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Heart Surgeon Shortage Predicted
Date:7/28/2009

Trend toward stenting rather than bypass could be a cause, expert says,,,,

TUESDAY, July 28 (HealthDay News) -- Over the next 15 years, there could be a severe shortage of cardiothoracic surgeons at a time when an aging population will probably increase the demand for surgical procedures that fall under their purview, a new study predicts.

The shortage could lead to diminished quality of care and delays in care for people needing heart and lung surgery, according to the study, which was done by the Center for Workforce Studies at the Association of American Medical Colleges.

By 2025, the researchers say, there could be a 46 percent increase in the demand for cardiothoracic surgeons, but a drop of at least 21 percent in the number of available surgeons.

The looming shortage of surgeons is a matter of supply and demand, said lead researcher Dr. Atul Grover, director of government relations for the association.

"We have not managed to keep up with population growth over the last two decades, so our physician production has stagnated to a point where the number of new entrants into the physician workforce is not going to be enough to keep up with the number of folks retiring," Grover said.

On the demand side, he said, the number of people over age 65 is expected to double in the next 20 years, from 35 million to more than 70 million.

"Those are the people who use the greatest number of health services," Grover said. "Those are the ones with cardiac disease. Those are the ones with pulmonary disease. And those Medicare beneficiaries are the ones who are really going to suffer without an adequate physician workforce."

The conclusions stem from the researchers' analysis of general population data as well as health-care workplace information, using various scenarios to predict what could happen. Their findings are published online July 27 in Circulation.

The number of active cardiothoracic surgeons has fallen for the first time in 20 years, according to the report.

In 2007, 33 percent of thoracic surgery fellowship positions went unfilled, the researchers reported. In addition, they said that residents in training in cardiothoracic surgery were having difficulty finding employment after completing five years of general surgery training and two years of a cardiothoracic surgery fellowship.

They speculated that this could be, at least in part, the result of a decrease in the number of people having heart bypass surgery, which is the most frequent operation done by cardiothoracic surgeons. The number of heart bypass surgeries fell 28 percent between 1997 and 2004, the study reported.

But over the same period, the use of stents increased 121 percent, it said. That procedure is usually done by cardiologists, not cardiothoracic surgeons.

"As we get better at identifying cardiac and pulmonary diseases earlier on and have better treatments for those diseases, you want to make sure you are adequately able to ... have the most qualified professionals treating those patients," Grover said.

Even if the number of people entering the cardiothoracic field were to increase, he said, there still would be a shortage in coming decades because of the expected increase in the over-65 population and the fact that it takes 10 years to train a cardiothoracic surgeon.

This shortage could result in significant waiting times before people get needed surgery and possibly in unnecessary complications and deaths, he said.

The expected shortage of surgeons comes at a time when cardiologists could also be in short supply, the study reported.

Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, said that a shortage of cardiothoracic surgeons could, indeed, create problems.

"The findings that the number of active cardiothoracic surgeons has fallen for the first time in 20 years and projections that demand for cardiothoracic surgeons will greatly exceed supply are of great concern," Fonarow said.

Cardiovascular disease is the leading cause of death and disability in the United States and is likely to remain so in coming decades, he said.

"Having well-trained and experienced cardiothoracic surgeons is essential for providing high-quality care and achieving good outcomes for cardiovascular patients that require surgical procedures," Fonarow said. "Health-care reform efforts need to ensure that there will be adequate funding and resources to provide this critical training, meet patient care needs and sustain the practices of cardiothoracic surgeons."

However, not everyone agrees.

"I think it is unnecessary to worry about a doomsday when we don't have enough cardiac surgeons," said Dr. Byron Lee, an associate professor of cardiology at the University of California, San Francisco.

"The recent decline in cardiac surgeons is expected since more patients are appropriately getting stents instead of bypass operations," Lee said. "If the need for cardiac surgery increases in the future, I would expect market forces to lead to the training of more cardiac surgeons."

More information

The American Heart Association has more on bypass surgery.



SOURCES: Atul Grover, M.D., Ph.D., director, government relations, Association of American Medical Colleges, Washington, D.C.; Gregg C. Fonarow, M.D., professor, cardiology, University of California, Los Angeles; Byron Lee, M.D., associate professor, cardiology, University of California, San Francisco; July 27, 2009, Circulation, online


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