The first signs of a coming health care crisis

Why can’t our best and brightest new cardiac surgeons get jobs?

by Danielle Bochove

Photograph by Cole Garside

Sebastien Trop knew from his second year of medical school that he wanted to be a heart surgeon. A star student, he went through university and medical school on full scholarships, and landed a highly competitive residency spot at McGill University. The one thing he didn’t consider during his 12-hour marathons in the O.R., the 90-hour workweeks, the years of study, was that at the end of it all, he wouldn’t have a job. “It’s a lot to ask your spouse,” says Trop, who finished training to be a cardiac surgeon in 2007. “At the end of all this sacrifice to tell her: ‘You know what? I need to take every little job that comes my way because I don’t know if, in a couple of months time, I’ll have something to put bread on the table.’ ”

Trop has cobbled together a living out of a collection of part-time jobs at three Toronto hospitals. Like most newly trained cardiac surgeons in Canada, his resumé is stacked with additional qualifications; he has a Ph.D. in experimental medicine and immunology, and a specialty in critical care. He currently works as an ICU doctor, does lab research and clinical work, and assists on cardiac surgeries. A father of three, he knows he’s treading water at a huge financial cost. So far, Trop estimates he’s at “over half a million dollars in potential revenues lost from not being able to land the job I was trained for.”

His situation is far from unique. The hiring landscape for today’s new heart surgeons is dismal, with one in five failing to find full-time work. It’s a problem that may soon affect the public, as the current employment situation discourages today’s medical students from joining the profession. “It seems paradoxical but a lack of jobs for new surgeons today may lead to a shortage of heart surgeons in the future,” says Maral Ouzounian, a cardiac surgery resident at Dalhousie University and lead author of one of two groundbreaking papers due to be published this week in The Annals of Thoracic Surgery. Until 2006, Canadian cardiac surgery residency programs—which require six years of training after medical school, usually followed by fellowships—were full. In 2009, 55 per cent of spots stayed empty. If that continues, Canada’s cardiac surgical workforce could be cut in half in 20 years.

Last year, Ouzounian and her collaborators surveyed new cardiac surgeons about their experiences finding work. “Traditionally, heart surgery was a very competitive specialty that attracted the cream of the crop. But the best and brightest med students won’t apply to train for 10 years with the possibility of no job at the end,” Ouzounian says.

So why are today’s job prospects so grim? Technology is partly to blame, as coronary artery stents have offered a less invasive alternative to bypass surgery. But analysis suggests this reduction will be more than offset by the impact of an aging population—we just haven’t seen it yet.

There is another factor, which proves a little touchier. In much of Canada, surgeons are paid on a “fee-for-service” basis, a system that actually creates a financial incentive not to hire. “If you are in a heart centre that does a thousand heart surgeries a year, and you have five people doing those surgeries, each person gets one fifth of the fees associated with those thousand cases,” explains Christopher Feindel, senior cardiac surgeon at Toronto General Hospital. “If you add two more surgeons, it’s the same fees coming in, but more surgeons, which means everyone gets less. There’s a certain disincentive to taking on new people.”

The fee-for-service structure worked well in the past when there weren’t enough surgeons to meet demand, notes Feindel, who was the principal investigator on both papers. “It’s a very efficient way to get people to work very hard when there’s a definite need.” But in a recessionary environment, in which older surgeons may be tempted to retire later and work more, the benefits are less obvious.

“If surgeons actually maintain their level of cases, rather than absorbing the additional cases that you’d expect with the increasing population,” notes Carolyn Teng, a graduate of McGill’s cardiac surgery program, “that alone would get rid of the excess of surgeons that we have right now by the year 2013.” Teng is benefiting from a surgical team that’s opted to do just that. After completing a fellowship in North Carolina, she failed to find a full-time job in Canada and ended up working at St. Michael’s Hospital in Toronto, “assisting” on cardiac surgeries, a lesser job that requires only two years of training after medical school. Over time that’s evolved, and she now operates as a fully privileged attending cardiac surgeon one or two days a week, as well as assisting. The interim arrangement allows her to maintain her skills until she can find a permanent, full-time job.

For Canadians, used to hearing about doctor shortages and long waiting times for surgery, it may seem counterintuitive that there aren’t enough patients to go around. But in some areas, even established surgeons aren’t working at full capacity. Bottlenecks occur for all sorts of reasons: limited O.R. space, or a shortage of nurses, for example. In the case of cardiac surgery, the problem isn’t a shortage of surgeons—at least not yet.

That, according to the second paper in the journal, is about to change. The results of the paper, which examines future demand for cardiac surgery in Canada, show the country headed for a shortage of cardiac surgeons, possibly as soon as 2021. “As our aging baby boomer population gets in their more senior years and requires more cardiac surgery, demand is going to go up. But supply is going to be drastically decreased. So it’s going to hit us when we need it the most,” says Sonia Vanderby, the paper’s lead author and an industrial engineer with a specialty in health care. Her analysis shows “substantial potential” for shortages within the next 15 to 20 years. In the worst-case scenario, they occur in about a decade.

There is anecdotal evidence that shortages could develop in a number of surgical specialties as the population ages. But Feindel believes cardiac surgery will suffer more, because its training programs are already half-empty. “I think there’s going to be a very severe shortage,” he says. “People are going to yell and scream and say ‘Where are all the heart surgeons?’ And they’re going to say, well, you know, we’ll have some in 10 years. That’s not going to help the person who needs heart surgery tomorrow.”

In an ideal world, the number of cardiac surgical residents hired today would match the number of cardiac surgeons needed at the end of their training. But absurdly, decisions about training and hiring continue to be made with virtually no knowledge of the country’s future needs. “We desperately need better health human resource planning—in every specialty—so that we can keep supply and demand of physicians relatively balanced,” Ouzounian notes. In Ontario, the Ministry of Health and the Ontario Medical Association are developing a simulation model, to estimate future demand in the province for doctors in all certified specialties. But nobody is tracking Canada-wide demand, making Vanderby’s model for cardiac surgeons significant.

But Trop says it’s not as simple as matching supply and demand. Today’s health care system, he says, relies on relatively cheap cardiac residents to keep running. “Why does a training program continue to train so many people when it’s known, for a fact, that there’s not going to be a job at the end, if it’s not simply to keep the machine turning?” he asks. “I think there is an onus on the surgeons who trained all these people to provide the means for these trained surgeons to maintain their skills.”

The alternative is brain drain. Having received, on average, 10 years of training after medical school, most cardiac surgeons are in their mid- to late 30s before they finally start looking for a job. Many have massive levels of debt and, unlike American cardiac surgeons, aren’t allowed to practise any other specialty without years of retraining. Ontario’s Ministry of Health estimates it costs $828,500 to train a cardiac surgeon. And Ouzounian’s research shows that when opportunities can’t be found in Canada, many new cardiac surgeons look to the United States.

When Kapil Sharma finished his cardiac residency in Montreal in 2006, the job he’d been promised never appeared. He was advised to do a fellowship in the U.S. and wait. After a year at Stanford he had offers in Texas and California, but nothing in Canada. Today, Sharma is director of thoracic aortic surgery at Mercy General Hospital in Sacramento, Calif. It’s a good position and he’s grateful for it—it’s just not where he wants to be. “My wife is Canadian, I’m Canadian. We’d much rather be in Canada with our families, obviously. It’s almost like we’re exiled, and just waiting for this job market to clear up.”

Meanwhile others continue to bide their time at home. “Surgery is a tough life,” Trop admits. “But, for me, I can’t see myself doing anything else and that’s why it’s so hard to give up. I love it.”




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The first signs of a coming health care crisis

  1. He could easily find higher paying work in the US, they are always desperate for doctors.

    • Cardiac surgeons are finding it hard to get jobs in the US too.

  2. The answer is to pay the physicians a salary. We are already doing this in specialties such as Internal Medicine. That way, you still attract doctors to the specialty and no one "hogs" the cases – allowing everyone to keep up their skills. It also helps ensure that surgeries are being done in appropriate situations – ie: when the patient will benefit as apposed to generating income for the physician despite the fact that the patient may not be a good candidate.

    • Nah. The answer is to divide the amount of pay they recieve by the number of days of wait time patients are experiencing. You'd see them pushing their boards for new hires then, damn straight.

      • Right, because no Canadian surgeon is begging already for more OR time from his or her hospital that can't or won't supply it.

        • What a lovely straw-man. Did I claim that lack of OR time was not a problem? No? Go burn it down somewhere else then.

          I was addressing the argument put forward in the article. If you'd care to have a relevant comment on that, perhaps we can have a discussion.

          • No, you implied the fat cat surgeons are comfortable in their well-paid rut and indifferent to the suffering of their patients languishing on the waiting list. And you suggested that the threat of a financial penalty might get these lazy slobs to agitate more effectively to reduce the wait. Which is a pretty disgusting characterization of surgeons struggling in our resource-starved single-payer public-administration sclerotic monopoly.

            If you'd care to explain how more hires "damn straight" would reduce the wait-list problem when there is no more OR time (and no more staffing, and no more post-op beds on wards and in ICUs) to accommodate them…? You did not claim that lack of OR time was not a problem.. You just thoroughly ignored that it is a problem.

  3. An interesting article, but I'd argue that fee-for-service is less of an issue here than in some other specialties – many cardiac surgeons work in academic centres, after all, where they are typically paid via something resembling a salary. From the perspective of a med student, there are other reasons why cardiac surgery is not an attractive path. There is a perception – largely justified – that cardiac surgeons have "lost" with the increasing preference for endovascular techniques and improved medical therapy. Cardiologists control the patients and the referrals, and the range of procedures performed by cardiac surgeons has become quite limited.

  4. The answer is not in salary vs fee for service thinking. The solution is in finding alternative funding mechanisms to the public system and medical tourism.

    • I wonder if you could post a possibly vaguer more unhelpful response. Cardiac surgeons for whatever reason failed to take on endovascular techniques and so ceded them to interventional radiologists and cardiologists. They've always been busy enough doing daily CABGs, but their job market is simply supersaturated at the moment, which – unsurprisingly given their limited range of procedures – makes cardiac surgery an unappealing career choice.

      …. medical tourism??

      • He means people coming from other countries (aka, the US) to take advantage of our medical services illegaly (and yes, folks, it is illegal).. although now that I think about it, you probably knew that and were more questioning what his point was.. fair enough and my apologies..

        I think, then, what happened is he lost track of what the hell he was responding to, and instead of sticking to the topic of how do we get more cardiac surgeons, was expanding to the wider topic of health care in Canada in general.

        • How is it illegal if the foreign patient pays the bill in full?

          No, folks, it is not illegal for non-Canadians to come to Canada to receive health care. Thwim's second parenthesis is bonkers.

          • Did I say it was illegal for them to come here and recieve health care? No, I said when they come to take advantage of our medical services illegally. However, I can see how my parenthetical remark may have confused you. That was directed toward the people who feel that it's fine for their relatives and friends to come up and make use of of health system for free — I should have been more clear in the intended audience thereof.

          • Actually, that's what you called realist's "medical tourism." Your definition (medicare fraud by foreigners) is a mistaken definition of medical tourism.

      • I can't figure out what he means either. But since we are guessing, how about this. There is actually a trend now that *doctors* are going overseas for medical tourism, not as patients, but to perform procedures at foreign hospitals on medical tourists. Seems kind of wacky but it is happening. So maybe that's the solution – shipping under-employed doctors offshore to satisfy the demands of medical tourists.

  5. well…none of the above.

    Medical Tourism is the process in which patients travel to receive care outside of their country., In Canada, it would be possible to provide the services for out of country citizens who may be looking for access to care through their own insurance companies. Of course, this would require some independent facilities and acceptance of private infrastructure which could still be regulated by government.
    The reality is that this is already happening as US insurance companies send their patients overseas for care to access less expensive service.

    One of the main arguments against having private provision in Canada is that there is a shortage of providers. In the case of cardiac surgeons, it appears that the opportunities in the public system are not adequate to provide a full career to new graduates.

    We won't likely solve the shortage of providers with the current thinking and we won't likely solve the access issues if we don't start thinking about funding mechanisms outside of the public system. With obesity and cardiovascular disease set to double not to mention the doubling of dementia, diabetes, cancer and age related problems, not to mention the long term care tsunami we are facing, the public system will flounder.

    Efficiencies won't be enough.

  6. Public health care harms the public… Interesting.

  7. The obsession with maintaining the status quo of monopoly funding for health care in Canada and particularly in Ontario perpetuates insufficient numbers of providers and/or insufficient facilities-tools for the patients and providers.

    Either way, the public monopoly on health care dooms any sustainable reform and dooms any progress on the Social Determinants of Health front.

    With more and more public dollars going to health care, the true equalizers in society including education, affordable housing, and opportunity for employment will be ignored.

  8. And this is what happens to the doctors (and nurses, myself included); they go to the USA. Now that I see Canada from working here in the US for twenty years, I look back and see that Canada has something better: Equal healthcare for everyone, no bills to worry about. Canadians need to be proud of their health care system and make it a better quality system for everyone!
    Doc, sure go to the States and make your money but come back to Canada eventually like I probably will.

  9. “If you add two more surgeons, it's the same fees coming in, but more surgeons, which means everyone gets less. There's a certain disincentive to taking on new people.”

    Is there really no wait-list for cardiac surgery? That would be phenomenal news, if true. But then, that should be the headline: Backlog cleared: Surgeons left with nothing to do, so no one is hiring.

    The disincentive to taking on new people is because of a fight for scarce OR time, I suspect, way more than it is a fight for patients needing (some desperately) a procedure.

    • There really is no wait list for Cardiac Surgery. Really. The point of the article is that many surgeons are going to retire in the next ten years. At the same time, the number of patients who need surgery is going to go up. By the time the crisis is recognized, it will take ten years to train surgeons to deal with the crisis.

      There's no problem now. The problem is in 2015-2025. But in order to be ready for it, we need to act ten years early, because that's how long it takes to train a cardiac surgeon, after med-school. Which means we should start acting in 2005 to solve the problem.

  10. In a free market, out-of-work surgeons would charge less to be competitive. But Canada has a socialist system. The solution, then, is to eliminate the govt. and CMA cartels altogether.

    • Nothing like the usual fact-free paean to the free market, is there? The fees charged by surgeons is not the issue by any stretch, but rather limited OR time. Surgeons don't pay OR nurses or anesthesiologists (to say nothing of staffing for ICU, IMCU, or regular ward beds). It's not clear that we actually need a great deal more OR time for cardiac surgery specifically; there was wait lists, but the situation is altogether unlike that in arthroplasty. Additionally, cardiac surgeons tend to carry far more additional costs than just their per-procedure fee, which is quite negligible next to the cost of specialized anesthesiologists, perfusionists (and their equipment), and a CVICU bed + stepdown + possible bed on the floor. It's expensive and resource-intensive, in terms of personnel, time, and equipment. Out-of-work cardiac surgeons need more nurses and open beds to support additional OR time; I don't think there's much interest from agitators for private care either, who seem more interested in outpatient imaging, elective arthroplasty, and, of course, cosmetic work.

      • The facts are there for all honest people to see: limited OR time is a consequence of a centrally planned (i.e. socialist) funding structure that treats every patient as a "cost" rather than a customer providing opportunity. The hospital receives its money from the ministry and then rations among them — needs of *individual* health care consumers be damned! In a free market for health care — i.e. individuals free to contract with providers according their best rational judgement — the price mechanism of the market within the context of a proper legal framework that protects the rights of individuals, the issue of labour excesses or shortages is mitigated by the price system! Add to that, the fact that a less restrictive system of labour regulation among physicians (and nurses, i.e. in those areas where physician shortages could be mitigated by physicians delegating more freely to nurses certain jobs, or cardiac surgeons who could easily train in the field of interventional), and the incontrovertible solution is always: free up our health care system from gov't and the special interest groups that use gov't force, and allow the free market to function.

        • It all sounds so magical! Will the free market be funding expensive residency positions too? (Not the issue here, of course…) NPs and nurse specialists are already employed extensively in the acute care setting… which I'd assume you'd know. Not that I'm clear why you felt it necessary to include your credentials. In any case, several provinces – BC and now Ontario – are introducing "activity-based" funding for hospitals. Whether this introduces any kind of perverse incentives – is it always good that patients become "sources" of revenue rather than costs? – is yet to be determined.

          • This "activity-based" funding for hospitals hopefully will reduce waiting list, on the other hand it might also increase unnecessary interventions/procedures for monetary gain. With this model, I wonder if this will worsen the health care financing crisis we are facing right now. How do other countries that occupy the top in WHO list, for efficient health care system with less funding than us, manage theirs?

          • Snide and dismissive comments about the logic and veracity of the free-market notwithstanding, the extent to which the issues chronically affecting health-care remain a permanent and worsening — everything from labour and capital shortages, waiting lists, etc. — it is a consequence of the failures of central planning in health care. I believe my credentials and experience of nearly a decade of bedside practice give me at least a modicum of authority on this issue, and shows that at least one member of my profession doesn't tow the line of faith in socialized healthcare. For example, my experience has demonstrated (contrary to your claim) that acute care nurse practitioners are profoundly under-utilized and I daily face the frustration of internists who wish they could delegate and divide their labour among capable colleagues in the nursing and allied health fields. (Perhaps NPs are more well utilized in peripheral, non-urban hospital and clinic settings.)

            Lastly, I'm ultimately not an advocate for "activity-based funding" unless it is a means to the ultimate dismantling of publicly funded health care altogether. The fundamental issue is not how funding for residency positions will materialize, nor is it even equal access to healthcare for all: it is about each and every Canadian having the right to freely contract with a health care provider, just as this right is protected in the myriad of other aspects of our lives from doing business with my car mechanic, to my visit to the dentist.

          • I'm not clear on what kind of authority "nearly a decade" of bedside practice gives you on this matter, considering your "solution" is nothing more than a statement of idealistic principle with no practical application. Libertarian rhetoric is no substitute for actual plans or proposals. Regarding NPs, they are significant part of inpatient and outpatient care in Nova Scotia, and I'm sure elsewhere as well – though this applies mostly in the acute, tertiary care setting. Of course, one of the major problems in the acute care setting is the degree to which beds are occupied by ALC patients. Where does your rhetoric fit in with dealing the long-term care problems facing the country, particularly since that area is a classic case of mixed public/private spending?

          • Witnessing, first hand, the failure of central planning — with the occupancy of ALC patients in acute care beds and insufficient long term care beds as a classic example — while witnessing the abundance of quality products and services in other sectors of the economy left relatively free (including health-care related) is an honest statement of fact and principle. I witness how easy it is for seniors to exit the acute care setting and gain placement in an assisted living or retirement homes, while long term care (nursing home) patients can wait months and months while distraught and frustrated family members talk about how they would be gladly pay for a proper placement. Of course, the patient and family can't sit down and work out a long-term care placement based on needs, desires, and financial means, because unlike retirement homes, the regulation of nursing homes has resulted in a supply shortage. Nurses and social workers at my work have joked about opening up a nursing home ourselves to make a ton of money. But this is a joke, or course, because it is virtually impossible due to the red tape and regulatory burdens imposed on those that would attempt to do so.

            I find it amusing how those that dismiss the idea of allowing freedom for individuals in planning their own lives vis a vis health care, cannot be open about their own ideological position. There is no "plan or proposal" or capacity to legislate into existence an ideal solution to health care woes. Imagine trying to "plan" the appropriate distribution of grocery stores or auto shops across the country? Most people would call that absurd and we would anticipate all the problems (like shortages and rising costs), and yet the same approach is thought to be appropriate for health care.

          • So your argument comes down to talk of Econ 101 "barriers to entry"? What regulations should be done away with? Are retirement homes unregulated? What about other regulated sectors (i.e. everything)?

          • Funny you should ask. In fact, in Ontario, retirement homes are *not regulated.* There is an entirely *private*, non-profit accreditation body called the Ontario Retirement Communities Association. From their website: "The Province of Ontario does not regulate the operations of retirement residences. ORCA is the only agency that sets standards, inspects and accredits these residences. Not all retirement residences are ORCA approved, only those that meet and maintain ORCA's standards for accreditation. When searching for a retirement residence, be sure to ask for proof of ORCA membership. If it is not an ORCA member, it has not been accredited." Note that every retirement home doesn't have to belong to the organization by fiat.

            Much of our regulatory bodies in health care, from those that licence practitioners to those that approve drugs and medical equipment would follow similar models of approving for safety, quality, etc. could be phased out and/or turned over to the private sector. And these organizations already exist in other sectors (does Underwriter's Laboratory ring a bell?) but unlike some monolithic government bureaucracy such as the Ministry of Health and Long Term care, or the FDA in the US, they do not wield the kind of omnipotent power to prevent people from making choices (i.e. to use a certain drugs, therapies, or purchase certain health care services).

            The fields of health care such as dentistry are another great example of how a significantly less regulated sector results in better results. A dentists can essentially open a clinic in an area where there is demand, invest in the expensive equipment and hire staff. You never hear of "dentist shortages" (other than local ones), just as you never hear about the retirement home shortages.

  11. The problem with our healthcare system is clearly lack of integration and coordination of care/service providers with hospitals,universities and Canada Health.Everybody does his own thing,hardly thinking of the bigger picture and acting accordingly.
    Is it really the best way to pay almost all physicians the same way as mechanics at,let's say ,Canadian Tire?Yes, both are paid by the "piece" ie.:a fixed amount of money for a specified piece of work.A certain repair for the mechanic,a specific operation or consultation for the physician.The more "units" you squeeze into your day, the more money you make.Simple as that. That's why your GP often has you in and out of his office in three minutes flat and why he does not take your blood pressure even so you complained about being unusually tired lately.They are on piecework,that's why!Just like coal miners.But their pay is better than in almost all any other profession,thanks to their monopolistic "self-governing" medical association.
    Do you really want to be operated on by somebody on piece work?Or by a resident at the end of his 16hour day?
    We get on average excellent care from our nurses,who are not on piece work but salaried.Why are not all physicians on salary in Canada?It works well in several countries outside North America.If money is all that matters to our physicians,they are in the wrong job.They should go into the financial services industry.
    And why can't health administrators at the different levels of government not stick their heads together with hospitals,universities and the CMA to determine the future needs for Physicians in their different specialities?It is not exactly nuclear science,- just plain planning and coordinating.
    All it takes is a sense of responsibility for the Canadian Citizen,which currently is sadly lacking.

  12. There is lots of talk about "integrating" and finding efficiencies through better collaboration. While these are important, we should consider what happens when the efficiencies fail to produce the needed savings…if any. We only need to look at the jittery start of eHealth and the billions that will be required to implement province-wide and even nation-wide electronic sharing of health information and the LHINs lackluster performance in Ontario.

    There is lots of talk about the payment model of physicians being changed to salaries. This isn't a solution either as physicians' fees only account for about 13% of the overall health budget.

    What is clear is that the solution will be multifaceted. Piecework or no piecework, the cost of health care is going to go up and it is time to consider a variety of options including what has worked well in other OECD nations including hybrid public/private systems.

    • Fortunately "Ontario" is not interchangeable with "Canada", insofar as other provinces have implemented actual regionalization rather than the half measure of the LHINs. Why continue with local hospital boards and administration *and* create regional authorities? You are pointing to specific policy failures of the McGuinty government – does this really say much about the "system" nationwide?

      As you point out, physician fees are only a small part of the equation and are not driving cost increases (Drugs on the other hand…). Your argument would be more convincing if so-called "hybrid public/private" systems could be shown to be better at containing costs. Indeed, only physician services can be said to be (nearly) purely public in Canada – so is this an argument that physicians should have access to private payments? (Let's call that "extra-billing") If so, in what respect does this address the components of spending driving increases? Like drugs? Or long-term care or ALC generally? Of course, it absolutely does nothing of the sort.

      As for the usual European models trotted out, they almost invariably have higher levels of public spending in health and just about every other sector. Should we consider moving to something more like the German social insurance model? I think there's much to be said for better administration and less politics, but you've offered no particular solution other than the usual evident refrain of "let us (extra)bill privately". I'm sure that will be a real winner at the ballot box. So what specifics of this European models should we be adopting?

  13. The same can be said for other specialities in medicine. It is hard to find a job, in say, radiology at present. Same reason… no incentive for hospitals or groups of radiologists to hire as it would decrease their income…

  14. It becomes a vicious cycle where the Canadian system has perpetually inadequate human health resources because the system is limited in its ability to fund more providers…whether they are physicians, nurses, nurse practitioners or other. This creates ongoing rationing of care…which in turn creates more noise from vocal groups who say that we can't have any other option for necessary medical care outside the system ie options for private providions—because it would siphon off providers and make access in the public system worse.

    This is faulty thinking since it is the monopoly public health care system that creates the rationing in any number of ways and which is the very cause of the shortage of providers.

    Strange thinking that more of the same will provide improved care somehow.

  15. Dear Madeyoulook,

    There really is no wait list for Cardiac Surgery. Really. In fact, in Toronto they are closing the Cardiac Service at Sunnybrook because of a lack of cases. Look it up.

    The point of the article is that many surgeons are going to retire in the next ten years. At the same time, the number of patients who need surgery is going to increase due to an aging population and increased obesity. By the time the crisis is recognized, it will take ten years to do anything about it.

    There's no problem now. The problem is in 2015-2025. But in order to be ready for it, we need to act ten years early, because that's how long it takes to train a cardiac surgeon, after med-school. Which means we need to start doing something five years ago in 2005 to solve the problem.

  16. My husband, who is an Ear, Nose and Throat surgeon, is having the same problem. The only difference is, we are from England and doing a fellowship in Canada. There are hardly any ENT jobs around, they have a bulge of surgeons coming through the system, but not enough surgeons are retiring and also the National Health Service is making budget cuts.
    I know it is not fashionable to feel sorry for doctors, but after moving 5 times with 2 small children to follow his career, only to find out there is no job at the end of it is just so painful for the families. At nearly age 40 I don't feel as though I can move more than once more.
    Also, there is not a hospital in England or Canada that has not got a fairly large waiting list for ENT or cardiology.
    Perhaps he will have to retrain as a GP, but what a waste of skills.

    • ENT is a highly coveted specialty. Good lifestyle, great pay, get to do lots of procedures. But again, it's a supply vs demand issue. Why should your husband get a job just because he trained to do something? There are no jobs because there is no demand for ENTs at the moment.

  17. It is crazy and heartbreaking to see the huge mismatch in skills and opportunities. What a waste of human capital, how hard it must be for those who have worked ridiculous hours and spent days in text books to find out those skills can't be utilised.

  18. OK, You make a rational argument for why private health care is more responsive to user needs, my question then is how do you provide "equal and equitable" access and care????

  19. It is such as shame that someone works so hard training to better themselves and then have to go though so much more just to try and find a stable job. The current fee system doesn't seem to work well at all, why are there so many surgeons earning such a high income (and working under extreme pressure, which could lead to mistakes) when there are so many unemployed surgeons out there ready and willing to work, it doesn't make sense.

  20. Why should there be jobs? Supply vs demand. Why should 100 cardiac surgery residencies be created, when there is only a demand for say, 30 that year?

    Years ago, cardiac surgeons had a chance to get in on what is not interventional cardiology's bread and butter, but they turned their noses up at it. Interventional cardiology won. Fewer and fewer people need open heart surgery now. This is evidenced by all the 80+ year old people (huge risk, multiple co-morbidities) that cardiac surgeons have to operate on to make a living.

    • should be "what is now", not "what is not interventional cardiology's bread and butter"

  21. No significant wait times in BC.
    http://www.health.gov.bc.ca/waitlist/cardiac.html

    In fact, at St. Paul's Hospital, every summer there is a summer slowdown. They do 3-4 cases mon-friday instead of 5.

    I tell every bright eyed student to choose another specialty, because open heart surgery will soon be a thing of the past. That's what innovation and research brings forth. A star cardiac surgeon is now performing more laser lead extraction surgeries. From what I've seen of the surgical specialties, they attract very old school thinkers. Medical specialties attract more innovators for sure. Just my opinion, though.

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