Is the CT market starting to correct itself?

cardsurgguy · May 17, 2007

Had a recent discussion about this and want to get some input from people who know more about this than I do.

What do you guys think, has CT seen its worst days?

Obviously, the last 5-10 years since stenting has really come into play haven't been kind to CT, however is it me, or are things at the bottom only to start going upward?

Hear me out on this one...3 reasons
1. It seems the market is correcting itself. I've heard that there's a decline in the number of people applying to CT and that plenty of programs are going unfilled.
2 statements in the thoracic interview thread: "CT surg is wide open, all you need is a pulse" and 55-79 people looking for CT spots (of which I've read there's about 140 in the country available).
So fewer people each and every year are applying and therefore getting trained to become CT surgeons.

2. People don't live forever. The baby boomers who are 55-65 now will have (or should have if they don't operate forever like Debakey or Cooley or whichever kept operating until his 80's) a mass exodus out of the workforce in the next 10 years.

So basically summing up 1 and 2, the supply of CT surgeons is declining on both ends of the spectrum.

3. There's pediatric CT, which has stable demand obviously, however, heart failure is growing and growing with the baby boomers and surgical interventions such as VAD's will probably grow with it, so heart failure can be a whole new source of demand for CT surgeons.

So what do you think? Sound logic or wishful thinking for those of us who unfortunately happened to be interested in CT?

Winged Scapula · May 18, 2007

The decline in number of physicians training in CTS and your hope that means an upswing in the need for them presumes that we are training the correct number.

The long-recognized problem was that we had too many CTS fellowship training programs, so not filling the programs is not a bad thing and it doesn't necessarily mean that we will be underserved in the future for CTS. It may mean that we will find the appropriate number and not flood the market again in 20 years with too many highly trained people for too few jobs.

But otherwise I agree, the 55-60 yo surgeons will be retiring soon but remember they have a whole generation of CTS trained surgeons, many without adequate jobs, left to fill those spaces.

There will always be a need for CTS, but we need to be more judicious about the number of people we train for an evolving field.

Skylizard · May 22, 2007

Kimberli Cox said:
...There will always be a need for CTS...

I am looking forward to what I hope will be an excellent match in a solid CTSurge fellowship. I think the demise of the field is drastically mistated.

This field as any other needs individuals with skill and a desire driven by an attraction to and satisfaction from the work involved. It doesn't matter if you go into CTS, Vascular, Colo-rectal, MIS, Plastics, Breasts, General, etc... What it comes down to is will you be happy with what the bread and butter of the field is? Are you adapatable and able to ride the wave of change in each field? If you choose a field based predominantly on an equation of work hours to salary ratio, you will not be happy no matter what the field. As it stands, any qualified surgeon in a specialty of surgery can make a good living and support their family.

I like chest work. I like CTS. The patients get sicker and the challenge increases. New technologies come and a good surgeon needs to learn something new...more challenge. It is what I have always found most intellectually stimulating and challenging. As it stands, CTS involves wide open "big wack" cases and a multitude of variations on minimally invassive...VATS, Robotics, Stenting, "mini-mitrals", on-pump, off-pump, EGD, Photodynamic therapies, etc... A well trained CTSurgeon can go down numerous paths. When all is said and done, you have the potential to have a huge positive impact on a patient...and have fun too

GAdoc · May 24, 2007

Skylizard said:
I am looking forward to what I hope will be an excellent match in a solid CTSurge fellowship. I think the demise of the field is drastically mistated. I do not claim to know all the ins and outs of the need and demand of this or any other field....
But, I believe that this field as any other needs individuals with skill and a desire driven by an attraction to and satisfaction from the work involved. It doesn't matter if you go into CTS, Vascular, Colo-rectal, MIS, Plastics, Breasts, General, etc... What it comes down to is will you be happy with what the bread and butter of the field is? Are you adapatable and able to ride the wave of change in each field? If you choose a field based predominantly on an equation of work hours to salary ratio, you will not be happy no matter what the field. As it stands, any qualified surgeon in a specialty of surgery can make a good living and support their family.

I like chest work. I like CTS. The patients get sicker and the challenge increases. New technologies come and a good surgeon needs to learn something new...more challenge. It is what I have always found most intellectually stimulating and challenging. As it stands, CTS involves wide open "big wack" cases and a multitude of variations on minimally invassive...VATS, Robotics, Stenting, "mini-mitrals", on-pump, off-pump, EGD, Photodynamic therapies, etc... The hours and challenges can be great but if you love it then it is great satisfaction. The list is large. The impact and patient population is broad. It's not just CABG. A well trained CTSurgeon can go down numerous paths. When all is said and done, you have the potential to have a huge positive impact on a patient...and have fun too

LS

Don't cardiothoracic surgeons perform heart transplants? I can't see the field of invasive cardiology encroaching on that domain anytime soon! The number of people looking for new hearts will certainly not decrease (someone mentioned the baby boomers all reaching retirement age). People (espcially Americans) have an affinity for things that wreck their hearts: excessive smoking and drinking, eating themselves to death, sedantary lifestyles, remote controles, and a severe distaste for excercise.

In addition, I would think there will continue to be advancements in valve replacement and even completely artificial heart technology. I doubt cardiologists will ever perform any procedures like these.

I agree that many of the "bread and butter" type cases which were left solely to the CTS until recently have been largely taken over by cardiologists. On a daily basis I'm sure this does affect the number of surgeons the system can support. But, once the system reaches equilibrium (as Dr. Cox mentioned), there will continue to be plenty of cases for CTS and cardiologists alike. So we can all "just get along".

TxMed · May 24, 2007

GAdoc said:
Don't cardiothoracic surgeons perform heart transplants? I can't see the field of invasive cardiology encroaching on that domain anytime soon! QUOTE]

true, but the issue is that there is not enough transplant and valve work to go around. maybe surgeons can double-scrub and charge twice for the procedure?!?

-tm

johnny_blaze · May 24, 2007

Ive been spending a lot of time in CT for the past 2 years so I think I can make useful comments about this topic (which has been discussed to death). Several points people are not taking into consideration are as follows.

- Cardiologists wont just stop with the interventional procedures, even if the results arent good now that doesnt mean they wont get better. Once they master percutaneous valve placement, thats another big chunk out of the cardiac surgeons work load.

- Peads and Transplant sound good on paper but it takes a lot of training and there may not be a consultant post waiting for you as its very specialised and practice is limited to a finite number of cases. Also, paediatric cardiologists can fix things too (I.e. ASD, VSD, PDA, ect).

- Those who specialise in Aortic Work are also limited to a finite number of cases and results generally arent that good.

- Cardiac trauma doesnt occur that frequently (unless you live in Detroit hehe)

- Those who maintain a thoracic interest are fairly safe however, you cant specialise so if u really want to do oesophagectomies and aortic reconstructions youll have to find a very understanding employer.

I know the future looks dim, however, I still plan on pursuing a career in CT as I quite like the thoracic side of it and would be willing to settle for the odd CABG/valve. If you really want to get into the field you might as well try because youll probably kick yourself if you dont

Is the CT market starting to correct itself?

cardsurgguy

Senior Member

Winged Scapula

Cougariffic!

Skylizard

GAdoc

GAdoc

TxMed

SpottieOttieDopalicious

johnny_blaze

And my name is hawkeye

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