MODELING THE CARDIAC SURGERY WORKFORCE AND DEMAND IN QUÉBEC

Changing demographics are driving epidemiologic shifts for many cardiovascular diseases. The aim of this study was to estimate the cardiac surgical volume and workforce over the next 20 years in Québec. We developed a demand and supply model based on data from Québec’s Association of Cardiac, Vascular and Thoracic Surgeons (ACCVTQ). Recruitment data from the Canadian Residency Matching Service (CaRMS) and census population projections were also used. Using these data, we modeled the attrition and graduation rates and thus workforce by year. We calculate procedure-specific performance rates stratified by sex and age and matched these to population projections to estimate the surgical volume. We considered different scenarios for recruitment policy, residency program retention rates, shifts in disease incidence and the implementation of new technologies and treatment modalities. In Québec in 2015, 48 practicing cardiac surgeons performed 7136 procedures. Of these, ischemic heart disease (IHD) accounted for 3838 (53.8%). Aortic and non-aortic valvular heart disease (VHD) accounted for 1372 (19.2%) and 1393 (19.5%), respectively, while other procedures accounted for the remainder (533; 7.5%). The overall performance rate was highest in males and amongst 70-79 years old, followed by 60-69 years olds and 80+ years old. The size of the 70-79 group will increase from 606,664 in 2015 to 1,082,885 in 2035 (78% increase). Additionally, males account for the majority of procedures in a 3:1 to 4:1 ratio. The 70-79 years old male-to-female ratio will increase from 0.87 in 2015 to 0.96 in 2035. Specifically, the male 70-79 subgroup will increase from 281,896 to 529,665 (88% increase) over the same period. The projected overall annual case volume will change from 7136 in 2015 to 10442 in 2035 (46% increase). Considering 1 graduate per year, in the reference scenario the case load will increase from 160 to 255 cases annually (59% increase), while 2 and 3 graduates per year case load would increase by 28% and 7%, respectively. Considering a scenario of rapid and aggressive shifts to non-surgical treatment modalities, case load would increase by 49%, 23% and 3% for 1, 2 and 3 graduates per year, respectively. Changing demographics will place increasing demand on the cardiac surgery manpower in Québec in the coming years. We estimate the overall case volume will increase by 46% over the next 20 years. Sustainable recruitment policy should account for these shifts to avoid treatment gaps.