CARDIOVASCULAR/THORACIC SURGERY (CVT SURGERY)

GENERAL INFORMATION
(Sources: Canadian Medical Residency Guide, RCPSC)

For purposes of presenting the data provided in the National Physician Survey (NPS), the specialties of cardiac surgery and thoracic surgery are combined (and will henceforth be referred to as CVT surgery). However, The Royal College of Physicians and Surgeons of Canada separate these specialties for certification purposes and as such, the following description and training requirements appear for both. Cardiac Surgery Cardiac surgery is the area of surgery that deals with diseases of the pericardium, heart and vessels. Procedures that are performed include coronary artery bypass, valve repair or replacement, heart transplantation, replacement of the aorta, pulmonary thromboendarterectomy and procedures to correct congenital abnormalities. It is a demanding, technical specialty that is very diverse. It exposes practitioners to a wide variety of medical problems and requires them to interact often with other physicians including the operating room team comprised of specialized nurses, technicians and anesthetists. After completing medical school, there are three pathways one can take to become certified in cardiac surgery that include 6 years of approved residency training in the disciplines of core general surgery, cardiac, vascular and thoracic surgery. For further details on training requirements go to: http://rcpsc.medical.org/residency/certification/training/cardiac_surgery_e.pdf Thoracic Surgery Thoracic surgery is the branch of surgery concerned with congenital and acquired diseases of the chest wall, mediastinum, lungs, trachea, pleura, esophagus and diaphragm. After completing medical school, to become certified in thoracic surgery requires that you first obtain RCPSC Certification in general surgery, cardiac surgery, or enrolment in a RCPSCapproved training program in these areas. All candidates must be certified in their primary specialty in order to be eligible to write the RCPSC certification examination in thoracic surgery. For further details on training requirements go to: http://rcpsc.medical.org/residency/certification/training/thoracic-surgery_e.pdf CVT surgeons have a great deal of direct patient contact, which can be viewed as a positive aspect of this specialty. While patients are often seriously ill, treatment can result in immediate and dramatic improvement. It involves long and irregular hours, which can take its toll on the physicians personal lifestyle. Life-and-death situations and emergencies requiring rapid, critical decisions are major causes of pressure within this specialty. There are currently 352 CVT surgeons practicing in Canada. Of these, a mere 2% are under the age of 35, with the majority (53%) aged 35-54. Forty-two percent are aged 55 or older. An overwhelming 91% of CVT surgeons are male and only 9% are female. (Source: 2012 CMA Masterfile).

DETAILED INFORMATION

The remainder of the data contained in this specialty profile has been extracted from the 2010 National Physician Survey (NPS), unless otherwise stated. All percentages are for respondents only. A total of 56 CVT surgeons responded (for a response rate of 18%). Complete data table for CVT surgery from the 2007 NPS are available at: http://www.nationalphysiciansurvey.ca/nps/2010_Survey/Results/physician-surg-e.asp For an index to all specialties, go to: http://www.nationalphysiciansurvey.ca/nps/2010_Survey/2010results-e.asp

In Training According to the Canadian Resident Matching Service (CaRMS), there were 12 cardiac surgery residency spots available to Canadian medical graduates in 2011. Results produced from Ontarios Population Needs-Based Physician Simulation Model indicate that there currently is and there will continue to be a shortage of cardiologists to meet the provinces needs. Please note that this projection is for Ontario only. Similar projections for the rest of Canada are not available. In general, surgical specialty residents most frequently cited intellectual stimulation/challenge as the reason for choosing medicine as a career (89%), followed by the doctor-patient relationship (65%) and the wide variety of clinical opportunities (59%).

Practice Setting Almost three-quarters of CVT surgeons (71%) work setting is in an academic health sciences centre (AHSC), 15% work in community hospitals and 21% in non-AHSC teaching hospitals. The AHSC (64%) is the primary place in which they see their patients, followed by 27% in all other types of hospitals.

Practice Profile Almost half (45%) of CVT surgeons work in a group practice (where on-call duties, office staff, equipment, office space and expenses may be shared amongst the physicians), while 30% are in a solo practice and 22% are in interprofessional practices. In 2007, during a typical week, CVT surgeons saw approximately 38 patients. Almost three quarters of CVT surgeons (73%) serve mainly an urban or suburban population. CVT surgeons work an average of 67 hours per week on professional activities (excluding oncall). The majority of this time (44 hours per week) is devoted to direct patient care, with or without a teaching component. A further 5 hours per week is spent on indirect patient care (making appointments with specialists, charting, meeting a patients family, etc.) and 4 hours per week is spent on administration.

The vast majority (83%) of all CVT surgeons report that they make themselves available to their patients (i.e., on-call) outside of their regularly scheduled hours, spending an average of 195 hours per month on-call. Given the nature and primary location of their practice, this on-call is to service hospital in-patients, but a large number of CVT surgeons also make themselves available to non-hospitalized patients. Of those who take call, 30% report spending up to 120 hours per month, 27% put in between 121 and 180 hours per month, but more than a third (35%) are on-call more than 180 hours per month. While on-call they spend an average of 73 hours on direct patient care and see an average of 23 patients.

Income Thirty-eight percent of CVT surgeons report that they receive 90+% of their income from fee-forservice, while 37% receive their income from a blended source (made up of a combination of 2 or more payment methods like fee-for-service, salary, capitation, sessional, contract, benefits/pensions, on-call remuneration or some other form). According to the Canadian Institute for Health Informations National Physician Database, the average fee-for-service payment per CVT surgeon in 2009-10 was $466,453. Note that this is gross billings and does not take into account deductions for overhead expenses, taxes, etc.

Satisfaction In general, 69% of CVT surgeons are very or somewhat satisfied with their current professional life. CVT surgeons expressed high levels of satisfaction (very or somewhat satisfied) with their relationship with patients (82%) and with their relationship with specialist physicians (75%). Slightly fewer were very or somewhat satisfied with their relationship with family physicians (70%).

ADDITIONAL INFORMATION Additional information on this specialty can be found from: The Canadian Cardiovascular Society: http://www.ccs.ca/ The Canadian Thoracic Society: http://www.lung.ca/