A growing concern for cardiothoracic surgeons like Dr. Jeffrey Morgan is the anticipated shortage of specialists in their field within the coming two decades. Having graduated from Albert Einstein College of Medicine in 1999, Dr. Morgan underwent his general surgery residency at Mount Sinai from 1999 to 2005. After completing his cardiothoracic surgical residency in 2007 at New York University, he furthered his training with a fellowship at Columbia Presbyterian.
Shortage
In a study conducted by Dr. Susan Moffat-Bruce and her team from Ohio, it was found that by the year 2035, there will be a critical shortage of cardiothoracic surgeons in the United States. They presented their findings at the 96th annual meeting of the American Association of Thoracic Surgery in Baltimore, MD in 2016. Having used data from the American Board of Thoracic Surgery (ABTS), they found that there were approximately 4000 practicing cardiothoracic surgeons who performed over half-a-million procedures in 2010. To estimate the number of cases that would require the specialty, they consulted the Census Bureau to find population projections for 2035 which estimated approximately 853,912 cases.
With a 61% increase in cases alone, surgeons would likely experience a caseload increase of approximately 121%. According to Dr. Jeffrey Morgan, these statistics may be attributed to a simple supply and demand model; with an aging population prone to cardiovascular disease along with a decreasing number of professionals practicing as cardiothoracic surgeons, he predicts that there will be a significant need for medical professionals in this specialty.
Aging Population
It is estimated that by the year 2035, the population of the USA will be approximately 389 million, with about 77 million individuals being over the age of 65. This age group is more prone to heart disease and frequently require the services of cardiothoracic surgeons. With this population almost doubling within a 25-year time frame, this is going to put a great amount of strain on the specialty.
Dr. Jeffrey Morgan explains that alongside cardiac illnesses, lung and esophageal disease are part of the scope of a cardiothoracic surgeon. In the study by Moffat-Bruce et al., they estimated that the proportion of procedures being performed on those above 65 would be approximately 50% for cardiac related surgeries, 63% for esophageal procedures, and about 70% for lung related surgeries. It was using these estimates and the projected population that the group was able to come up with the estimated number of cardiothoracic cases for 2035. As the generation X and baby boomers age, this crisis is only going to get worse for not only cardiothoracic surgery, but also most healthcare fields.
Rise of Cardiothoracic Diseases
Another cause for increased demand of cardiothoracic surgeons is the rise in both incidence and prevalence of cardiovascular and lung diseases, with one of the top reasons being the obesity epidemic. Dr. Jeffrey Morgan claims that the National Center for Health Statistics estimated that almost 40% of all adults (ages 20 and above) were considered to be obese in 2016, while an additional 32% fell into the overweight range, with another estimate by the CDC in 2014 showing that 17% of children from the ages of 2-17 were obese. These rates have been rising at alarming rates, increasing four-fold in a span of 14 years alone from 1986-2000, with morbid obesity rates rising five-fold in the same time period. This population is at high risk for both all-cause mortality, as well as many cardiovascular health diseases such as hypertension, hypercholesterolemia, and diabetes mellitus type II. All of these contribute to poor heart health and can eventually lead to needing cardiac surgery. With childhood obesity on the rise, these are the patients that will have the increasing need to be seen by a cardiothoracic surgeon in the coming couple of decades. Medical expenses in this patient population is approximately $147 billion annually and will grow an additional $1.24 billion annually until 2030.
Another risk factor that is on the horizon is the increasing use of vaping products, such as Juul. While statistics have shown an overall decrease in the number of people using traditional cigarettes, more and more people, especially adolescents, are beginning to use electronic cigarettes and other vaping products. Dr. Jeffrey Morgan states that the trend is still fairly new and not enough studies have been conducted on the safety of these products, especially on the lungs. Preliminary evidence has shown that although not as harmful as cigarettes, these products still pose a large risk to the population and should be used with care. Damage to lungs and the cardiovascular system as a whole should be considered, and it can be estimated that this population will also cause an increasing demand on cardiothoracic surgeons in the future.
Decreasing Number of Specialists
While the demand for cardiothoracic surgeons increases, the supply of them has continually decreased over the years. Between 1996 and 2014, only 2335 new certifications were given out by the ABTS, averaging 123 new cardiothoracic surgeons yearly. The problem here is that in actuality that number has only been 90 per year since 2014, and that is expected to drop even lower in the coming years.
Not only are medical students, and surgical residents shying away from the specialty causing a significant gap, those that are choosing to go into the specialty are having difficulty passing board examinations. Dr. Jeffrey Morgan found that approximately 30% of cardiothoracic surgeons have been failing the oral examinations, with 20% failing the written component. If the rate of 90 new specialists yearly continues, it is estimated that less than 3000 cardiothoracic will be practicing by 2035, as an estimated 133 will be retiring yearly. This deficit of 43 surgeons yearly, taken along with the increasing demand will lead to workloads almost impossible to deal with by 2035. Currently the caseload sits at 135 per physician per year, but this is expected to rise to 299, an increase of 121%. Dr. Jeffrey Morgan believes that the ABTS along with other organizations must work together to help prevent this crisis from occurring over the next couple of decades.
