The "rant"
What follows are the un-edited thoughts of a resident in cardiac surgery from a Canadian institution. The "rant" shows the frustration about the uncertain future of cardiac surgery and the difficulties faced by those trying to get a job today.
"While I applaud the recent focus of cardiovascular surgeons on the oversupply of cardiothoracic surgeons, I feel the need to express my viewpoint. After all, I am a resident in cardiac surgery, not a surgeon who has enjoyed a long and successful career!
Cardiac surgery has always been an academic and prestigious profession. This ivory tower mentality however, has also been its downfall. Current surgeons have only recently begun to pay attention to the crisis we face. Despite promises of the future, volumes are slowly eroding. This has encouraged surgeons to look at their own financial futures and perhaps even think about how recent graduates will possibly survive. If it wasn’t affecting many established surgeons, would this even be discussed?
At every meeting, someone speaks about how the solution is simply to diversify and “take back” areas that are traditionally surgical. For example, endovascular stenting and percutaneous valve technologies. While these may be growth areas, even the most optimistic trainee recognizes that these are far from “surgical” areas. Perhaps I want to live in the past, but this is not what I wanted to train to do. If so, I would have gone into cardiology or interventional radiology. Why shouldn’t I pursue intensive care? Cardiac surgeons have traditionally taken care of their own patients and this is a valuable skill. Most trainees do not balk at this, except for the unwritten rule of surgeons who train in intensive care – “they can’t operate”. This prejudice is still prevalent and while I have not eliminated this possible, a future of defending myself to my colleagues fills me with dread. While areas like minimally invasive valve repair and heart failure seem like areas of growth, there are limited centers of excellence and training positions.
The numbers of trainees is decreasing. This is not surprising, however, I shudder at the recent talk of encouraging young medical students and residents to enter this field . Cardiothoracic surgery is a long and difficult road and to lead poor medical students down this path with only vague promises of a brighter future seems cruel. I have to admit that while I will tell young trainees that I love cardiothoracic surgery and that it is the best field to train in, I also will never encourage others to pursue it! In fact, I often wish I had been dissuaded earlier when I still had a chance to avoid the difficulties ahead of me. For those who want to encourage applications, the best way would be to make the future brighter for those who currently face it!
Propaganda abounds about the current job market. Many of us check CTS.net frequently for jobs. Although it appears promising, we all must realize that many of the jobs that are advertised are only done so out of academic necessity. Upon application to these positions, the response is often that it is already “filled” immediately following the posting. There are stories of both residents and fellows who had numerous job offers and those who have none. I can say I know both. I also know that I would prefer many of those who had had no offers taking care of me or my family to those who have received many offers. It is not an issue of lack of quality of those seeking positions, rather an issue of the quantity of qualified surgeons at this time. We have all been told “not to panic” and that within a few years things will be better. I have been hearing this since I entered residency, and I wonder how many years of fellowship training I will have to complete while I wait for this day. I also am worried about my friends and colleagues who are currently facing this uncertainty. Will they be “passed over” for newer trainees once positions become available? I don’t think that anyone dreams of a “career” of assisting other surgeons, although this may face many of us.
I feel like I should apologize for my outburst, I don’t want to leave you thinking that I do not have hope for the future of cardiac surgery. I do have hope – because that’s all that keeps me training in this field."
"While I applaud the recent focus of cardiovascular surgeons on the oversupply of cardiothoracic surgeons, I feel the need to express my viewpoint. After all, I am a resident in cardiac surgery, not a surgeon who has enjoyed a long and successful career!
Cardiac surgery has always been an academic and prestigious profession. This ivory tower mentality however, has also been its downfall. Current surgeons have only recently begun to pay attention to the crisis we face. Despite promises of the future, volumes are slowly eroding. This has encouraged surgeons to look at their own financial futures and perhaps even think about how recent graduates will possibly survive. If it wasn’t affecting many established surgeons, would this even be discussed?
At every meeting, someone speaks about how the solution is simply to diversify and “take back” areas that are traditionally surgical. For example, endovascular stenting and percutaneous valve technologies. While these may be growth areas, even the most optimistic trainee recognizes that these are far from “surgical” areas. Perhaps I want to live in the past, but this is not what I wanted to train to do. If so, I would have gone into cardiology or interventional radiology. Why shouldn’t I pursue intensive care? Cardiac surgeons have traditionally taken care of their own patients and this is a valuable skill. Most trainees do not balk at this, except for the unwritten rule of surgeons who train in intensive care – “they can’t operate”. This prejudice is still prevalent and while I have not eliminated this possible, a future of defending myself to my colleagues fills me with dread. While areas like minimally invasive valve repair and heart failure seem like areas of growth, there are limited centers of excellence and training positions.
The numbers of trainees is decreasing. This is not surprising, however, I shudder at the recent talk of encouraging young medical students and residents to enter this field . Cardiothoracic surgery is a long and difficult road and to lead poor medical students down this path with only vague promises of a brighter future seems cruel. I have to admit that while I will tell young trainees that I love cardiothoracic surgery and that it is the best field to train in, I also will never encourage others to pursue it! In fact, I often wish I had been dissuaded earlier when I still had a chance to avoid the difficulties ahead of me. For those who want to encourage applications, the best way would be to make the future brighter for those who currently face it!
Propaganda abounds about the current job market. Many of us check CTS.net frequently for jobs. Although it appears promising, we all must realize that many of the jobs that are advertised are only done so out of academic necessity. Upon application to these positions, the response is often that it is already “filled” immediately following the posting. There are stories of both residents and fellows who had numerous job offers and those who have none. I can say I know both. I also know that I would prefer many of those who had had no offers taking care of me or my family to those who have received many offers. It is not an issue of lack of quality of those seeking positions, rather an issue of the quantity of qualified surgeons at this time. We have all been told “not to panic” and that within a few years things will be better. I have been hearing this since I entered residency, and I wonder how many years of fellowship training I will have to complete while I wait for this day. I also am worried about my friends and colleagues who are currently facing this uncertainty. Will they be “passed over” for newer trainees once positions become available? I don’t think that anyone dreams of a “career” of assisting other surgeons, although this may face many of us.
I feel like I should apologize for my outburst, I don’t want to leave you thinking that I do not have hope for the future of cardiac surgery. I do have hope – because that’s all that keeps me training in this field."
posted by Luis G. Quiñonez, M.D. at
2:22 AM
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