On the Future of Adult Cardiac Surgery

Abstract

Considerable uncertainty exists about the role that will be played by cardiac surgery for acquired heart disease in the coming decade. In many institutions the volume of surgery for ischemic heart disease has already been affected by advances in interventional cardiology; the impact of those advances can only increase with the inexorable advance of technology. Percutaneous catheter intervention for valvular heart disease is also being pursued aggressively. Yet, like so many medical and surgical specialties, cardiac surgery has been forced to accept reduced reimbursements, and was also the first (and in many states is still the only) specialty to be required to submit to public audits and arbitrary standards for surgery volumes and outcomes. Hospital support for cardiac surgery programs has become less generous, and inevitably, the specialty has lost much of its desirability as a career choice. There is considerable concern about the specialty's ability to continue attracting the best surgical talent to its residencies, and in each of the last 2 years, 20 of 140 training positions did not fill in the initial match. (The implications of this phenomenon are made more confusing by uncertainty about the number of trainees that will be needed in the next decade.).