Am Heart Hosp J. 2011;9(1):15–18
Lozenge Reference
Five Years On Surgery
Future Directions in Cardiac Surgery—Part II Lawrence H Cohn, MD and James Hubbard, MD
I
Five years later, Editor Weinberg has again asked me to comment on my predictions of 2006 to see how accurate they were and to predict where we are heading in cardiac surgery in 2011. Did any or all of my predictions come true?
n 2006 I was asked to predict the future directions in cardiac surgery for the American Heart Hospital Journal.1
This review will bring the readership up to date on the various aspects of cardiovascular surgery in 2011. What is clear is that there is now an intermix of interventional devices, surgical operations, and new technology in all areas of our field. In addition, the service-line concept for cardiac disease has become a reality in many areas of the US. It has been estimated that over 50 % of cardiologists are now working full-time for the hospitals in which they practice and many more cardiovascular surgeons are also becoming employees of the hospitals in which they practice, so this element is a major change in the practice demographics of 2006. There has been more and more pressure on the economic aspects of high-end medical therapy such as cardiology/cardiac surgery and, therefore, closer relationships between the practitioners and the hospitals in which they serve is becoming a reality to improve efficiency and decrease overall medical costs.
Education and Training
I predicted that cardiothoracic surgical training would change. As I wrote the article in 2006, the American Board of Thoracic Surgery (ABTS) eliminated the requirement for American Board of Surgery (ABS) certification in general surgery as a prerequisite for ABTS certification. Before that time, four to five years of general surgery and ABS certification were required for ABTS certification. As I mentioned then, general surgery was changing, and it has changed dramatically since that time and now bears little
In addition, many practicing cardiac surgeons are now recognizing the imperative for cross-training to learn percutaneous techniques, catheter and wire skills, coronary angiography, and endovascular training for stent grafting. As percutaneous valves become more and more relevant in the treatment of patients with aortic valve disease, these techniques and training modalities will be extremely important and many cardiac surgeons are retraining.
• Correspondence: Lawrence H Cohn, MD, Harvard Medical School, Division of Cardiac Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115. E:
lcohn@partners.org
Summer 2011 Future Directions in Cardiac Surgery—Part II 15
relationship to the training areas of several decades ago when most practicing cardiac surgeons found the general surgical experience invaluable, particularly in vascular surgery. Vascular surgery has turned into an area of percutaneous catheter intervention as well as open vascular surgery and they have set their own standards and separate board certification requirements, which are also quite different from general surgery. There are now three educational formats for ABTS certification in the US. We still have the general surgery track of four years (without ABS) followed by two to three years of cardiothoracic surgery. Another track is the 4/3 program, which involves three years of general surgery, a fourth combined year of cardiothoracic and general surgery and finally three years of cardiothoracic surgery. This gives the trainees considerably more exposure to cardiothoracic surgery, the specialty in which the individual plans to practice. Finally, a six-year program has now been established that begins straight out of medical school as an intern with six years of cardiothoracic residency all pre-established. This program currently exists in approximately 10 academic centers in the US and although no trainees have graduated from the programs yet, it is encouraging that many in these programs feel this is going to be successful. Thus, more attention is being paid to cardiothoracic surgery and much less attention is being paid to general surgery.
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