Division Chief's Statement: 2007 Annual Report
By: Benjamin C. Sun, M.D.
According to the Center for Workforce Studies at the Association of American Medical Colleges (AAMC) “Between now and 2025 the likely range of demand is going to be 1,000-2,000 thoracic surgeons higher than the number available, [even] if we increase the number of new trainees to 150 per year from the current 129.” These projections were reported as “very conservative”.
Though there are 129 certified training positions available per year in the United States, we are training less than 100 surgeons. A shortage crisis is looming. The question becomes, “Why?”
Perception becomes reality. The perception is that procedures are rapidly declining for the Cardiothoracic Surgeon as coronary artery bypass grafting (CABG) rates have dropped. The reality is that Medicare claims data for 1999-2004 have indeed shown a 10% drop in CABG claims; at the same time, there were nearly double the claims for valve operations and other non-CABG heart procedures, along with a 25% rise in general thoracic procedures. In addition, with the current outcomes data on coronary stents being less robust than expected, there is a recent stabilization of CABG volumes with an anticipated modest increase.
Trainees report difficulty finding a suitable position after graduating, reflecting a current surplus of practitioners. The challenges for current trainees and potential trainees lie here. While roughly one-third of U.S. physicians overall are age 55 or older and hence likely to retire in the next 10-15 years; the problem is even more pronounced in the Cardiothoracic surgery field, with more than half of the 4,800 board-certified Cardiothoracic surgeons active today age 55 years or older. Most of these older Cardiothoracic surgeons plan to retire between 2011 and 2015—just as a huge wave of baby boomers reaches age 65 and starts to place much heavier demands on the health care system. We may be starting to see the early effects of these trends as the job market is giving a sense of softening this year.
The Division of Cardiothoracic Surgery has been fortunate in continuing to attract quality trainees (and fill our match) despite this challenging environment. This is due to all of our team members who are dedicated to all three components of our mission: clinical care, research, and education. Our current trainees are the best reflection of this. They are our most vocal supporters and our future legacy.
The other growing challenge to all of us is the rapid move towards outcomes and quality public disclosures for medical care. The intent is to increase consumer awareness as well as financially rewarding higher performing programs and organizations. To no surprise, Cardiovascular Disease management including Cardiothoracic Surgery data is the first to be scrutinized. We are chosen because we are the first to gather and maintain comprehensive databases to help understand our outcomes and therapies, with sources like the STS and ACC. Hence, we are the first to have data to which we can be compared.
These databases were intended for academic analysis and self improvement as a field, but are now used to differentiate our programs. The result of which, the public face of the Ohio State University Medical Center will in a large part be a reflection of the quality and outcomes measures of Cardiovascular Diseases because that is what will be the first to be reported. Our team is ready for this.
The Division of Cardiothoracic Surgery is a highly functioning and nimble team that is deftly managing the current challenging environments, and developing a growing national notoriety as leaders in the field. I feel privileged to be a part of this team.