Cardiothoracic Surgery at a Crossroads: Trust, Stability, and the Future of the Workforce

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We entered this specialty knowing it would be challenging yet deeply rewarding. The hours, the weight of the operating room, the conversation with a family when things did not go as planned—we accepted all of it. What many of us did not anticipate was a different kind of difficulty: trying to practice, grow, and lead inside systems that are themselves under profound strain.

The numbers now confirm what many surgeons have long felt quietly. HRSA projects a 31 percent shortfall of cardiothoracic surgeons by 2035—the largest projected shortfall of any physician specialty it evaluated¹. A recent survey of cardiothoracic surgeons found that 40.9 percent of respondents had experienced bullying during their careers².  And our specialty has become overwhelmingly institutional: more than three-quarters of thoracic surgeons now practice in hospital-based or academic settings, with independent private practice increasingly the exception³—part of a wider shift across U.S. medicine, where the share of physicians in wholly physician-owned practices fell from 60.1 percent in 2012 to 42.2 percent in 2024⁴.

These are not abstract statistics. They are the background behind surgeons who keep working, keep covering, and quietly wondering what kind of support will allow them to keep serving.

Consolidation has reshaped our labor market in ways we are still learning to name honestly. In many regions, one or two dominant systems may function as the only realistic employers. Restrictive covenants and noncompete agreements—which the Society of Thoracic Surgeons has recognized as a barrier to specialized care—can make mobility and career recovery more difficult¹.When programs merge, volumes shift, contracts change, and reporting structures are realigned, a surgeon's professional life can be disrupted not because of a failure of commitment or character, but because the system around the surgeon changed.

When surgeons cannot raise concerns early and honestly, the consequences are rarely confined to the individual. Psychological safety—the lived ability to raise a concern, ask for support, or say “this environment is not working” without fear of professional consequence—is not simply a wellness concept. It is operational. Its absence affects teams, outcomes, and the people who hold everything together⁵. We were trained to project steadiness. That training saves lives in the operating room. Outside it, it can delay honest conversations until the cost of not having them becomes very high.

Commercial aviation faced a similar reckoning. In the 1970s, catastrophic failures occurred not because pilots lacked skill, but because cockpit culture made it difficult to challenge authority. Aviation's answer was not to demand more toughness. It was to redesign the system. Crew Resource Management—formalized after a 1979 NASA workshop—flattened authority gradients and made speaking up an expectation rather than an act of courage, helping transform flying into one of the safest endeavors in modern life⁶. Surgery borrowed aviation's checklists. We have been slower to borrow its deeper lesson: excellence is fragile when the culture around it makes honesty difficult.

Our field is facing its own version of that reckoning. None of this is anyone's fault. Hospitals are navigating genuine financial, staffing, and regulatory pressures of their own. But the absence of blame does not mean the absence of responsibility. Asking surgeons to be more resilient without examining the structures around them is incomplete. Strengthening those structures is part of leadership.

The remedies are not novel, and I have argued for them at greater length elsewhere: transparent expectations before recruitment; honest conversations when difficulties arise; compensation that rewards outcomes and relationships, not volume alone; governance that distributes operative opportunity and builds succession; peer review that is educational rather than punitive; and mentorship that is protected, consistent, and real⁷.

This is also a call to how we treat one another. We should be careful not to mistake a linear resume as the only marker of reliability. We can hold high standards without personal diminishment. We can review complications without reducing a colleague to one. We can recognize that a non-linear career—shaped by research, family constraints, locum work, program rebuilding, or the search for a better fit—may reflect resilience rather than risk.

Some of the most capable surgeons I know are those who had to rebuild, who stepped into coverage roles when programs needed help, and who kept operating through transitions that would have unsettled anyone. Their records may show movement; their work shows endurance.

Before any policy changes, each of us can treat the colleague whose path looks unconventional, or who is quietly struggling, as a full peer worth keeping—in the hallway, in the hiring committee, and in credentialing review. That shift costs nothing, and it is where every durable culture begins.

The future of our specialty will not be determined by innovation alone. It will be determined by whether we build environments where good surgeons can find a stable place to contribute, recover, grow, and lead at different stages of their careers. That is a workforce question, a patient-safety question, and a question of who we choose to be for one another.

We have mastered the training of exceptional cardiothoracic surgeons. The next challenge is workforce stewardship: the deliberate work of supporting, retaining, and developing surgeons through the transitions, disappointments, recoveries, and renewals of a long career. The future of our specialty may depend not only on producing exceptional surgeons, but on building environments worthy of their long-term commitment.

A humane specialty is not a weaker one. It is a more durable one. And in surgery, durability is what keeps patients safe—and allows good surgeons to keep serving.

Dr. Jeffrey Shuhaiber is a practicing cardiovascular surgeon and physician-investigator in Boston. He is the author of “Ethical Leadership in Cardiothoracic Surgery in an Era of Consolidation: A Framework for Trust, Transparency, and Workforce Stability,” published in the May 2026 issue of The Journal of Thoracic and Cardiovascular Surgery.

References
     1. The Society of Thoracic Surgeons. Advocacy issue: physician workforce [Internet]. Chicago: The Society of Thoracic Surgeons; 2026 [cited 2026 May 31]. Available from: https://www.sts.org/advocacy-issue-physician-workforce
     2. Sydorenko AY, Spindler H. Exploring bullying in cardiothoracic surgery: the role of psychological safety and personal traits. Cardiol Young. 2024;34(9):1-5. doi:10.1017/S1047951124025198
     3. Daniel J, DeCamp M, Romano J, Tong B, Moulton M, Mitchell J, et al. Understanding our thoracic surgery workforce: who, what, and where we practice. JTCVS Open. 2025;28:760-767. doi:10.1016/j.xjon.2025.08.016
     4. Kane CK. Physician practice characteristics in 2024: private practices account for less than half of physicians in most specialties [Internet]. Chicago: American Medical Association; 2025 [cited 2026 May 31]. Available from: https://www.ama-assn.org/system/files/2024-prp-pp-characteristics.pdf
     5. Edmondson A. Psychological safety and learning behavior in work teams. Adm Sci Q. 1999;44(2):350-383. doi:10.2307/2666999
     6. NASA Aviation Safety Reporting System. Crew resource management [Internet]. Moffett Field (CA): NASA ASRS; 2003 [cited 2026 May 31]. Available from: https://asrs.arc.nasa.gov/publications/callback/cb_279.htm
     7. Shuhaiber J. Ethical leadership in cardiothoracic surgery in an era of consolidation: a framework for trust, transparency, and workforce stability. J Thorac Cardiovasc Surg. 2026;171:1169-1176. doi:10.1016/j.jtcvs.2026.02.010