A Report of Salaries of Academic Cardiothoracic Surgeons Based on Race and Ethnicity.

BACKGROUND: Diversity in the physician workforce improves patient care, physician well-being, and innovation. Workforce diversity is dependent on fair compensation that is unbiased by race or ethnicity. The purpose of our study was to determine if a disparity of representation and salary based on race/ethnicity exists in academic cardiothoracic surgery. METHODS: We performed a cross-sectional analysis of data collected by the Accreditation Council of Graduate Medical Education (ACGME) and Association of American Medical Colleges (AAMC) Faculty Data for U.S. Medical School Faculty 2021 and 2022. Salary data was not available if an academic rank and race/ethnicity had fewer than 6 cardiothoracic surgeons. We performed a descriptive analysis of the number of faculty and compared median and mean salaries according to academic rank using paired t-test. RESULTS: Of the 758 academic cardiothoracic surgeons, 64.9% were white, 25.2% Asian, 3.3% Black/African American, 4.9% Hispanic/Latino, and 1.7% other race/ethnicity. Cardiothoracic surgeons at the academic rank of professor were 74.6% White, 17.7% Asian, 3.4% Black/African American, 3.9% Hispanic/Latino, and 0.4% other races. Asian faculty earned 89-171%, Black/African American faculty earned 59-94%, and Hispanic/Latino earned 84-165% of the median salary earned by White faculty. Black/African American faculty consistently and significantly (p = .002) earned lower median salaries compared to White faculty at each academic rank measured. CONCLUSIONS: The academic cardiothoracic surgery workforce lacks diversity, especially at the highest academic ranks. Salary equity among races/ethnicities is complex, requiring additional study. However, Black/African American cardiothoracic surgeons experience low representation and salary disparity at every academic rank measured.

The Cost of Being a Woman in Academic Cardiothoracic Surgery: Joint Collaboration of The Society of Thoracic Surgeons Workforces on Diversity, Equity, and Inclusion and Cardiothoracic Surgery Practice Models.

BACKGROUND: Gender disparity in the cardiothoracic surgery workforce is challenging to enumerate and quantify. The purpose of our work is to use the most current data to quantify the percentage of women in academic cardiothoracic surgery and salary disparity between women and men. METHODS: We performed a cross-sectional analysis of data collected by the Accreditation Council for Graduate Medical Education Data Resource Book 2021 and Association of American Medical Colleges Faculty Data for U.S. Medical School Faculty 2019, 2020, and 2021. We used descriptive analysis of the number of faculty and mean salaries of academic cardiothoracic surgeons according to academic rank and gender. Salary disparity in cardiothoracic surgery was compared with salary disparities seen among surgical specialties and academic clinicians. RESULTS: Over the past 3 years, women comprised 11.5% of the cardiothoracic workforce. In 2021, cardiothoracic surgeons who were women earned $0.71 to $0.86 for every $1.00 earned by cardiothoracic surgeons who were men. Ascending academic rank correlated with greater gender salary disparity; women professors earned less than men of equal and lower academic rank. From 2019 to 2021, women of the academic ranks of associate professor, professor, and chief of cardiothoracic surgery experienced a decrease in mean salaries, whereas men of equivalent academic ranks experienced an increase in mean salaries. CONCLUSIONS: Gender disparity in cardiothoracic surgery persists, with low representation of women and salary disparity at every academic rank.

Assessment of the well-being of significant others of cardiothoracic surgeons.

OBJECTIVES: We aimed to evaluate how the current working climate of cardiothoracic surgery and burnout experienced by cardiothoracic surgeons influences their spouses and significant others (SOs). METHODS: A 33-question well-being survey was developed by the American Association for Thoracic Surgery Wellness Committee and distributed by e-mail to the SOs of cardiothoracic surgeons and to all surgeon registrants of the 2020 and 2021 American Association for Thoracic Surgery Annual Meetings with a request to share it with their SO. The 5-item Likert-scale survey questions were dichotomized, and associations were determined by χ2 or independent samples t tests, as appropriate. RESULTS: Responses from 238 SOs were analyzed. Sixty-six percent reported that the stress on their cardiothoracic surgeon partner had a moderate to severe influence on their family, and 63% reported that their partner's work demands didn't leave enough time for family. Fifty-one percent reported that their partner rarely had time for intimacy, 27% reported poor work-life balance, and 23% reported that interactions at home were usually or always not good-natured. SOs were most affected when their partner was <5 years out from training, worked in private vs academic practice, and worked longer hours. Having children, particularly younger than age 19 years, and a lack of workplace support resources further diminished well-being. CONCLUSIONS: The current work culture of cardiothoracic surgeons adversely affects their SOs, and the risk for families is concerning. These data present a major area for exploration as we strive to understand and mitigate the factors that lead to burnout among cardiothoracic surgeons.

Imaging of lung cancer.

Lung cancer is the leading cause of cancer-related mortality globally. Imaging is essential in the screening, diagnosis, staging, response assessment, and surveillance of patients with lung cancer. Subtypes of lung cancer can have distinguishing imaging appearances. The most frequently used imaging modalities include chest radiography, computed tomography, magnetic resonance imaging, and positron emission tomography. Artificial intelligence algorithms and radiomics are emerging technologies with potential applications in lung cancer imaging.

Patient and provider perspectives to utilization of telemedicine in surgery.

Objectives: Determine patient and provider perspectives on widespread rapid telemedicine implementation, understand the key components of a surgical telemedicine visit and identify factors that affect future telemedicine use. Summary of background data: Compared to other specialties, the field of surgery heretofore has had limited adoption of telemedicine. During the COVID-19 pandemic Healthcare, including the surgical specialties, saw new widespread use of telemedicine. Methods: We conducted a prospective cohort study during the COVID-19 California stay-at-home and physical distancing executive orders. Utilization data were collected from clinics and compared to usage data during the same time 1 year later. All patients and providers who participated in a telemedicine visit during the study period were asked to complete a survey after each encounter and the surveys were analyzed for trends in opinions on future use by stakeholders. Results: Over the 10-week period, the median percentage of telemedicine visits per clinic was 33% (17%-51%) which peaked 3 weeks into implementation. One hundred and ninety-one patients (48% women) with a median age of 64 years (IQR 53-73) completed the patient survey. Patients were first-time participants in telemedicine in 41% (n = 79) of visits. Fifty-seven percent (n = 45) of first-time users preferred that future visits be in-person versus 31% of prior users (p = 0.007). The median travel time from home to the clinic was 40 min (IQR = 20-90). Patients with longer travel times were not more likely to use telemedicine in the future (61% with longer travel vs. 53% shorter, p = 0.11). From the 148 provider responses, 90% of the visits providers were able to create a definitive plan with the telemedicine visit. A physical exam was determined not to be needed in 45% of the visits. An attempt at any physical exam was not performed in 84% of routine follow-up or new-patient visits, compared to 53% of post-op visits (p = 0.001). Conclusion: Telemedicine is a viable ambulatory visit option for surgical specialists and their patients. During rapid telemedicine deployment, travel distance did not correlate with increased use of telemedicine, and in-person visits are still preferred. However, nearly half of all visits did not need a physical exam, which favors telemedicine use.

Racial Health Disparities Research in Cardiothoracic Surgery Under-represented in Major Meetings.

INTRODUCTION: Black/African Americans and Latinos face significant health disparities and systemic inequities. Heart and lung disease are leading factors affecting morbidity and mortality in these groups. Given this disparity, we sought to determine how often this topic is presented at the most relevant United States annual cardiothoracic surgery meetings. METHODS: Specialty-specific annual meeting abstract books were queried between 2015 and 2021. We included the Society of Thoracic Surgeons, American Association for Thoracic Surgery, Western Thoracic Surgical Association, and the Southern Thoracic Surgical Association. Scientific abstract titles and content were searched for the following keywords and phrases: "racial health disparities," "race," "racism," "racial bias," "institutional racism," and "health disparities". If an abstract included a keyword or phrase, it was counted as a racial health disparity abstract. We calculated the proportion of racial health disparity abstracts and abstracts published as manuscripts in the meeting-associated journals. RESULTS: A total of 3664 abstracts were presented between 2015 and 2021. Of those, 0.90% (33/3664) abstracts presented contained at least one of the keywords or phrases. Of these abstracts, the percentage that went on to publication represented 0.38% (14/3664) of the total number of abstracts presented. CONCLUSIONS: Abstracts on racial health disparities in cardiothoracic surgery represent a very small fraction of total meeting peer-reviewed content. There is a significant gap in research to identify and develop best practice strategies to address these disparities and mitigate structural racism within the care of underserved patients with cardiothoracic diseases.

Demographics of Current and Aspiring Integrated Six-year Cardiothoracic Surgery Trainees.

BACKGROUND: The integrated 6-year thoracic surgery (I-6) residency model was developed in part to promote early interest in cardiothoracic surgery in diverse trainees. To determine gaps in and opportunities for recruitment of women and minority groups in the pipeline for I-6 residency, we quantified rates of progression at each training level and trends over time. METHODS: We obtained 2015 to 2019 medical student, I-6 applicant, and I-6 resident gender and race/ethnicity demographic data from the American Association of Medical Colleges and Electronic Residency Application Service public databases and Accreditation Council for Graduate Medical Education Data Resource Books. We performed χ2, Fisher exact, and Cochran-Armitage tests for trend to compare 2015 and 2019. RESULTS: Our cross-sectional analysis found increased representation of women and all non-White races/ethnicities, except Native American, at each training level from 2015 to 2019 (P < .001 for all). The greatest trends in increases were seen in the proportions of women (28% vs 22%, P = .46) and Asian/Pacific Islander (25% vs 15%, P = .08) applicants. There was also an increase in the proportions of women (28% vs 24%, P = .024) and White (61% vs 58%, P = .007) I-6 residents, with a trend for Asian/Pacific Islanders (20% vs 17%, P = .08). The proportions of Hispanic (5%) and Black/African American (2%) I-6 residents in 2019 remained low. CONCLUSIONS: I-6 residency matriculation is not representative of medical student demographics and spotlights a need to foster early interest in cardiothoracic surgery among all groups underrepresented in medicine while ensuring that we mitigate bias in residency recruitment.

Well-being of Cardiothoracic Surgeons in the Time of COVID-19: A Survey by the Wellness Committee of the American Association for Thoracic Surgery.

The prevalence of burnout among physicians has been increasing over the last decade, but data on burnout in the specialty of cardiothoracic surgery are lacking. We aimed to study this topic through a well-being survey. A 54-question well-being survey was developed by the Wellness Committee of the American Association for Thoracic Surgery (AATS) and sent by email from January through March of 2021 to AATS members and participants of the 2021 annual meeting. The 5-item Likert-scale survey questions were dichotomized, and associations were determined by Chi-square tests or independent samples t-tests, as appropriate. The results from 871 respondents (17% women) were analyzed. Many respondents reported at least moderately experiencing: 1) a sense of dread coming to work (50%), 2) physical exhaustion at work (58%), 3) a lack of enthusiasm at work (46%), and 4) emotional exhaustion at work (50%). Most respondents (70%) felt that burnout affected their personal relationships at least "some of the time," and many (43%) experienced a great deal of work-related stress. Importantly, most respondents (62%) reported little to no access to workplace resources for emotional support, but those who reported access reported less burnout. Most respondents (57%) felt that the COVID-19 pandemic has negatively affected their well-being. On a positive note, 80% felt their career was fulfilling and enjoyed their day-to-day job at least "most of the time." Cardiothoracic surgeons experience high levels of burnout, similar to that of other medical professionals. Interventions aimed at mitigating burnout in this profession are discussed.

Sex differences in authorship in cardiothoracic surgery during the early coronavirus disease 2019 pandemic.

Objectives: The coronavirus disease 2019 (COVID-19) pandemic negatively impacted cardiothoracic (CT) surgery, with changes in clinical, academic, and personal responsibilities. We hypothesized that the pandemic may disproportionately impact female academic CT surgeons, accentuating preexisting sex disparities. This study assessed sex differences in authorship of 2 major CT surgery journals during the early part of the COVID-19 pandemic. Methods: All accepted submissions to The Annals of Thoracic Surgery and The Journal of Thoracic and Cardiovascular Surgery between April and August of 2019 and the same period in 2020 were reviewed. Article type and author characteristics were obtained from the journals. Author sex was predicted using a validated multinational database (Genderize.io) and verified with authors' institutional and public professional profiles. Results: In total, 1106 submissions were accepted during the 2019 period, whereas 900 articles (18.6% decrease) were accepted during the same period in 2020. Original research articles comprised 33.3% of the 2019 articles but only 4.9% of the 2020 articles. Female authors contributed to 39.3% (23.1% original research and 16.2% nonoriginal articles) and 29.4% (3.3% original research and 26.1% nonoriginal articles) of articles during the 2019 and 2020 periods, respectively. This represents a marked change in the type of articles that female authors contributed to. Conclusions: Early on during the COVID-19 pandemic, the type of articles accepted, and authorship demographic changed. There was a decrease in contribution of female-authored CT surgery articles submitted to both journals, especially for original research. Future research will elucidate the long-term impact of the pandemic on sex disparities in academic productivity.

Comprehensive Review of Chest Tube Management: A Review.

IMPORTANCE: Thoracostomy, or chest tube placement, is used in a variety of clinical indications and can be lifesaving in certain circumstances. There have been developments and modifications to thoracostomy tubes, or chest tubes, over time, but they continue to be a staple in the thoracic surgeon's toolbox as well as adjacent specialties in medicine. This review will provide the nonexpert clinician a comprehensive understanding of the types of chest tubes, indications for their effective use, and key management details for ideal patient outcomes. OBSERVATIONS: This review describes the types of chest tubes, indications for use, techniques for placement, common anatomical landmarks that are encountered with placement and management, and an overview of complications that may arise with tube thoracostomy. In addition, the future direction of chest tubes is explored, as well as the management of chest tubes during the COVID-19 pandemic. CONCLUSIONS AND RELEVANCE: Chest tube management is subjective, but the compilation of data can inform best practices and safe application to successfully manage the pleural space and ameliorate acquired pleural space disease.