Survey Reveals the State of CT Surgery

STS News, Fall 2012 -- The results of a recent cardiothoracic surgeon survey are shining a light on several aspects of the specialty, including career satisfaction, educational debt, retirement plans, and more.

STS partnered with the American Association for Thoracic Surgery on the 56-question survey, which was sent to 5,265 surgeon members of either organization in late 2009. The results were published in the January 2012 issue of The Annals of Thoracic Surgery, in an article by Richard J. Shemin, MD and John S. Ikonomidis, MD, PhD.

Dr. Ikonomidis, Chair of the STS Workforce on Adult Cardiac and Vascular Surgery, said it’s crucial that the Society conduct these types of studies. “These results provide data for professional organizations to better serve the membership, and in addition, the data enhance our advocacy efforts,” he said.

Career Satisfaction High
Overall, 72% of the survey respondents said they were satisfied, very satisfied, or extremely satisfied with their current career. Congenital heart surgeons were the most likely to rate their satisfaction as “extremely” or “very,” while adult cardiac surgeon respondents were most likely to say that they were not at all satisfied or only somewhat satisfied.

Despite this high rate of career satisfaction, only 58% of respondents said they would encourage their children or grandchildren to go into medicine—and just 37% said they’d suggest cardiothoracic surgery in particular. What’s behind the disconnect? “Most surgeons in this survey have noticed a decrease in their earning potential, resulting in the requirement for them to work even harder to make comparable incomes,” Dr. Ikonomidis said. “Professional demands, now more than ever, clearly compete with the balance between personal and professional life.”

Financial Costs a Concern
Educational debt is a topic of national prominence, and cardiothoracic surgeons are a prime example of these rising costs. In this survey, the average cumulative educational debt was $56,000. Compare this to the average of $41,000 in the 2000 survey and $39,000 in 2005. “Length of training and the costs accrued therein likely have an impact on the future of the specialty, and we have partially responded by working to create training paradigms that decrease the amount of time required to achieve board certification and as such, likely decrease the debt owed by residents,” Dr. Ikonomidis said.

Alongside this debt, the cost of malpractice insurance has risen, going from a reported average of $55,947 in 2005 to $59,673 in 2009. The cost varies greatly by region—surgeons in the New England area reported premiums more than three times as high as those in the Pacific region.

Strong Showing for STS National Database
The survey results highlighted the relevance of the STS National Database, as 84% of all respondents said they participated. Of note, more than 50% of those who are not currently participating say they plan to join the Database in the near future. It was further reported that most of the costs associated with Database participation are paid by the respondents’ hospitals, indicating the value that these institutions place on this STS resource.

Future CT Surgeon Shortage?
According to the survey, the average age of a cardiothoracic surgeon is 53, and half of the currently practicing surgeons plan to retire in about 12 years. These data raise the possibility that a significant shortage of CT surgeons may develop as the US population ages.

To address this potential problem, Dr. Ikonomidis said it’s important to continue developing training paradigms that will attract the best and brightest students, such as the “4/3” paradigm and the integrated six- or seven-year paradigm. “These paradigms—which, for the most part, admit candidates immediately upon completion of medical school—may revitalize some of the enthusiasm for the specialty and allow us to move forward to train and increase the number of cardiothoracic surgeons for the perceived shortage that looms in the future,” he said.