The Current and Future Landscape of Cardiothoracic Surgery in the United States: Bridging the Gap

Background: An aging US population, rate of retiring cardiothoracic (CT) surgeons and graduation rates portend a workforce shortage. How residency matriculation rates and graduates entering the workforce impact this shortage are unknown. Methods: Using publicly available data from the Association of American Medical Colleges (AAMC) and Accreditation Council for Graduate Medical Education (ACGME), we gathered data on current cardiothoracic surgical practice. Data from the Census Bureau was used for population projections. Available data from the National Residency Matching Program (NRMP), American Board of Thoracic Surgery (ABTS), immigration population, and retirement information were used to forecast the number of CT surgeons needed. Examination statistics were gathered from the American Board of Surgery (ABS) and ABTS. Results: Between 2019–2022, there were an average of N = 137 CT first-year residency positions which were offered (integrated and traditional), demonstrating an increasing fill rate and number of applicants over the past decade. Residency programs have graduated an average of 127 surgeons annually from 2018 to 2022: a 13% increase from 2012. The US population is anticipated to grow 8% by 2050, with a 42% increase in those aged 65 and above. The projected workforce gap predicts a shortage of approximately 12% by 2050 and 18% by 2075. We estimate by 2075, the average surgeon caseload will need to increase to 196 cases per year, a 45% increase in cases per surgeon. Conclusion: There is an increasing career interest among candidates towards CT surgery, evidenced by more applicants and higher residency fill rates. In contrast to previous workforce gap and workload estimates, we show that this gap is actually getting smaller, yet it comes with an increasing workload.