Impact of Gender in Congenital Heart Surgery – Results from a National Survey

Intersection of Race and Gender in the Cardiothoracic Workforce: Study of Representation and Salary

BACKGROUND

Cardiothoracic surgery lacks gender and racial/ethnic diversity. Recent studies have highlighted disparities based on gender and race/ethnicity among academic cardiothoracic surgeons. The impact of the intersection of these factors on representation and salary is unknown.

METHODS

A cross-sectional analysis of Accreditation Council for Graduate Medical Education and Association of American Medical Colleges data was performed on the number of trainees and clinical faculty stratified by race/ethnicity and gender using χ2 testing.

RESULTS

The number of women and underrepresented minorities was low in cardiothoracic surgery compared with other specialties, with lowest representation at the intersection of race/ethnicity and gender. Among trainees, 8% were Asian, 2% were Black/African American , and 1.5% were Hispanic/Latina women. Among cardiothoracic faculty, 3.4% were Asian, 0.8% were Black/African American, and 0.4% were Hispanic/Latina women. Women in academic medicine, surgery, and cardiothoracic surgery earned 80%-87% the salary of men of equal academic rank. White assistant professors earned more than their colleagues (all clinical faculty, surgeons, and cardiothoracic surgeons), this difference was further compounded by gender.

CONCLUSIONS

Salary disparities exist among cardiothoracic surgeons at the intersection of gender and race/ethnicity. Women experience salary disparity across all academic ranks and specialties. When considering the intersection of gender and race/ethnicity, gender is the predominant factor driving salary inequity.

The journey of becoming a congenital heart surgeon: Too long, too costly, too unpredictable

OBJECTIVE

The pathway to become a congenital heart surgeon (CHS) is challenging and unpredictable. Previous voluntary manpower surveys have shed partial light on this problem but have not included all trainees. We believe that this arduous journey merits more attention.

METHODS

To examine the real-life challenges of recent participants in Accreditation Council for Graduate Medical Education-accredited CHS training programs, we conducted phone interviews with all graduates of approved programs from 2021 to 2022. This institutional review board approved survey focused on issues including preparation, length of training, debt burden, and employment.

RESULTS

All 22 (100%) graduates during the study period were interviewed. Age at fellowship completion was a median 37 years (range, 33-45 years). Pathways to fellowship included traditional general surgery with adult cardiac (43%), abbreviated general surgery ("4 + 3," 19%) and integrated-6 (38%). Time spent on any pediatric related rotation before CHS fellowship was a median 4 months (range, 1-10 months). During CHS fellowship, graduates reported medians of 100 (range, 75-170) total cases and 8 (range, 0-25) neonatal cases as the primary surgeon. Debt burden at completion was a median of $179,000 (range, $0-$550,000). Maximal financial compensation during training before and during CHS fellowship were medians of $65,000 (range, $50,000-$100,000) and $80,000 (range, $65,000-$165,000), respectively. Six (27.3%) are currently in roles in which they cannot practice independently (5 [22.7%] faculty instructors, 1 [4.5%] CHS clinical fellowship). Median salary in first job is $450,000 (range, $80,000-$700,000).

CONCLUSIONS

Graduates of CHS fellowships are old, and training is highly variable. Aptitude screening and pediatric-focused preparation are minimal. Debt burden is onerous. Further attention to refining training paradigms and compensation are justified.

Report of the 2022 Society of Thoracic Surgeons Congenital Heart Surgery Practice Survey

BACKGROUND

The Society of Thoracic Surgeons Workforce on Congenital Surgery performed a practice survey to analyze contemporary data.

METHODS

An electronic survey was sent to congenital heart surgeons in North America. Details on demographics, training paradigm, clinical practice, and work satisfaction were queried, tabulated, and analyzed.

RESULTS

Of 312 unique contacts, 201 (64.4%) responded. Of these, 178 (89%) were practicing. The median age was 52 years (interquartile range, 43, 59 years), and 157 (88%) were male. The number of female respondents increased from 12 (7%) in 2015 to 18 (11%) at present. Practice composition was predominantly mixed pediatric and adult (141; 79%), although 15 (8%) surgeons practiced exclusively pediatric surgery. Most surgeons (154; 87%) reported performing the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery category 4 and 5 procedures. One-fourth (42; 24%) reported performing fewer than 50 pediatric cases per year, and 18 (10%) stated that their primary role was as a surgical assistant. Individual surgeon case volume was most commonly 100 to 149 total cases (29%). Although one-half (91; 51%) reported their volume as being "just right," 74 (42%) reported that their case volume was "too small." Seventy-six (43%) reported too many surgeons in their region. Of the 201 practicing surgeons, 30 (14.9%) plan retirement in the next 5 years. Most described career satisfaction, with 102 (57%) being very satisfied and 48 (27%) somewhat satisfied.

CONCLUSIONS

Although most congenital heart surgeons in North America are satisfied with their careers, more than 40% believe that their caseload is inadequate and that there are too many surgeons in their region. Further analysis is warranted regarding career dissatisfaction and diversity.