MANAGED CARE November 2009. ©MediMedia USA
News reports about an impending primary care physician shortage are grim, but primary care is not the only area of concern. Cardiothoracic (CT) surgeons will also be a limited bunch come 2020, according to a study in Circulation: The Journal of the American Heart Association. That does not bode well for both elderly patients (more than two thirds of Americans over age 65 are diagnosed with cardiovascular disease) or for the future supply of cardiothoracic surgeons.
“Any specialty that cares primarily for adults is going to experience a shortage because of the silver tsunami that we’re facing,” says Atul Grover, MD, PhD, chief advocacy officer at the Association of American Medical Colleges. He was lead author of the study.
For managed care, this means that it will be harder to negotiate contracts, says Grover, especially in specialties like anesthesia, orthopedic surgery, and radiology — wherever demand outpaces supply.
In 2007, the AMA reported 4,820 active CT surgeons. That number dropped to 4,758 in 2008.
Recruiting new physicians has been difficult, says Grover. “We’ve had limits on our ability to train physicians across the board.” Factors affecting recruitment include the long training period and a number of challenges after medical school and residency are completed.
“We’re not going to have enough doctors. That is true across the board, from primary care physicians to specialists,” says Grover.
Projected shortfall in cardiothoracic surgeons
Between 2005 and 2030, as the population over 65 increases by nearly 100 percent, the number of cardiothoracic surgeons will fall significantly because of retirements, even if trainees are increased. The baseline assumes that 130 complete training each year, even though the number is much lower at present (84 positions were filled in the 2007 residency match). Alternative projections are for 75 and 150 trainees per year.
Percent growth relative to 2005
Source: Grover A, Gorman K, Dall TM, Jonas R, Lytle B, Shemin R, Wood D, Kron I. Shortage of cardiothoracic surgeons is likely by 2020. Circulation. 2009;120:488–494.