Attrition in cardiac surgery: Structural drivers, career pathways, and implications for workforce retention

Workforce shortages in cardiac surgery (CS) are increasing despite high initial interest among young physicians. Attrition remains poorly understood and is often attributed to individual limitations rather than systemic factors. This study aimed to identify determinants of attrition, characterize subsequent career pathways, and define targets for improving retention.

A German nationwide, anonymous, questionnaire-based survey (47 items) was conducted between July 2024 and January 2026 among physicians with previous employment in German CS departments. Descriptive statistics and subgroup analyses were performed.

Seventy-five participants were included. Initial motivation for pursuing CS was high and mainly driven by interest in the specialty's technical and intellectual complexity. However, satisfaction with key aspects of training was low, particularly regarding surgical training (23.3% [17 out of 73]), scientific support (24.7% [18 out of 73]), and professional mentorship and career development (28.8% [21 out of 73]). The most frequently reported reasons for leaving were poor work-life balance (74.2% [46 out of 62]), dissatisfaction with workplace culture (67.7% [42 out of 62]), limited career opportunities (66.1% [41 out of 62]), and lack of appreciation (62.9% [39 out of 62]). Attrition occurred across all career stages, including board-certified surgeons and senior staff. Despite leaving the specialty, most participants were satisfied with their decision (95.1% [58 out of 61]), although only 11.7% (7 out of 60) considered returning to CS.

This exploratory survey suggests that attrition from CS is frequently associated with dissatisfaction regarding work-life balance, workplace culture, career perspectives, and training conditions rather than with self-perceived individual limitations. Although causal relationships cannot be established, the findings highlight potentially modifiable organizational factors that may represent targets for future retention strategies in CS.