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Ann Thorac Surg 2003;76:1779-1781
© 2003 The Society of Thoracic Surgeons
a Department of Surgery, St. Louis University, St. Louis, Missouri, USA
* Address reprint requests to Dr Lee, Department of Surgery, 3rd Floor, St. Louis University, 3635 Vista Ave at Grand Blvd, St. Louis, MO, USA 63110-0250
e-mail: leer2{at}slu.edu
In 1994, 156 US medical school graduates applied for the 146 available training positions in cardiothoracic (CT) surgery. This was the last time that the number of applicants from US medical schools exceeded the available number of positions. Since then, the number of US medical school graduates applying for CT surgery has progressively declined and now falls far short of approved residency positions [1]. The remaining positions have been filled by qualified international graduates, residents recruited outside of the match, or have been left unfilled. This has raised the question, "Why are only 100 people from US medical schools interested in entering the field of cardiothoracic surgery?"
Every recent president of the STS and AATS, including Dr Delos Cosgrove [2], Dr William Baumgartner [3], Dr Mark Orringer [1], Dr Fred Crawford [4], and Dr Timothy Gardner [5] has discussed the application decline during each of their presidential addresses. Although there are many facets to this problem, most of our thoracic surgery leaders believe that one component of the solution is to provide strong role models to potential applicants [1, 3–6]. However, role models come in many forms. These may be senior faculty, junior faculty, or our field's most direct ambassadors to potential applicants, CT surgery residents. Understanding the perspective of the CT surgery resident is vital to understanding how potential applicants view our field. Two critical issues facing CT residents are their prospects for employment and their assessment of their training experience.
In an effort to gain insight into the CT residents' view of residency training and the current job situation, the Thoracic Surgery Residents Association (TSRA) conducted a survey 2 weeks before graduation in June 2002. All available CT surgery residents were e-mailed through CTSNet. Graduating residents were asked to go to a Web-based link and complete an extensive survey with an open section for comments. Topics included demographic information, job search information, assessment of the job market, key factors in obtaining a job, marketable skills, and satisfaction with training. Sixty residents responded, representing approximately 40% of the graduates. The results of the survey were presented at the TSRA meeting at the STS in February 2003. The results are highlighted here with a few selected comments that provide the view of some graduates.
Demographics
The mean age of graduates was 35.5 years old, with a range from 32 to 44 years old. Eighty-nine percent were male and 83% were married. Sixty-five percent had two or more children. Slightly more than one-half of the respondents (58%) spent 2 years of clinical training in cardiothoracic surgery. Twenty-six percent spent 3 years in training, and 16% trained longer. Only 19% did not spend any time in research between medical school and completion of cardiothoracic surgery training. However, 45% spent at least 2 years dedicated to research. Almost one-third of residents (29%) graduated without educational debt, but over one-third (36%) owed more than $75,000.
Job search
Most applicants started looking for a job early. Whereas 67% percent began seeking employment at least 9 months before graduation, 19% percent began their search more than 1 year before they finished. This yielded between one and three interviews for the majority (71%) of graduates. The interviews led to one job offer in 38% of graduates in 2002; only 26% of graduates received more than two offers. Initially, 44% of graduates wanted to practice cardiac surgery exclusively, but only 34% percent were able to do so. Twelve percent chose thoracic surgery exclusively. The remainder of the graduates practiced both. Although only 3% of respondents began their search with the intention of extending their training, 11% decided to obtain more training by the time that they graduated. Often, it was because they could not find acceptable employment, as reflected in some of the comments: "Job situation is very bad. I have accepted position as clinical fellow in order to continue search for decent job;" "I originally sought to be a cardiac surgeon, but the job market was dismal, so I did an extra year and decided on thoracic."
Assessment of the job market
Most applicants found it difficult to find a desirable job. Eighty percent thought that it was difficult to extremely difficult. Only 17% thought it was easy to find employment. Ninety-three percent of respondents knew colleagues that were having a difficult time finding a job. In the end, only 33% of these graduates were satisfied with the opportunities available to them.
Obtaining a job
When evaluating the most effective method for obtaining a job, there was nearly a consensus. Ninety-three percent of the respondents felt that personal contacts were the most effective means in obtaining a job. Journal ads, recruiters, and letter mailing were felt to be ineffective techniques. Some of the respondents believed that the role of their program director in their job search was minimal. The question presented and response was: The role that my program director played in my job search was: (A) integral,25%; (B) important, 12%; (C) not important, 21%; (D) inconsequential, 42%.
Valuable skills
We asked about several areas of experience that candidates thought were marketable in their job search. They are summarized in Table 1.
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Most graduates (97%) believed that their training adequately prepared them for independent operating. However, 25% thought that they were not adequately prepared for the American Board of Thoracic Surgery Exam. Despite their satisfaction with their operative experience, 41% of the 2002 graduates reported that they would submit a different match list if they could resubmit today. Twenty-three percent of the 2002 responding graduates would not again become cardiothoracic surgeons.
Proposed solutions
Although it may not be practical, because of antitrust legislation [2], many graduates proposed that we decrease the number of residency positions. A few of their comments are listed: "There are too many heart surgeons. Cut the number of spots and programs." "Very tight job market. Too many surgeons and declining volume of cases. The RRC needs to cut the number of cardiac surgery residency positions." "There should be less people accepted into cardiothoracic training programs because there are no jobs out there, and it is only going to get worse with stents, etc. Only the most competitive will survive the drought."
Comment
Overall, these results are surprising and somewhat disappointing. Two of the most noteworthy responses were the residents' view of the contribution of their program director in their job search and the high percentage of residents who would submit a different match list if again given the opportunity. It seems that if this is the view of nearly one-half of our ambassadors to potential applicants, it is almost surprising that we have as many applicants as we do. In addition, the fact that nearly one-fourth of the respondents would not again become CT surgeons demands that we look to our residents and try to improve their view of our specialty.
There are obviously limitations with this survey that must be recognized when interpreting the results. As only 40% of graduates responded, there is no way to know if the view of the respondents accurately reflects the view of the nonrespondents. It is possible that those residents less satisfied with their training and employment opportunities were more likely to respond, thus magnifying the proportion of negative responses. Nonetheless, even if this is true, it remains that a significant minority of trainees perceive problems in their training and employment prospects.
This survey attempts to better define and quantify the views of our graduates on these issues. There is a paucity of data regarding how our graduates perceive the job market and the quality of their training. Our field is one of the most aggressive in terms of measuring outcomes in order to improve results. This same precision with which we approach patient care needs to be applied to the evaluation of our resident training and placement. Only then can we improve. However, any attempt at progress must involve cooperation among residents, faculty, program directors, and all the organizations in thoracic surgery.
To get more information about theses issues, the TSRA will repeat the survey each year. This should provide insight into the CT surgery residents' perception of the job market, as well as important trends in graduate characteristics and satisfaction. Hopefully, we can obtain information from 100% of the graduating residents. With appropriate planning and cooperation among residents and program directors, this should be achievable.
In addition, the TSRA will begin to track the placement of each resident from every program. This will enable applicants to identify residency programs that have a history of successful placement in line with an individual resident's career goals. This is a measure of evaluating the success of a program that was previously unavailable. Although the TSDA, RRC, and ABTS ensure that programs train safe, qualified CT surgeons, the placement of graduates has not been compared between institutions. Objective comparisons of placement between programs are overdue.
However, this is only a beginning. Once we have a more comprehensive understanding of the issues facing CT residents, we need help from our thoracic surgery leaders and colleagues to design and implement measures that will improve the residents' view of our field. As cardiothoracic surgeons, we are by nature problem solvers. An incredible opportunity is presently before us. We can work together as a community in order to improve both the ability of our graduates to find good positions and the ability of employers to find the best candidates. More importantly, we can improve resident satisfaction with their training experience. This will be the most effective way to encourage others to enter the field. The message that our ambassadors send is powerful: we should work together to make it a positive one.7
References
This article has been cited by other articles:
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  F. A. Crawford Jr Thoracic Surgery Education-Past, Present, and Future Ann. Thorac. Surg., June 1, 2005; 79(6): S2232 - S2237. [Abstract] [Full Text] [PDF]
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G. H. Wheatley III Job Availability for Finishing Cardiothoracic Surgery Residents Ann. Thorac. Surg., January 1, 2005; 79(1): 384 - 384. [Full Text] [PDF]
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T. J. Gardner Residency Training for the Future, Not the Past Ann. Thorac. Surg., November 1, 2004; 78(5): 1519 - 1521. [Full Text] [PDF]
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J. D. Salazar, R. Lee, G. H. Wheatley III, and J. R. Doty Are There Enough Jobs in Cardiothoracic Surgery? The Thoracic Surgery Residents Association Job Placement Survey for Finishing Residents Ann. Thorac. Surg., November 1, 2004; 78(5): 1523 - 1527. [Abstract] [Full Text] [PDF]
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