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.
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