Understanding our thoracic surgery workforce: Who, what, and where we practice

The makeup of the thoracic surgical workforce can influence policy, training, and certification, but it is not well defined. Using data from the American Board of Thoracic Surgery, this study explored practice-based demographics concerning geography, gender, age, subspecialty, and university affiliation.

American Board of Thoracic Surgery Diplomates taking the 10-year Maintenance of Certification examination opted for the cardiac, general thoracic, cardiothoracic, or congenital modular exam. Using module selection as a surrogate for the examinee's predominant clinical practice, we explored the relationship regarding type of practice, geography (metropolitan vs other), gender, age, and university affiliation.

A total of 2273 American Board of Thoracic Surgery Diplomates took the Maintenance of Certification exam from 2018 to 2024. Adult cardiac surgery was the predominant subspecialty (46%), followed by cardiothoracic (24%), general thoracic (22%), and congenital surgery (8%). Significant gender disparity persisted, with women constituting 7% of certified Diplomates and 5% of adult cardiac surgeons. Mean ages ranged from 58.0 years (general thoracic) to 63.3 years (cardiothoracic), with younger surgeons trending toward specialized practices (cardiac P = .01, congenital P = .04). Most surgeons practiced in metropolitan areas (80%), particularly congenital surgeons (96%). Surgeons practicing in university (47%) and nonuniversity settings (53%) were nearly evenly distributed.

Thoracic surgery is increasingly subspecializing, with younger surgeons choosing cardiac, general thoracic, or congenital surgery modular Maintenance of Certification exams. The percentage of female Diplomates remains low. Maintenance of Certification exam-eligible diplomates constitute a predominantly older workforce with noticeable urbanization. Understanding our workforce provides important insight for American Board of Thoracic Surgery certification, the development of training paradigms, and anticipating workforce needs.