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At a standing-room-only presentation at STS 2024, STS Past President Dr. Mike Mack and Dr. Cherie Erkman presented data from the STS’ first annual survey on surgeon compensation. 

The first-of-its-kind survey, conducted in October 2023, was designed to help US-based cardiothoracic surgeons understand their value and make informed career decisions using reliable benchmarks specific to the specialty. 

“There is a lot of data out there on what cardiothoracic surgeons are paid, but that data is all over the place,” said Dr. Mack, chair of the Compensation Taskforce appointed by STS President Tom MacGillivray. “Understanding compensation begins with accurate data. That was the genesis behind conducting the survey.”

Nearly 850 STS members participated in the survey, a 27% response. Participants provided information on their total annual compensation, including salary and compensation related to RVUs/productivity – which represents about 80% of compensation – and other services provided. The survey also captured subspecialty, career stage, gender, ethnicity, geographic location, service area, and employment model. 

The survey affirmed expected pay differences between specialty, practice, career stage, and geography, as well as gender pay disparities between men and women surgeons, according to Dr. Erkman. Her analysis revealed that women cardiothoracic surgeons earn between 64 to 84 cents for every dollar their male counterparts earn, depending on their specialty.

While cardiothoracic surgeons provide tremendous value to the patients and institutions they serve, it has been a challenge to understand that value and translate it into fair compensation, explained Dr. MacGillivray. “This survey gives us a starting point,” he said. “We need to understand where there are disparities and inequities, and then fix them.”

“I’m proud of STS and Dr. MacGillivray for taking action to help us better understand compensation in our specialty and shine a light on pay disparities,” said Taskforce member Dr. Shanda Blackmon. “This gives women surgeons the knowledge and power we need to advocate for ourselves.”

The limited sample size produced some regional variability, Dr. Mack said, and the data do not reflect that cardiothoracic surgeon residents and fellows are compensated far less than attending surgeons during their many years of training. 

“Cardiothoracic surgeons train for an average of 15 to 16 years and start their first attending job at age 34 or 35,” Dr. Mack explained. “Many accumulate significant debt during medical school and training.” A recent Thoracic Surgery Residents Association survey found that 53% of residents have more than $200,000 in debt.

Workload is not reflected in the report, Dr. Mack said, but US-based cardiothoracic surgeons work 65 to 80 hours per week, sometimes more, performing both scheduled and emergency operations. 

STS is working with consulting firm Gallagher, an expert in physician compensation and valuation services, to collect and analyze data, and produce an annual compensation report. Data collected by Gallagher is confidential and will not be shared with STS, explained Dr. MacGillivray. 

The 2023 Cardiothoracic Surgeon Compensation Report will be available in early February. STS members who participated in the survey will receive it at no cost. Members, nonmembers, and institutions interested in purchasing the report can add their name to the interest list.

“The Society plans to conduct the compensation survey annually. We encourage US cardiothoracic surgeons to participate every year so the report provides the most accurate data, and so they can receive the report for free,” said Dr. Mack.
 

During this session, investigators unveiled findings from the largest multicenter study of post-arterial switch operations (ASO) that resulted in increased survival rates for adolescents and adult patients – as well as an increase in the potential for these patients to require cardiac reoperations to address arterial switch related complications that arise later in life.

At day two's presentation on “Burden of Reoperative  Cardiac Surgery among Adolescents and Adults Who Have Undergone Prior Arterial Switch Operation: Society of Thoracic Surgeons Database Analysis,” Bret Mettler, MD, from Johns Hopkins University, examined a multi-year assessment of the prevalence and types of cardiac surgical interventions in patients who previously underwent ASO using data from the STS National Database. 

“Anatomical repair of transposition of the great arteries (TGA) and related anomalies by arterial switch operation (ASO) achieves a normal anatomic and physiologic cardiac configuration,” said Dr. Mettler.  “And as survival rates have increased, so have the potential for these patients to require cardiac reoperations to address resulting ASO-related complications.”

As most reoperations involved multiple procedures, the presentation examined how a hierarchical stratification of procedure categories was established, with each eligible surgical hospitalization assigned to the single highest applicable hierarchical category.
  
Dr. Mettler's presentation also examined implications for surgical counseling, post-operative clinical surveillance, and therapeutic management. An analysis of the role of procedural prevalence, timing, categories, trends, and the growing number of reoperations was discussed.

An engaging presentation on day two of STS 2024 focused on how socioeconomic disadvantage is associated with inferior patient survival following heart transplantation, while closely examining how future efforts and national policy changes are needed to improve longitudinal follow-up care and address systemic barriers to necessary healthcare. 

“Hospital Volume Does Not Mitigate the Effect of Community Socioeconomic Deprivation on Outcomes of Heart Transplantation” was given as part of the J. Maxwell Chamberlain Memorial Papers Perioperative and Critical Care Surgery session. 

Sara Sakowitz, MS, MPH, from UCLA David Geffen School of Medicine, reported on the independent association between neighborhood area deprivation and survival following heart transplantation, showing that patients who live in socioeconomically deprived communities demonstrate inferior long-term outcomes.
 
“These disparities were not mitigated by receiving care at high-volume heart transplantation centers and have persisted over the last two decades,” said Ms. Sakowitz. “Our study findings underscore the need to improve access to and engagement with longitudinal follow-up care, remove barriers to medication and appointment non-adherence, and directly address the underlying and systemic root causes of community-level inequities in transplant outcomes.“

This talk demonstrated the need for a team-based, collaborative approach to solve the issue. Clinicians and hospitals should consider implementing certain programs for their own communities – including expanded patient navigator services, social support groups, and clinical pharmacy services.

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“Over the past year, the STS has reaffirmed our mission to improve the lives of patients with cardiothoracic disease. We have revised our strategic plan and identified three top priorities: champion the value and impact of the specialty; advance the health, well-being, and inclusion of all cardiothoracic surgeons; and enhance the STS member value and educational experience.

It’s been an extraordinary year. We have been champions of the specialty and champions of each other. Thank you for the honor of being your president.”

STS President Dr. Tom MacGillivray

The Hub made its debut at STS 2024. In the Exhibit Hall, meeting participants attended the "Early Career Journey Roundtable: Trade Secrets for a Successful Career Journey," creating peer-to-peer connections while networking. 

Watch our day two wrap-up video!

Watch our day three wrap-up video!

Shortly after the 60th STS Annual Meeting began, a packed crowd attended the "Trends and Research from the STS Adult Cardiac Surgery Database (ACSD)" session, beginning with a presentation by Michael E. Bowdish, MD, of the Smid Heart Institute, Cedars-Sinai Medical Center. He looked back at the origins of the ACSD, which was established in 1989 to collect information on cardiac surgery procedures, track outcomes, and provide insights into opportunities for quality improvement. 

Today – more than three decades later – the Database offers more than nine million recorded procedures making it one of the most comprehensive, robust, and sophisticated contemporary clinical databases in use.   

For example, 95% of centers performing coronary artery bypass grafting (CABG) in the United States, and 97% of patients receiving CABG are included in the STS ACSD. Every year 10% of the participating sites undergo a data audit assessing data accuracy and completeness with strict thresholds to pass quality control. Continuous education of data managers is a further element to ensure data quality. 

"STS ACSD is a vital source of data for outcomes research quality improvement, with overall volumes that are stable with notable trends in aortic surgery," said Dr. Bowdish.

The STS ACSD has provided the foundation for national benchmarking in adult cardiac surgery through the development of regularly updated and recalibrated risk models and performance metrics, the availability of feedback reports to database participants and individual surgeons, quality-improvement efforts, voluntary public reporting, and comparative effectiveness research. 

Opening remarks were given by STS President Tom MacGillivary, MD, who introduced the C. Walton Lillehei Lecture from Mortimer J. Buckly, Chairman & CEO, Vanguard.

During the Plenary Speaker event on the main stage, Illya Yemets, MD, PhD, delivered his speech titled, "Ukraine Experience of Cardiac Care from 'Cradle to Longevity' During Russian Invasion," while poignantly reflecting on the past, with hope for the future of Ukraine, which “will not survive without help.”

Congratulations to the winners of this year's CT Surgery Resident Showdown Champions from ... the University of Iowa!

Watch our day one wrap-up of video!