STS News, Fall 2016 -- Professional satisfaction is high among cardiothoracic surgeons. A recent survey of STS members found that 73% of practicing cardiothoracic surgeons are satisfied, very satisfied, or extremely satisfied with their careers.
The findings come from the 2014 STS Practice Survey, the latest installment of surveys conducted approximately every 5 years since the early 1970s to provide the specialty with a better understanding of demographics, practice patterns, caseloads, and other trends in cardiothoracic surgery practice.
The 63-question survey was sent to 4,343 STS Active and Senior Members between October 1 and November 5, 2014. A total of 1,262 (29.1%) responded. The results will be published in the November issue of The Annals of Thoracic Surgery; an article in press is now available on annalsthoracicsurgery.org.
“This survey found that CT surgeons are pleased with their jobs and are managing to maintain stable operative volumes,” said John S. Ikonomidis, MD, PhD, who wrote the Annals paper. “We are expanding our armamentarium of surgical techniques and becoming very outcome and quality savvy.”
Shift to Employment Model Seen
A much higher percentage of surgeons than in past surveys (76%) reported being employed by a third party in some fashion.
“I think the employment model is becoming more attractive because of the juxtaposition of the declining earning power of the CT surgeon with the need for increased nonsurgical resources to track and report the myriad outcome and quality metrics currently required by CMS and other reimbursement carriers,” Dr. Ikonomidis said.
One way surgeons can track such information is through the STS National Database. Participation in the Database exploded in the 2014 survey—89.9% of respondents said they participated, compared with only 35.4% in the 2009 survey. This may be because participation in a comparative database has essentially become mandatory at many institutions, Dr. Ikonomidis theorized. There also is significant patient and media interest in public reporting of outcomes.
Financial Burdens a Concern
The length of training for a cardiothoracic surgeon doesn’t come without a financial impact. The percentage of respondents who said they had $60,001 or more of debt has steadily risen over time, from 24.4% in 2005 to 30.0% in 2009 to 34.2% in 2014. This partially may be explained by the fact that many surgeons are spending additional training time developing specialized skills that will give them a competitive edge.
Similar to the 2009 survey, average malpractice insurance premiums ranged between $54,310 and $57,402, and most surgeons (71.7%) reported that their individual premiums had stayed the same over the past 2 years.
"We are expanding our armamentarium of surgical techniques and becoming very outcome and quality savvy."
The survey cemented the fact that the cardiothoracic surgery workforce is getting older. The percentage of surgeons aged 60 years or greater was 29.1%, compared with 25.7% in 2005. As the demographic continues to age and surgeons retire, the remaining workforce may need to perform more surgeries, and patients may need to wait a little longer to have their elective operations performed.
“The primary issue here is surgeon availability. We currently are experiencing a shortage of CT surgeons to fill available jobs,” Dr. Ikonomidis said. “This could result in closure of smaller, rural programs and increased centralization of services to large, urban programs.”
Perhaps unsurprisingly, given the aging workforce and current shortage of surgeons, a majority of respondents (52.3%) said that their institution was planning to hire a new surgeon in the next 2 years. This is a shift from previous surveys, in which the majority did not plan to hire. Nearly 40% of these respondents indicated that they would be looking for surgeons with “special skills” to fill these vacancies.
On a positive note, the specialty is becoming more inclusive, with a higher percentage of female respondents (6.9%) than in 2009 (4.6%) or 2005 (3.0%).
Operative Load Increasing
Clearly, there is demand for the services of cardiothoracic surgeons, as nearly half of the respondents (42.6%) said that their total major operations performed increased in the last 12 months, while previous surveys found that operative load had stayed the same or decreased.
The most commonly performed procedures included Maze (any technique) for atrial fibrillation, off-pump coronary artery bypass grafting surgery, thorascopic lobectomy, and right thoracotomy mitral valve replacement/repair. Only a small percentage of surgeons (7.6%) said that they frequently performed minimally invasive cardiac surgery; less invasive approaches were somewhat more commonly utilized among general thoracic surgeons, with 38.5% reporting that they used them 41% or more of the time.
In addition, a majority of respondents (68.7%) reported that they worked at least 61 hours per week. But despite the increased workload, cardiothoracic surgeons love the job. “Cardiothoracic surgery is a fast-paced, highly technical, very satisfying specialty,” said Dr. Ikonomidis. “The best things are the patients, the cases, teaching opportunities, and the exciting research directions we are taking; I think my colleagues would agree.”