Integrated Cardiothoracic Surgery Residency Programs Largely Produce Cardiac Surgeons—Is the General Thoracic Surgeon an Endangered Species?

Abstract

Introduction

Integrated cardiothoracic surgery residency programs were introduced in 2008 in response to a decline in cardiothoracic surgery trainees. Since their inception, the number of integrated programs has grown, while the availability of independent fellowships has diminished. We hypothesize that the rise in integrated residencies will adversely affect the number of general thoracic surgery graduates.

Methods

We reviewed websites and social media pages of all accredited integrated cardiothoracic surgery residency programs and independent fellowships from 2020 to 2024. Programs without graduates or publicly available graduate data during this period were excluded. Data on each graduate’s first position after residency was obtained.

Results

Since 2008, the number of traditional cardiothoracic surgery fellowship positions has decreased by 29.2% (130 to 92), while integrated positions have increased 16-fold (3 to 48). Of the 479 alumni, 330 pursued cardiac surgery and 149 pursued thoracic surgery. Among cardiac surgeons, 30.6% (101) completed additional training post-residency, compared to 6.7% (10) of thoracic surgeons. Graduates from 2021 and 2022 were significantly less likely to pursue thoracic surgery compared to 2020 (OR 0.485, 95% CI 0.241-0.974, P = .042; OR 0.491, 95% CI 0.244-0.988, P = .046). Only 5.4% (8) of integrated program alumni entered thoracic surgery, with these graduates having 86.3% lower odds of pursuing thoracic surgery than those from independent fellowships (OR 0.137, 95% CI 0.0610-0.310, P < .001). Program leadership specialty did not significantly impact outcomes.

Conclusion

The increasing number of integrated cardiothoracic residency positions and decreasing independent fellowship opportunities contribute to a shrinking general thoracic surgery workforce, as most integrated program graduates enter cardiac surgery.