Rising debts and decreased employment opportunities: the American landscape of thoracic surgery

$200,000 & counting: the escalating educational debt of thoracic surgery residents in the United States. Presenting the results of the 2010 Workforce Survey Report (Sarkaria et. al). Despite impending surgeon shortages of catastrophic proportions today’s new surgeons are unable to find full-time employment.

Sarkaria et al. (2011) recently published data from the 2010 Thoracic Surgery Residents Association Workforce Survey Report and the results are alarming.

In 2010 – there were 299 thoracic surgery* residents training in the United States.  Of these, 76% were US residents.   These residents are among the 11% of all graduating general surgery residents who are considering cardiothoracic surgery as a career.  Despite the low numbers of residents in a specialty anticipated to have severe shortages, the realities for many emerging thoracic surgeons remains bleak.

* 22% of thoracic surgery residents are pursuing a career in general thoracic surgery (versus cardiac only, or combined cardiothoracic).

With escalating outstanding educational debt and diminished job opportunities – the future of thoracic surgery in the United States remains uncertain.  But several facts are clear – the enormous costs of specialty surgical training are crushing obstacles for many residents considering a future in thoracic surgery.

In just three short years – the percent of thoracic surgery residents owing in excess of $200,000 more than doubled – from 8% in 2007 to 17 percent in 2010.  (Almost half of all thoracic surgery residents (46%) reported owing more than $100,000.)

At the same time – decreased cardiac surgery volumes, program closures, and delayed retirement among older surgeons (due to the prolonged economic recession in North America) decreased the amount of available positions for new and practicing surgeons.  This means that in spite of projected shortages of cardiothoracic surgeons in 2020, today’s new surgeons face an increasingly competitive and limited employment opportunities.  According to Sarkaria et. al.  while 80% of thoracic surgery residents had gone on job interviews, 47% were still actively looking for a position (at the time of the survey).  In fact, according to the study, 30% of residents were still jobless two weeks before completing their specialty training.

None of these issues are new – high vacancy rates have existed within specialty training programs for years.  In fact, many argue that these statistics argue for an overabundance of specialty training programs, creating an excess of surgeons.  But, we are now faced with a critical cross-roads between medicine and society, as record numbers of baby boomers (surgeons included) and their co-morbid conditions tax our medical system beyond all known resources.

Advances in technology (mainly in interventional cardiology) have falsely decreased surgical volumes to a point where numerous surgical programs have been vastly reduced or shuttered entirely.  But now, these [cardiac] patients are back for ’round two’ as preliminary and stopgap measures fail.  At the same time, skyrocketing rates of diabetes have led to an even younger generation of candidates for revascularization.  All of these cardiac surgery issues play into the development and training of thoracic surgery residents due to the current structure of the majority of American training programs.  (In this study, 30% of residents surveyed planned to practice in cardiac surgery only, with another 20 to 25% planning to perform both cardiac and thoracic procedures.)

As thoracic surgery techniques such as VATS, RATS, HITHOC and uni-port procedures grow increasingly complex, and specialized, only one-fifth of all cardiothoracic surgery residents devote themselves exclusively to thoracic surgery.  Lung cancers, and esophageal cancer cases are at an all time high, yet, without significant changes to our existing medical system and resident education programs, our emerging surgeons will have nowhere to practice.