I doubt its 350k, and even if it is that you have to consider the long training period, high loan costs, high insurance costs etc. Whatever the figure is we seem to be developing a shortage of cardiac surgeons.
Cardiac surguns go through over a decade of training and can have hundreds of thousands of dollars in student loans to pay back.
--
Bill of Health - Surgeon Shortage
Wednesday, July 26, 2006
JEFF YASTINE, NBR CORRESPONDENT: It sounds unlikely. How could the best and brightest of medical grads not be drawn to one of the glamour jobs of the profession, being a heart and lung surgeon? The work is rewarding, but the training period is longer, the hours are longer, and the pay is "not" competitive with other specialties. That's keeping lots of medical grads away these days.
Good morning and how are you getting along?
YASTINE: Doctor Robert Cline is a thoracic surgeon, operating on the hearts and lungs of patients who need his skills with a scalpel. But after nearly four decades of practice, he and other thoracic surgeons could become a rarer breed of doctor in the years ahead.
The problem? Of the nation's 3500 thoracic surgeons, about half are expected to retire in the coming decade. But the training of a new generation of thoracic surgeons has fallen woefully short.
DR. ROBERT CLINE, THORACIC SURGEON: And we're most concerned now because this year we have 126 training spots for residents for heart and lung surgery, only 91 people applied for those 126 positions. And this is the third year where we have this reduction in people, medical students, graduating and applying for these residencies. And we're concerned. We don't know where they're going to come from.
YASTINE: The Association of Thoracic Surgeons says med-school graduates are avoiding the specialty for one main reason -- money. The specific problem is declining Medicare reimbursement rates.
DR. BLAIR MARSHALL, CHIEF OF THORACIC SURGERY, GEORGETOWN UNIVERSITY HOSPITAL: The reimbursements for cardiac surgeons have been cut every year to the point that now, cardio-thoracic surgeons make about 35 percent per procedure of what they were billing for back in the late 1980's. If you take into account inflation, the Medicare cuts have to stop.
YASTINE: Established surgeons like Cline have seen those declining reimbursement rates first hand.
DR. CLINE: I did an open heart operation on a man with whom I'd done a first heart operation about 7 or 8 years ago. The second operation was even more difficult. However, the reimbursement will probably be half of what it was 8 or 10 years ago. So surgeons are basically saying, "I just can't do it anymore."
YASTINE: There are other problems. Training for thoracic surgery takes eight years - longer than most specialties. But med students have to start paying back their loans after four years. Thoracic surgeons say that's yet another financial disincentive, driving more med-school grads away from the field.
The American Association for Thoracic Surgery has been lobbying Congress, unsuccessfully, for changes in Medicare reimbursement, and longer loan payback periods. Surgeons say until there's a breakthrough, the brain drain in thoracic surgery is likely to continue. Jeff Yastine, Nightly Business Report, Bill of Health.
pbs.org
---
Training
After four years of medical school, these highly-trained doctors spend from six to eight more years in specialized training. A cardiologist receives three years of training in internal medicine and three or more years in specialized cardiology training. A pediatric cardiologist receives three years of training in pediatrics, and three or more years in specialized pediatric cardiology training. A cardiac surgeon must complete five years of training in general surgery before starting a two-or three-year cardiothoracic training program. Some cardiac surgeons have additional training to perform pediatric or transplant surgery.
acc.org
---
Heart surgeon pay plans range from production to equal shares
Cardiac and thoracic surgery practices, buffeted by loss of business to interventional cardiologists and by steep cuts in reimbursement rates, have in many cases adopted equal shares pay plans or hybrid plans with significant equal shares and production elements.
"No specialty has been harder hit" by Resource-Based Relative Value Scale revisions than has cardiothoracic surgery, says Marty O'Neill, CEO of the Heart Group in Evansville, Ind. CMS engineered a massive shift of relative value unit (RVU) procedure values from surgery to office evaluation and management visits, he notes (PCR 5/02, p. 8).
Income has been falling for almost all heart surgeons for several years, says Donald Philip, FACMPE, administrator of Northwest Surgical Associates in Portland, Ore. Stents and other procedures performed by cardiologists have reduced caseloads. Reduced government reimbursement also hurts. For instance, says Philip, a recent change in Oregon Medicaid eligibility has resulted in "more zero-pays than we've ever had."
However, a distinct shortage of cardiothoracic surgeons could develop over the next five to 15 years. Surgeons in the field have stuck with it despite income declines, Philip says, but enrollment for fellowships is way down in response to the declines. He adds that there probably will be many retirements from the field over the next 10 years. "It's a life-saving, end-of-line service," he notes.
Advertisement
A recent academic piece forecasts a 42% jump in cardiothoracic surgery procedures between now and 2020 (see story, p. 5), based on aging of the population and frequencies of various cardiothoracic procedures by patient age. Ronald Evans, CMPE, executive director of South Texas Cardiothoracic & Vascular Surgery Associates in San Antonio, predicts that despite the loss of procedures to cardiology, there will be plenty of demand for cardiothoracic surgery over the next 10 to 15 years unless a drug is developed that "wipes out atherosclerosis," the disease syndrome that underlies most heart disease...
findarticles.com
---
I really enjoyed meeting Ben, Tea, Mark, Chand, and Tom Martin at the meeting. Until I saw Tea, I'd never seen anyone with a leather holster for their cell. Tea, Mark, and I had a nice dinner with Neil Kon. The hot topic, besides mitral repair, was discussing the fact that, for the upcoming match, there were only 43 applicants for 130 CT surgery slots in US and Canada. My earlier advice to radically cut down the number of programs looks like it'll happen due to market forces. Obviously, word has gotten out to students and residents that cardiac surgery ain't what it used to be. Draconian cuts in reimbursement along with eroding cardiac surgical volumes have produced the finally expected effect. Neil seems to think that there will be a shortage of cardiac surgeons within 5-10 years. Hope he's right, but I'm afraid the public
will pay.
hsforum.com
---
As for "single payer" as a solution -
/Dec/2000 Wanted: Cardiac surgeons
By: AARON DERFEL
Quebec is suffering from a severe shortage of cardiac surgeons - one of the main factors in the lengthy waiting lists, the chief heart surgeon at the Jewish General Hospital said yesterday.
At present, there are 38 cardiac surgeons for the whole province when ideally there should be 48, said Dr. Yves Langlois. Compounding the problem is that half of the surgeons are expected to retire within the next 10 years.
7/Dec/2000 Heart-surgery waiting list up by 28 per cent
By: AARON DERFEL
The number of patients waiting for heart surgery has jumped by about 28 per cent this year on Montreal Island, despite millions of dollars in provincial spending to shorten waiting lists.
Some patients at Notre Dame Hospital have been biding their time at home for more than a year as surgeons struggle with a mounting backlog of cases, the chief of cardiology said yesterday.
wednesday-night.com
Physicians' Concerns
Mr. Stuart Murray (Leader of the Official Opposition): My question to the Premier was about the report that was received on December 6, 2001. Mr. Speaker, I understand that members of these departments voiced their concerns about the shortage of cardiac surgeons in Manitoba and the negative impact this shortage is having on patient care. Indeed, they noticed that some actions taken were not in the best interests of patient care.
Can the Premier indicate if he or the Minister of Health (Mr. Chomiak) met with any of the surgeons or physicians regarding their concerns about Manitoba's cardiac surgery program and what action they have taken to address those concerns?
Hon. Gary Doer (Premier): Mr. Speaker, we were advised pursuant to the Wade-Bell report, and after the former government rejected the Wade-Bell recommendation to have one administration and two sites. We were strongly advised that our ability to retain cardiac surgeons and ultimately recruit cardiac surgeons would be jeopardized with the recommendation to have just the one site. So we went with the Wade-Bell recommendation as I recall it. We believe, over time, especially when maintaining the cardiac surgical centre at St. Boniface Hospital that was slated for closure in 2001 and maintaining and enhancing the operating theatres in the Health Sciences Centre, we think will strengthen our position.
One of the weaknesses we have had in cardiac surgery has been a shortage of nurses with different–[interjection] Well, a lot of surgeries, with the greatest of respect, when you fire 1000 nurses it does sometimes have an effect on the number of operations that are conducted. We are working very hard to rebuild our nursing capacity in health care.
gov.mb.ca
Mrs. Driedger: Mr. Chairperson, the minister has been very evasive about dealing with the number of cardiac surgeons in Manitoba, and certainly we have heard that we have nine. We now only have five. We appear to be short. That is verging on almost half of the surgeons that we would normally have.
gov.mb.ca |
