Why Become a Cardiothoracic Surgeon?

These are trying times for the specialty of cardiothoracic surgery.  The educational process for completion of training is criticized for being too lengthy.  The work loads and work hours during the required general and cardiothoracic surgical residencies are excessive and stressful, leaving too little time for formal didactic teaching, individual study, family responsibilities, and recreation.  Cardiothoracic program directors and other attending surgeons have been criticized for devoting too little time to the welfare of their trainees. Some are considered disinterested or abusive.  The educational debt accumulated by many residents upon completion of their training is staggering, averaging about $50,000 and exceeding $100,000 to $150,000 in some instances.  Jobs are more difficult to find, both in the private and academic settings.  Starting salaries have fallen, malpractice insurance rates are becoming prohibitive, and maintaining the current levels of reimbursement for services rendered is a continuing struggle.  Many practicing cardiothoracic surgeons are disillusioned, contemplating early retirement or career changes, and voicing their unhappiness to anyone who will listen.

Medical students about to make career specialty choices are keenly aware of all of these difficulties and are justifiably shying away from cardiothoracic surgery and other specialties with long training periods and high malpractice insurance rates.  Only a minute fraction (less than half of one percent) of American medical students currently indicate an interest in pursuing training in cardiothoracic surgery.  Presently in the United States, fewer graduates of American medical schools apply for residency positions in cardiothoracic surgery each year, than the number of positions available.

Why then, one might ask, would anyone want to become a cardiothoracic surgeon?  In the discussion that follows, I will state the reasons why I became a cardiothoracic surgeon, and why I believe it remains a viable, exciting, stimulating, challenging, and rewarding specialty for young physicians.  I made the decision to become a physician when I was 9 years old.  I underwent an emergency appendectomy and was so impressed with the general surgeon and the others who cared for me that I decided then and there that I wanted to be a physician and a surgeon.  My surgeon was a quiet, compassionate, but highly skilled individual who was totally dedicated to his profession.  He loved his work and his patients. Another physician, an otolaryngologist and a family friend, knew of my interest in becoming a doctor and would take me on his rounds and permit me to assist him with minor surgical procedures when I was still in high school.  These two surgeons were exemplary role models, and they stimulated me to pursue a surgical career.

During my first year in medical school in 1957, down the hall from where the freshman histology course was being taught, several of the faculty thoracic surgeons (there were no “cardiac” surgeons in those days) were assembling and testing the second Gibbon-Mayo heart-lung machine (the first one was located at the Mayo Clinic) in preparation for its use in humans.  It had been purchased with funds donated by the citizens of St. Louis through a fund-raising effort by one of the local newspapers, and had been manufactured in St. Louis by a small engineering company.  I wandered down the hall from the histology laboratory on many days and watched these surgeons and an anesthesiologist who was serving as the perfusionist, operate on a series of dogs to become familiar with the apparatus and to master the techniques of cannulation and optimal perfusion.  It was a fascinating experience and I was hooked!  This fascination with cardiopulmonary perfusion and its physiology remains with me to this day, some 47 years later.  That a human being can be connected to such an apparatus, have his or her circulatory and respiratory functions totally performed by a machine for up to three or four hours, have a major cardiac condition corrected, and emerge from anesthesia physiologically intact is nothing short of miraculous.

In my junior and senior years in medical school I would watch cardiac surgical procedures from the observation gallery whenever I had time.  I also took an elective in pediatric cardiology and was encouraged by my preceptor to pursue a career in cardiac surgery.  Other physicians during my years as a general surgical and cardiothoracic surgical resident served as mentors and role models, and encouraged me to stay the course.  I have acknowledged these individuals and the impact they had on my career in a previous publication [1].

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