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We thank Dr Baciewicz for his comments [1Baciewicz F.A. Edelman D. Are there enough general thoracic surgeons? (letter).Ann Thorac Surg. 2010; 90: 1062-1063Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar]. To answer his first question, “Are increasing numbers of thoracic surgery patients being seen by general surgeons?,” we queried the National Inpatient Sample [2HCUP DatabasesHealthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality, Rockville, MD1998http://www.hcup-us.ahrq.gov/nisoverview.jspGoogle Scholar]. Using the same definitions as outlined in our article [3Schipper P.H. Diggs B.S. Ungerleider R.M. Welke K.F. The influence of surgeon specialty on outcomes in general thoracic surgery: a national sample 1996 to 2005.Ann Thorac Surg. 2009; 88: 1566-1573Abstract Full Text Full Text PDF PubMed Scopus (98) Google Scholar] and over the same time span (1996 to 2005), we compared the percentage of surgeons each year meeting each definition (cardiac surgeon, general thoracic surgeon, or general surgeon). In general, 70% of surgeons doing general thoracic cases were general surgeons, 27% were cardiac surgeons, and 3% were general thoracic surgeons. These three percentages had slight variability from year to year but were largely similar across this time period, with no increasing or decreasing trends.We then examined the percentage of cases performed by each of these surgeons. We found that for cardiac surgeons and general surgeons, the yearly total number of lobectomies and decortications was increasing and the yearly total number of pneumonectomies and wedge resections was decreasing. For general thoracic surgeons, there was year-to-year variability in total number of each index case, but no trend increasing or decreasing. The percentage of the yearly total number of each index case performed by each surgeon group varies slightly from year to year but is largely similar, with no increasing or decreasing trend.Our data do not support the statement that increasing numbers of thoracic surgery patients are being seen by general surgeons—or by cardiac surgeons or general thoracic surgeons. Rather, the division of labor seems to be fairly constant over this time span. Our data do show that general surgeons perform most of all three procedures, although the best outcomes are achieved by cardiac surgeons and general thoracic surgeons.Using out data, we are not able to answer Dr Baciewicz's second question, “Will this trend become increasingly problematic with fewer thoracic surgery residencies and fewer thoracic surgeons being trained each year?” However, we agree that a projected deficit of cardiothoracic surgeons is an important consideration for our profession, our government, and our society. It is especially important if the surgeons lacking could be doing better work cheaper.Drs Doug Wood and Farhood Farjah wrote an editorial that accompanied our article [4Wood D.E. Farjah F. Surgeon specialty is associated with better outcomes: the facts speak for themselves.Ann Thorac Surg. 2009; 88: 1393-1395Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar]. A summary of their editorial, with which we agree, is that the data exist. The data have been presented in several different articles from several different data sources, with similar conclusions as outlined in the editorial by Wood and Farjah and in our article. Cardiac and, in particular, general thoracic surgeons perform general thoracic surgery with less morbidity, less mortality, fewer hospital days, and with better outcomes (longer survival). The next step is to act on these findings through health care policy and education of patients, surgeons, referring physicians, insurers, and politicians to improve the health of our patients. We thank Dr Baciewicz for his comments [1Baciewicz F.A. Edelman D. Are there enough general thoracic surgeons? (letter).Ann Thorac Surg. 2010; 90: 1062-1063Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar]. To answer his first question, “Are increasing numbers of thoracic surgery patients being seen by general surgeons?,” we queried the National Inpatient Sample [2HCUP DatabasesHealthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality, Rockville, MD1998http://www.hcup-us.ahrq.gov/nisoverview.jspGoogle Scholar]. Using the same definitions as outlined in our article [3Schipper P.H. Diggs B.S. Ungerleider R.M. Welke K.F. The influence of surgeon specialty on outcomes in general thoracic surgery: a national sample 1996 to 2005.Ann Thorac Surg. 2009; 88: 1566-1573Abstract Full Text Full Text PDF PubMed Scopus (98) Google Scholar] and over the same time span (1996 to 2005), we compared the percentage of surgeons each year meeting each definition (cardiac surgeon, general thoracic surgeon, or general surgeon). In general, 70% of surgeons doing general thoracic cases were general surgeons, 27% were cardiac surgeons, and 3% were general thoracic surgeons. These three percentages had slight variability from year to year but were largely similar across this time period, with no increasing or decreasing trends. We then examined the percentage of cases performed by each of these surgeons. We found that for cardiac surgeons and general surgeons, the yearly total number of lobectomies and decortications was increasing and the yearly total number of pneumonectomies and wedge resections was decreasing. For general thoracic surgeons, there was year-to-year variability in total number of each index case, but no trend increasing or decreasing. The percentage of the yearly total number of each index case performed by each surgeon group varies slightly from year to year but is largely similar, with no increasing or decreasing trend. Our data do not support the statement that increasing numbers of thoracic surgery patients are being seen by general surgeons—or by cardiac surgeons or general thoracic surgeons. Rather, the division of labor seems to be fairly constant over this time span. Our data do show that general surgeons perform most of all three procedures, although the best outcomes are achieved by cardiac surgeons and general thoracic surgeons. Using out data, we are not able to answer Dr Baciewicz's second question, “Will this trend become increasingly problematic with fewer thoracic surgery residencies and fewer thoracic surgeons being trained each year?” However, we agree that a projected deficit of cardiothoracic surgeons is an important consideration for our profession, our government, and our society. It is especially important if the surgeons lacking could be doing better work cheaper. Drs Doug Wood and Farhood Farjah wrote an editorial that accompanied our article [4Wood D.E. Farjah F. Surgeon specialty is associated with better outcomes: the facts speak for themselves.Ann Thorac Surg. 2009; 88: 1393-1395Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar]. A summary of their editorial, with which we agree, is that the data exist. The data have been presented in several different articles from several different data sources, with similar conclusions as outlined in the editorial by Wood and Farjah and in our article. Cardiac and, in particular, general thoracic surgeons perform general thoracic surgery with less morbidity, less mortality, fewer hospital days, and with better outcomes (longer survival). The next step is to act on these findings through health care policy and education of patients, surgeons, referring physicians, insurers, and politicians to improve the health of our patients. Are There Enough General Thoracic Surgeons?The Annals of Thoracic SurgeryVol. 90Issue 3PreviewI enjoyed the article by Schipper and colleagues [1]. Full-Text PDF