The Good Old Times: Medicine and Cardiothoracic Surgery Are What They Used to Be and Possibly Even Better

Gloom pervades about medicine as a profession and about cardiothoracic surgery. Trainees and young surgeons are often tainted for not having the same work ethic as older folks. There is concern that we are neither attracting "the best and the brightest," nor is cardiothoracic surgery an attractive career. The evidence includes the fact that the number of applicants for Thoracic Surgery residencies dropped from about 200 in 1995 to 96 in 2007. Of the 96 applicants, 87 matched, leaving 33% of approved positions unfilled and 39% of all residency training programs unfilled [1].

It is indisputable that physicians are working harder for less pay. In comparison, the best young attorneys, finance, and high-technology professionals reap rich rewards. This contrast is said to blunt the attraction of young people to careers in medicine and cardiothoracic surgery. A series of recent events prompt me, nevertheless, to be optimistic about the younger generation and the future of medicine.

I interviewed two young women who were applying for “early decision” admission to my college, which has always attracted the best. They were at least as bright and as promising as any of my classmates more than 50 years ago. They were better informed and more aware of the world around them than we had been, in part because of new learning tools and better communication methods. All my classmates were men, and now women are admitted. All my peers in surgical residency were men, and now about half of surgical residents in many programs are women. This change has doubled the pool of outstanding applicants. That is progress!

Then I interviewed an applicant for "early decision" admission to my medical school, which is equally as selective as my college. Simultaneously, I was hosting a senior student from my Midwest school while he was being interviewed for residencies on the West coast. I seized the occasion to bring the applicant for admission and the senior student together, thereby gaining the opportunity to hear them interact somewhat outside the constraints of an interview situation. These students are as motivated to achieve excellence as my peers and I had been. Both the applicant for admission and the graduating senior had a stronger base of experience and knowledge than my generation at the same point in our careers. That is also progress!

Last week I was in Tokyo, lecturing about medical writing for non-English speaking specialists who now provide over 50% of articles published in our best journals [2]. As an aside, I was asked to look over a manuscript that an editor had returned for revision to a Japanese assistant professor. Because of a clinical problem that he had encountered, this surgeon made a hypothesis that the problem could be avoided if it were better understood. He studied 190 cadavers and he had succeeded with his research, but he did not know how to present his work because of the English Language Burden [3]. His manuscript had been rejected twice, but he had worked countless hours to improve it. Finally, reviewers recognized the value of his work. He and I worked on his revision for nearly four hours. I know that his manuscript will be published and that it will improve the impact factor of the journal in which it will appear. This author’s commitment to excellence in patient care and research is entirely consistent with that of the most dedicated people in my generation. His wish to publish in English is an indication of the exciting globalization of medicine. Few, if any, other professions allow a senior citizen like me to contribute in a country with another language regarding new findings that will improve outcomes globally. The human body and biology are international, and opportunity is worldwide.

The title for one of our recent Grand Rounds included the words molecular surgery. A practicing surgeon who heads a well-funded laboratory had used genomics and molecular biology that were nonexistent when I published my first paper in 1958 to study Islet of Langerhans transplantation. He and his colleagues dream of using this method routinely to treat diabetes mellitus with success. I was stimulated to reflect that in the 1960s and 1970s we and others dreamed of successful clinical lung transplantation that eventually became routine [4]. What can be more satisfying than a career that gives young people the opportunity to turn a dream into a method that successfully treats desperately ill patients? The beauty of medicine and the power of surgery are alive and well!

Enter reality in 2008. We are working more and getting paid less. There is less time for thought and teaching and research [5]. Research funding is awfully hard to get. Journalists continue to bash physicians. Talented young people are being diverted from medicine because they can earn more and work less in other professions. We have needed to form political action committees and to educate ourselves in the ways of government. We have reluctantly, and too slowly, recognized that it is better to be proactive than reactive. These important changes cannot and should not be denied.

There was gloom about the US economy in 1929, and here it is again in 2008. Franklin Delano Roosevelt’s reaction to the Great Depression that began in 1929 was, "We have nothing to fear, but fear itself." This concept now applies to medicine and cardiothoracic surgery.

If we remain imaginative and proactive in adapting to the socioeconomic forces around us, and work hard to give our successors the opportunities we had and that they deserve, medicine and cardiothoracic surgery will continue to attract the best and the brightest young people such as those with whom I have had the recent privilege of interacting.

References

1. National Resident Matching Program. Match Results Statistics, Thoracic Surgery Fellowship, Match Day June 13, 2007, Appointment Year 2008. http://www.nrmp.org/.
2. Benfield JR, Howard KM. The language of science. Eur J Cardiothorac Surg. 2000;18(6):642-648.
3. Benfield JR, Feak CB. How authors can cope with the burden of English as an international language. Chest. 2006;129(6):1728-1730.
4. Benfield JR, Wain JC. The history of lung transplantation. Chest Surg Clin N Am. 2000;10(1):189-199, xi.
5. Ludmerer KM. Time to Heal: American Medical Education From the Turn of the Century to the Era of Managed Care. Oxford, UK: Oxford University Press; 1999.