The cardiac surgery workforce: a survey of recent graduates of Canadian training programs.

BACKGROUND: The number of applications to Canadian cardiac surgery programs has declined recently. Perception of a difficult job market for new graduates may contribute to this decline. The objective of this survey was to document the experience of recent graduates of Canadian cardiac surgery training programs. METHODS: A 45-question, web-based survey was distributed to all graduates of Canadian cardiac surgery training programs who completed their training between 2002 and 2008. RESULTS: Of the 62 estimated recent graduates, 50 completed the survey (81%). Mean age was 36 + or - 3 years and 90% were male. The mean number of years of training after medical school was 9.4 + or - 1.6 years; 78% completed a graduate degree; and 27% extended their training because of a lack of jobs. When asked about employment, 74% mostly or definitely got the job they wanted, although 34% considered themselves underemployed. Most respondents (98%) considered finding employment for a new graduate in cardiac surgery today difficult or extremely difficult, and 64% believed that there is currently an excess of cardiac surgeons in Canada. Only 54% of participants would strongly recommend cardiac surgery to potential trainees. CONCLUSIONS: The majority of recent graduates from Canadian cardiac surgery training programs were successful in finding secure employment. A substantial proportion, however, extended their training because of a lack of jobs and reported feeling underemployed. Survey respondents agreed that a new graduate might have difficulty finding a job in cardiac surgery today. These concerns may contribute to the challenges of recruiting to the specialty.

Modeling the cardiac surgery workforce in Canada.

BACKGROUND: Limited employment opportunities for recently trained cardiac surgeons are deterring medical students from entering cardiac surgery residency programs. Given the lengthy training period and the aging of both the general population and currently practicing cardiac surgeons, this reduced enrollment raises concerns about the adequacy of the future cardiac surgery workforce. A workforce model was developed to explore the future need for cardiac surgeons in Canada. METHODS: A novel system dynamics model was developed to simulate the supply and demand for cardiac surgery in Canada between 2008 and 2030 to identify whether an excess or shortage of surgeons would exist. Several different scenarios were examined, including varying surgeon productivity, revascularization rates, and residency enrollment rates. RESULTS: The simulation results of various scenarios are presented. In the base case, a surgeon shortage is expected to develop by 2025, although this depends on surgeons' response to demand-supply gap changes. An alternative scenario in which residency enrollment directly relates to the presence of unemployed surgeons also projects substantial shortages after 2021. The model results indicate that if residency enrollment rates remain at the 2009 level an alarming shortage may develop soon, possibly reaching almost 50% of the Canadian cardiac surgical workforce. CONCLUSIONS: These workforce model results project an eventual cardiac surgeon shortage in Canada. This study highlights the possibility of a crisis in cardiac surgery and emphasizes the urgency with which enrollment into cardiac surgery training programs and the employability of recently trained cardiac surgery graduates need to be addressed.

Massive mechanical loss of microspheres with direct intramyocardial injection in the beating heart: implications for cellular cardiomyoplasty.

OBJECTIVE: Direct intramyocardial injection is a common route of donor cell administration for myocardial cell therapy. Studies have demonstrated a significant and rapid loss of implanted cells, which is thought to be biologically caused. We hypothesized that mechanical loss of cells from the contracting myocardium might actually be the main culprit. METHODS: Intramyocardial injections of fluorescent microspheres (10 microm) were carried out in both small and large animal models. The hearts of Lewis rats (250-350 g) received 3 x 10(6) microspheres injected into the left ventricular myocardium. Rats were divided evenly between two experienced operators. The nonbeating (n = 2) and beating (n = 5) hearts of piglets (7.5-7.8 kg) received 3 x 10(6) microspheres. The hearts were excised within 10 minutes, and the microspheres retained in the myocardium were quantified with fluorescent flow cytometry. RESULTS: In the beating-heart rat model, the microsphere retention rates after a single injection were similar with and without purse-string occlusion of needle puncture sites and slightly lower than after multiple site injections (6.19% +/- 4.05% vs 5.44% +/- 5.66% vs 8.83% +/- 3.29%). There were no significant operator-dependent differences. The retention rates in beating porcine hearts were higher than those in the rats (P < .05) but markedly lower than those in nonbeating porcine hearts (11.1% vs 67.4%). CONCLUSION: Mechanical leakage and washout may account for a major portion of cell loss after cell implantation, and efforts aimed at reducing mechanical loss in the beating heart may yield a greater benefit than those targeting biologic loss alone.

Reappraisal of recent clinical trials of angiogenic therapy in myocardial ischemia.

We review the clinical trials of angiogenic therapy for myocardial ischemia, focusing on why the results are unsatisfactory in more recent larger and better designed trials. Critical reappraisal of such trials, in view of the pathophysiologic complexity of the angiogenic process at a molecular level, suggests that the strategy of therapies based on a single growth factor protein or gene may not be adequate for optimal therapeutic response.

The formalin test: a dose-response analysis at three developmental stages.

We investigated the behavioral response of rat pups to intraplantar injection of varying formalin concentrations using a time-sampling method. At 3 days of age, the response was monophasic and persisted for the whole hour, even at low formalin concentrations. Flexion, shaking and licking the injected limb and hind-limb kicking correlated strongly with log formalin concentration (r = 0.82); behavioral state was altered only at the highest concentration. The response on day 15 was also monophasic, but it waned in 30 min, even at the highest formalin concentration tested. Flexion, shaking and licking of the injected limb were strong pain measures (r = 0.83). The response at 25 days was biphasic, and the adult measures, paw lifting and licking, produced a good formalin concentration-effect relationship (r = 0.80). The log concentration-effect relationships for formalin at the three developmental stages and for adult rats were parallel, but between 3 days and 15 days of age, the relationship shifted to the right by 2.5-fold, and by a further 4-fold between 15 and 25 days, when the sensitivity to formalin-induced pain was similar to that in adults. The data describe efficient, quantitative measures of formalin-induced pain for developing rats, show that the pain response is log-linearly related to formalin concentration throughout development, and demonstrate that the sensitivity to formalin-induced pain is about 10-fold higher in neonatal rats than in weanlings. the data imply that there are major qualitative changes in pain processing as the nervous system develops.