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(Circulation. 2009;120:488-494.)
© 2009 American Heart Association, Inc.

Cardiovascular Surgery

Shortage of Cardiothoracic Surgeons Is Likely by 2020

Atul Grover, MD, PhD; Karyn Gorman, MSPA; Timothy M. Dall, MS; Richard Jonas, MD; Bruce Lytle, MD; Richard Shemin, MD; Douglas Wood, MD; Irving Kron, MD

From the Office of Research and Development, Department of Veterans Affairs, Washington, DC (K.G.); The Lewin Group, Inc, Falls Church, Va (T.M.D.); Children’s National Medical Center, Washington, DC (R.J.); Cleveland Clinic, Cleveland, Ohio (B.L.); University of California, Los Angeles (R.S.); University of Washington, Seattle (D.W.); and University of Virginia, Charlottesville (I.R.).

Correspondence to Atul Grover, MD, PhD, Director, Government Relations, Association of American Medical Colleges, 2450 N St NW, Washington, DC 20037. E-mail agrover{at}aamc.org

Received April 1, 2008; accepted February 20, 2009.

Background— Even as the burden of cardiovascular disease in the United States is increasing as the population grows and ages, the number of active cardiothoracic surgeons has fallen for the first time in 20 years. Meanwhile, the treatment of patients with coronary artery disease continues to evolve amid uncertain changes in technology. This study evaluates current and future requirements for cardiothoracic surgeons in light of decreasing rates of coronary artery bypass grafting procedures.

Methods and Results— Projections of supply and demand for cardiothoracic surgeons are based on analysis of population, physician office, hospital, and physician data sets to estimate current patterns of healthcare use and delivery. Using a simulation model, we project the future supply of cardiothoracic surgeons under alternative assumptions about the number of new fellows trained each year. Future demand is modeled, taking into account patient demographics, under current and alternative use rates that include the elimination of open revascularization. By 2025, the demand for cardiothoracic surgeons could increase by 46% on the basis of population growth and aging if current healthcare use and service delivery patterns continue. Even with complete elimination of coronary artery bypass grafting, there is a projected shortfall of cardiothoracic surgeons because the active supply is projected to decrease 21% over the same time period as a result of retirement and declining entrants.

Conclusion— The United States is facing a shortage of cardiothoracic surgeons within the next 10 years, which could diminish quality of care if non–board-certified physicians expand their role in cardiothoracic surgery or if patients must delay appropriate care because of a shortage of well-trained surgeons.

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CLINICAL PERSPECTIVE

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Clinical Summaries
Circulation 2009 120: 459-460. [Extract] [Full Text]