authors had no financial disclosures.