Analysis: Heart surgeons under the knife

WASHINGTON, June 19 (UPI) -- A severe shortage of heart and lung surgeons is looming, and -- since training new ones takes 12 years -- it won't be fixed in a heartbeat, a doctor group said this week.

"This is the perfect storm that's happening and the decisions we make today are really going to have an impact on what happens," said Stephen Lahey, chief of the cardiothoracic surgery division at Maimonides Medical Center in Brooklyn, N.Y.

Cardiothoracic surgery, once at the apex of the medical profession, is the specialization of surgeons who repair the hearts and lungs of patients with heart disease, lung cancer and some other of the nation's deadliest conditions.

But faced with crushing student debt and plummeting physician reimbursement, the supply of young surgeons willing to endure the years of training after medical school is drying up.

For the last three years, there have been fewer applicants than available cardiothoracic residencies. Last week, in the 2007 resident selection process, only 87 of 130 positions nationwide were filled.

"These were the elite of training programs," Lahey said. "Now that is not the case. Both the quality of applicants and the number of applicants is really a threat."

That lack of new candidates comes at a time when the number of surgeons is already dwindling. In the last decade, while the number of specialists in other areas has increased by as much as 60 percent, cardiothoracic surgery is the only area that has seen an actual decrease in its numbers.

In 2005 there were 70 fewer cardiothoracic surgeons nationwide than in 1996.

Compounding the problem is the rising age of the profession. The average age of the surgeons is 55, and more than half plan to retire in the next 13 years, according to the Society of Thoracic Surgeons.

The solution is to help young would-be surgeons afford the years of training it takes to learn the specialization, doctors told reporters at a Capitol Hill briefing.

The specialty's average salary is $470,000, but beginning salaries can be substantially less, and many doctors are deep in a financial hole before they ever get there. The average starting surgeon is 36 years old and about $200,000 in debt.

Doctors also pay interest on their medical school debt while they are still in training as residents. Thus, many accrue tens of thousands of dollars in debt even after they stop taking out new loans.

"Regardless of what the salaries are, there aren't people going into the specialization," Douglas Mathisen, professor of thoracic surgery at Harvard Medical School and chief of thoracic surgery at Massachusetts General Hospital, told United Press International.

The financial rewards of practice are also declining, Mathisen said.

The reimbursement for a coronary artery bypass, for example, has decreased from $4,000 to $2,000 in nominal dollars over the last 10 years, he said. Meanwhile expenses like malpractice insurance, which can cost more than $40,000 per year, are on the rise.

Ironically, the lack of residents is also contributing to the problem, he said. When residents are not available, surgeons must pay nurse-practitioners or others to assist them during surgery -- a cost that is not taken into account in reimbursement.

If the problem is not corrected, "this is going to be a major access issue that's going to lead to death and complications," said Rep. Charles Boustany, R-La.

Boustany sponsored an amendment to a higher-education bill last year that would have offered loan forgiveness to medical students pursing needed specializations.

"Clearly one of the major factors is economic," Boustany told UPI.

Given the small number of surgeons who choose the specialty each year, he said, helping them would be a relatively inexpensive way to help patients.

A similar bill affecting a broader range of medical students was introduced by Sen. Christopher Dodd, D-Conn.

Still, many residents say they chose cardiothoracic surgery because they love it, not for the financial rewards -- though some economic relief would help.

"When you're in residency you fall in love with a specialization and you realize it's what you want to do for the rest of your life," Nathan Bates, a cardiothoracic resident at Maimonides Medical Center, told UPI.

Bates, who is the 37-year-old father of two children, will become a full-fledged surgeon in six months. He and his wife, also a doctor, have about $400,000 in total medical school debt.

He turned down a training opportunity at the respected Cleveland Clinic for financial reasons, he said. If he were not so indebted he could have pursued the training, which would have helped him better serve his patients.

Bates, however, said he does not regret his decision.

"I'd do it all again," he said.