Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner, August 13, 2009, by Todd Neale — If current trends continue, the nation’s aging population will face a shortage of cardiothoracic surgeons by 2025, researchers predict.

Assuming today’s patterns of healthcare use and delivery remain the same, a rapid increase in the 65-and-older population segment will increase demand for cardiothoracic surgery by 46% over the next 15 years, according to Irving Kron, MD, of the University of Virginia in Charlottesville, and colleagues.

At the same time, the supply of surgeons is expected to decline by 21% because of retirements and a declining interest among young doctors in cardiothoracic surgery fellowships, they reported online in Circulation: Journal of the American Heart Association.

The only combination scenario that could forestall such a shortage would involve a current surplus of surgeons, the elimination of coronary artery bypass grafting entirely, and an increase in the number of thoracic surgery trainees, the researchers said.

With each of those scenarios extremely unlikely, “by 2025, it is probable that there will be a shortage of at least 1,500 surgeons or 25% of the likely projected need,” they said.

The shortage could produce poorer patient outcomes “if non-board-certified physicians expand their role in cardiothoracic surgery or patients must delay appropriate care because of a shortage of well-trained surgeons,” they wrote.

Dr. Kron and colleagues derived their findings from a model incorporating population trends and current healthcare use from a variety of data sources.

The proportion of the population 65 and older in the U.S. is expected to swell rapidly from 13% to 20% by 2030, according to a U.S. Census Bureau report. (See World’s Population Grows Increasingly Long in the Tooth)

Unfortunately, the resulting increase in demand for the services of cardiothoracic surgeons from this aging population appears to be accompanied by declining interest in the specialty.

“In 2007,” Dr. Kron said, “33% of available thoracic surgery fellowship positions went unfilled in the National Resident Matching Program.”

One reason for the waning interest could be the decreasing popularity of CABG procedures — which declined by 28% from 1997 to 2004 — and the growing use of stenting, which increased by 121% over the same time period.

Exacerbating the problem is an aging population of cardiothoracic surgeons: more than half are at least 55 and nearing retirement, the researchers said.

Only one-third of physicians overall have reached that age.

Because they require more postgraduate training than most other specialties (an average of 8.3 years), the researchers said, efforts to increase the workforce to sufficient levels by 2025 would have to start today.

The researchers acknowledged some limitations of the analysis, including the uncertainty of how new technology and reimbursement practices will affect trends, and how surgical productivity will change. There were also limitations in the physician supply data and in the assumption that supply and demand were the same at baseline.

The study was funded by American Association for Thoracic Surgery and the Society of Thoracic Surgeons.

The authors made no financial disclosures.
Primary source: Circulation: Journal of the American Heart Association
Source reference:
Grover A, et al “Shortage of cardiothoracic surgeons is likely by 2020” Circulation 2009; DOI: 10.1161/CIRCULATIONAHA.108.776278.,, August 12, 2009, by Lois Romano  —  Van Jones may have one of the hottest assignments in the Obama administration — selling the notion of a new “green-collar” economy — but in a country burdened with a 9.4 percent unemployment rate, it’s not easy.

How do you tell an unemployed construction worker that it’s time to start thinking about installing solar panels instead of aluminum siding? “I think some of these ideas are complicated for people when they first hear them,” said Jones, senior green jobs adviser to the White House Council on Environmental Quality. Most people “don’t know what retrofitting a building means, or they haven’t heard of . . . a smart biofuel. And so a lot of times, people just sort of go yes, yes, but they aren’t really following you.”

Jones, 40, has been a leader in a growing movement that aims to hit two major social and policy challenges — the struggling economy and environmental quality — with one boulder. It’s a vision that has been embraced by various industries and advocacy groups intrigued by the promise of thousands of new green jobs as the country invests in energy efficiency and confronts climate change.

But skeptics say the reality of creating a “green economy” is more complex. As with any new business, start-up costs are high — and money is tight these days. And although the administration has allocated as much as $80 billion through the stimulus package to create more than 6 million green jobs, it is impossible at this point to quantify success. For one, there is no official federal definition of a green job — though the president’s budget includes money for the Bureau of Labor Statistics to work with other agencies to define the green economy and produce data on green-collar jobs by 2011.

Jones said anecdotal evidence is strong that the strategy is working, and he dismissed as “myth” reports that the plan merely moves jobs around the economy without creating new ones. “If you get people in on the ground floor of a growing industry, they can grow that industry,” he said.

His career path was not unlike President Obama’s. After graduating from Yale Law School, Jones worked as a community activist in Oakland, Calif., and founded the Ella Barker Center for Human Rights. A few years ago, he saw an opportunity to combine his commitment to racial and economic parity with work to solve the environmental crisis. He soon became a hero of the green movement as he talked about “greening the ghetto,” appearing on hip shows such as “The Colbert Report” and sending out his message on YouTube.

“I think sometimes when we think about ecological solutions, we think about very high-end stuff — you know, maybe space-age technology, way off in the future,” he said. “What we forget is most of the things we need right now to reduce pollution, to reduce greenhouse gas emissions, don’t require fancy technology. You know what it requires? A caulking gun.”

He launched a Green-Collar Jobs Campaign, which led in 2007 to Green for All, an organization he founded to help create and find jobs in the green economy for the poor and disadvantaged. “People need to have the opportunity to be a part of industries that are going someplace,” he said in an interview at his office across the street from the White House.

“When you’re working in communities where people don’t have a lot of hope for opportunity, you say, geez, [do you] you want to fight, but hard, to get people jobs that you know are going to be dead-end, or can you find them a job in a part of the economy that’s going someplace? . . . And so then I saw that these firms were going places, that’s when I got totally jazzed.”

White House Green Czar, Van Jones, Tells About the US Green Economy