The human face of the cardiac surgery job market in Canada

I have sent my CV and lettres of intent looking for a consultant's position in Cardiac surgery in Canada. After one e-mail follow-up I have received negative responses for 2/3 of all canadian centres that do cardiac surgery. The rest remain curiously silent. I want a job at any centre, community or academic. All I want to do is have the opportunity to practice independently. I am more that ready to do it. I have done residencies in general surgery, thoracic surgery, and cardiac surgery and I have written and passed the Royal College general surgery and cardiac surgery fellowship exams. I have done a 2 year clinical fellowship at the Mayo Clinic.

I awknowledge that I have made mistakes, both personal and professional, that have affected my career negatively. I have not been academically productive as much as I should have been, yet I am academically minded. I have not developed mentor relationships that would help me. However, I have worked hard, my patients have been well looked after, I have been honest and honourable, and I am an above average surgeon. I have nothing to hide and anyone can ask anybody with whom I have worked as a peer or a supervisor.

I believe in Canada and the public healthcare system, so I do not want to stay in the US. This would be difficut because of my J1 visa. I am not interested in wealth but I would appreciate a comfortable life with more pay than what I get as a fellow.

There are material things that I would like to have: I would like to have a house, a nicer car, nicer furniture, learn to SCUBA dive, become a pilot, learn to sail and take a few intreresting trips. I may even want a cottage.

More importantly, on the emotional side, I would like to have a sense of stabiltiy and pemanence without having to move around; I would like a place to call my own home; I would like to have some ownership of my time; I would like to be able to make my own decisions about my patients; I would like to be able to spend time wtih my dog; I would like to be treated with respect for what I know and what I am able to do; I would like to write more; I would like to develop some ideas of my own to improve the care of patients; I would like to not worry about my retirement.

I am 39 and I feel that I have lost many productive years of my life. By the time I start working in my 40's I will have lost about 5 or more years of surgical experience. I may not be able to to do all the things I want to do. Being a surgical trainee does not lend itself to exploring other pursuits.

I hate to sound like a complainer or a whiner. I am not. I have been fortunate and lucky in life. My basic needs are secure. I have had opportunities many would envy. I have a loving family. I have a loving girlfriend. I have self-respect and I have honour. I can be proud of my achievments.

But I think it is time for me to ask to have the opportunity to work. I am qualified and I am competent. I have invested time and effort. Canadian society has invested in me. I am loyal to Canada for this.

What does the system owe me? Some may say nothing. I think I am owed a timely opportunity to show what I can do and what I can contribute. After that, anyone can judge and decide if I deserve to go on. No guarantees if I screw up. Agreed.

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."