When you need surgery, How long will you wait? (and will there be anyone to perform the operation?) The on-going surgeon shortage now affecting South Australia.
There is more evidence of the changing demographics of healthcare and an aging population and its effects world-wide on cardiothoracic surgery as the Australian newspaper, Herald Sun published reports of lengthy patient waiting lists for surgical procedures including procedures categorized as “urgent.”
Long lines and waiting lists
More concerning, is the report of the number of patients who have died waiting for surgery*.
The report, which focuses on the Southern region of Australia highlights the shortage of specialty surgeons and the growing numbers of patients affected by these shortages.
Critics of the Australian government have also voiced concerns over the Surgeon Workforce project which aims to partially alleviate these shortages by using foreign-trained surgeons and imported labor. This comes at a time when Australia actually has an oversupply of general practice or internal medicine physicians.
The shortage of well-trained surgeons is affecting all surgical specialties but the cardiac and thoracic surgery specialties are particularly hard hit due to the lengthy, rigorous (and often costly) training regimen in many countries.
In the United States, this process is also exacerbated by an antiquated, sometimes arbitrary or impractical practice for residency placement that discourages international medical students. This, along with other concerns (legitimate as well as political) that govern the regulations that permit overseas graduates to practice in the United States restricts the possibility of reducing the growing shortage in a similar manner.
The lengthy educational process is not the only factor. Many medical students cite the strenuous work schedules, diminished job satisfaction and physically challenging surgical lifestyles as reasons medical students are choosing other specialties which are seen as being equally or more lucrative but allowing more work-life balance.
Similar shortages have been reported in Canada, the United States and the United Kingdom.
* Many international readers have asked if this is what is affecting the Americans Veteran’s Administration hospital system. Not really, (or if so, only partially). Th VA Scandal is a tragic example of the bureaucratic red tape that is becoming far too frequent for Americans seeking medical services.
a record number of surgeons fail to pass the American thoracic surgery certification exam, in the midst of a deepening shortage of surgeons.
A new report from the (American) Board of Thoracic Surgery shows a growing number of eligible surgeons are failing the thoracic surgery certification examination.
Record Failure Rate
As stated in the article published at Family Practice News, the failure rate has doubled to 28% in just a few short years. This comes at a critical period in American medicine as shortages in specialty surgeons have emerged around the country due to an aging workforce. This shortage is not confined to the United States – and has been echoed in Canada, the UK and several other industrialized nations.
Decrease in resident hours = decreased surgical knowledge
This record failure rate comes in the wake of recent reforms to resident surgical education – including several reductions in resident training hours, and the push for a condensed 6 year residency program.
Rapidly evolving surgical technology
At the same time, rapidly evolving surgical technology and research in thoracic surgery may actually require significant curriculum changes and increased length of specialty training, according to this report at Thoracic Surgery News.
But, as previously reported, the extensive training requirements for cardiothoracic surgery have led to fewer residents and widespread vacancies in residency programs as fewer and fewer surgical residents elect to devote themselves to cardiothoracic surgery due to concerns about diminishing financial returns, reduced economic opportunities, excessive student loan burdens and concerns related to the hardships of the ‘cardiothoracic lifestyle’.
Solo Cardiac, General Thoracic tracks may trump combined “Cardiothoracic”
Alternatively, North American surgeons may need to follow the example of many of their international peers and diverge into two separate tracks: cardiac surgery and general thoracic to maintain surgical proficiency without excessive education burden in an era of rapidly evolving surgical knowledge.
Additional Recommended Reading:
Ann Thorac Surg. 2009 Aug;88(2):515-21; discussion 521-2. doi: 10.1016/j.athoracsur.2009.04.010.
What is the future of thoracic surgery? Who are our brightest and best young surgeons? Who are the upcoming surgeons of tomorrow?
The future of Thoracic Surgery and the impending shortages of thoracic surgeons is something I’ve talked about before on my sister sites, but since it’s integral to any discussion on thoracic surgery – I’ve re-posted some of my thoughts here.
In discussions on the growing medical tourism phenomenon, we talked about the fact that these shortages, not cost, will soon be the driving force behind the outsourcing of American health care.
We also talked about the need to interview thoracic surgeons in other locations, tour their facilities, observe surgeries and evaluate the care – to establish our international networks now, in:
But, as this site grows and matures, I would also like to start profiling some of the wonderful and talented surgeons I have been interviewing and meeting during my travels. I also [and this is a big leap] would like to do MORE travelling, as part of an effort to meet more of our thoracic surgery counterparts all over the globe – and bring them here, to you, my readers.
K. Eckland ACNP
For a snapshot of Thoracic Surgeons (dated to 2002), the profession, and projections – this article gives an excellent overview.
Impending Thoracic Surgery Shortage – unable to fill residencies (2008)
Thoracic surgery education; Past, Present and Future (2005) – shortage projections, educational requirements and implications for the future