106. The Journey of Becoming a Congenital Heart Surgeon: Too Long, Too Expensive, Too Unpredictable
Children's Mercy Hospital
Kansas City, MO
United States - Contact Me
Dr. O'Brien is the Co- Director of the Ward Family Heart Center and Chief of Cardiothoracic Surgery at Children's Mercy Kansas City. He is also the Joseph Boon Gregg/Missouri Chair in Pediatric Cardiac Surgery and the director of the Congenital Heart Surgery Fellowship. He is a Professor of Surgery the University of Missouri-Kansas City School of Medicine.
Dell Children's Medical Center
Austin, TX
United States - Contact Me
Charles D. Fraser, Jr., M.D., is the J.L. Hern Endowed Chair of Pediatric and Congenital Heart Surgery at Dell Children's Medical Center in Austin, Texas. He also serves as the Director of the Texas Center for Pediatric and Congenital Heart Disease and is a Professor of Surgery, Perioperative Care and Pediatrics in the University of Texas, Dell Medical School. Dr. Fraser was recruited to the University of Texas to develop an integrated center focused on pediatric and congenital cardiac care. The center’s mission is to provide holistic, family centered care in a value-based, outcome driven program. Dr. Fraser’s clinical career has been dedicated to the surgical treatment of congenital heart disease and has included the development of leading pediatric heart and lung transplant and mechanical circulatory support programs. Dr. Fraser’s research interests have included congenital heart surgery outcomes, cardiopulmonary transplantation, mechanical circulatory support, neurologic protection, and bioengineering. He has contributed to over 400 peer-review professional publications, three textbooks, and has been awarded significant extramural peer-review research funding. He is recognized as one of the world’s leading pediatric heart surgeons and he and his teams have performed over 18,000 corrective operations in children and adults with congenital heart disease. Prior to joining the University of Texas, Dr. Fraser was a tenured Professor of Surgery and Pediatrics in the Baylor College of Medicine. From 1995 to 2018, Fraser served as Chief of the Division of Congenital Heart Surgery and from 2010 to 2018, Surgeon-in-Chief, at Texas Children’s Hospital in Houston, Texas.
Description
Methods: To examine the real-life challenges of recent participants in American Council of Graduate Medical Education accredited CHS training programs, we conducted phone interviews with graduates of all 11 approved programs from 2020-2022. This IRB approved survey focused on issues including preparation, length of training, debt burden and employment. Results are presented in n(%) and median(range).
Results: All 22(100%) graduates during the study period were interviewed and were predominantly male(77%), white(64%), married(86%) and have children(77%). (Table) Age at fellowship completion was 37(range: 33-45) years. Individuals were highly accomplished in college and medical school with the majority honors graduates and 33% having additional advanced degrees. Number of peer reviewed manuscripts at completion of training was 20 (range: 5-100). Pathways to fellowship included traditional general surgery with adult cardiac(43%), abbreviated general surgery("4+3", 19%) and integrated-6(38%). For CHS fellowship preparation, 1(5%) underwent visual acuity testing and 0 participated in formal leadership training. Time spent on any pediatric related rotation prior to CHS fellowship was 3(range: 1-7) months. Three(14%) participated in formal pediatric echocardiography or catheterization rotations. Nine(43%) participated in a formal cardiac morphology course. Neonatal cases actually performed as primary surgeon during fellowship was 8(range: 2-25). Debt burden at completion was $179,000(range $0-$550,000). Maximal financial compensation during training before and during CHS fellowship were $65,000(range: $50,000-$100,000) and $80,000(range: $65,000-$165,000) respectively. All are employed - 5(22.7%) as instructors, 13(59.1%) as assistant or associate professors, and 2(9.1%) private practice. Median salary in first job is $450,000(range: $80,000-$700,000). Nine(40.9%) had any financial savings at fellowship completion.
Conclusion: While graduates of CHS fellowships find jobs, individuals are old and compensation 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.
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