Association of Women Surgeons

Thoracic surgeons treat diseases of the chest including coronary artery disease; cancers of the lung, esophagus, and chest wall; abnormalities of the great vessels and heart valves; birth defects of the chest and heart; tumors in the organs contained in the chest cavity; and transplantation of the heart and lungs. The scope of thoracic surgery encompasses knowledge of normal and pathologic conditions of both cardiovascular and general thoracic structures. The range includes congenital and acquired lesions (including infection, trauma, tumors, and metabolic disorders) of both the heart and blood vessels in the thorax, as well as diseases involving the lungs, pleura, chest wall, mediastinum, esophagus, and diaphragm. In addition, the ability to establish a precise  diagnosis -- an essential step toward proper  therapy -- requires familiarity with diagnostic procedures such as cardiac catheterization, angiography, electrocardiography, imaging techniques, endoscopy, tissue biopsy, and biologic and biochemical tests appropriate to thoracic diseases.

Thoracic surgeons also must  be knowledgeable and experienced in evolving techniques such as laser therapy, thoracoscopy, and thoracoscopic surgery. This specialty includes the perioperative, operative care, as well as critical care of patients.  Many surgeons limit their practice to one or two of the major areas of thoracic surgery:  congenital, general adult thoracic or cardiac. Some of the most exciting technologies in medicine are evolving for the practice of thoracic surgery, including interventional molecular strategies, mechanical support, and endoscopic cardiac surgery. 

To qualify for Board certification in thoracic surgery,  one must first complete a residency in general surgery accredited by either the Accreditation Council for Graduate Medical Education (ACGME) or the Royal College of Physicians and Surgeons of Canada. Residency programs traditionally have been two or three years in duration. Most programs participate in the National Residency Matching program. The application process is conducted in the academic year  before appointment.  Recently, the American Board of Thoracic Surgery voted to change the requirements for Board certification (see Board Certification below). These changes will impact the structure of residency training in the  near future.

In the recent  past, it has become easier to be accepted in a program. As a result of the many new technologies available for coronary artery disease used by the cardiologists, fewer coronary bypass operations are being done currently, than in the past. Reimbursement rates for all types of surgery-especially bypass surgery-have been reduced, whereas malpractice insurance rates in many states are especially high for surgical sub-specialists. Also, increasing rates of lung cancer in  women,  as well as development of new surgical procedures for arrhythmias and heart failure, have increased. As the population continues to live longer, there will be a continuing need for thoracic surgery. From the pediatric point of view, the competition is greatest for those who want to specialize in congenital heart surgery, predominantly because  fewer children are being born in the United States with congenital defects.

Board Certification

In October 2001, The American Board of Thoracic Surgery (ABTS) changed the educational and training requirements  regarding certification for  those who enter thoracic surgery residency training in July 2003 and after. Certification by The American Board of Surgery (ABS) is  optional, rather than mandatory, for residents who begin thoracic surgery training in July 2003 and after. The ABTS has approved the following pathways to certification; the anticipated dates of implementation are noted with each pathway, which include successful completion of  the following:

2.    Categorical-Integrated six-year Thoracic Surgery Residency, to be developed by the Thoracic Surgery Directors Association (TSDA). Residents in these programs will be under the direction of the Thoracic Surgery  Program Director. Before this pathway is implemented, the Residency Review Committee for Thoracic Surgery (RRC-TS) must first approve the standards and requirements for such programs. Students match for such programs directly from medical school or at some later time. The first such programs  are estimated to begin to accept residents in 2004 at the earliest.

These prerequisites include:

Minimal operative experience criteria are established to qualify to sit for the  Board examinations. A list of the required cases, as well as additional  information, is available on the ABTS website. The Board examination  includes a written  examination offered in the Fall and an oral examination offered in the Spring. Diplomates certified after 1975 must be recertified every 10 years after the date of the original certification. If certification lapses, Parts I and II of the certifying  Boards are required to regain certified Diplomate status.

Grant Funding, Research Fellowships

An important source of funding for research and education in  thoracic surgery is The Thoracic Surgery Foundation for Research and Education (TSFRE). The Foundation is supported by the four major thoracic surgery professional societies: The American Association for Thoracic Surgery (AATS), The Society of Thoracic Surgeons (STS),  Southern Thoracic Surgical Association (STSA), and  Western Thoracic Surgical Association (WTSA). A 16-member Board, six nominated by the STS, six by the AATS, two by both the STSA and the WTSA, manage the TSFRE. In 1992, Dr. Eugene Braunwald and friends of Dr. Nina Braunwald established the Dr. Nina Starr Braunwald Memorial Fund to provide career development awards and research fellowships for women in academic surgery. Dr. Nina Braunwald was the first Board-certified thoracic surgeon. Other grant programs are offered for both men and women.

TSFRE also has  developed, in conjunction with Harvard  University, a  valuable intensive executive education program for physicians, trustees, and leaders of health care organizations, and government officials whose positions include a significant health care policy component. Skills for the New World of Health Care are designed as a constructive response to the educational needs of physicians and leaders in health care who want to have an active role in the evolution of the health care system. The  ten-day course is offered annually. Scholarships are available through TSFRE.

Memberships in Societies

STS

AATS

Regional Societies

WTSA is open to  Board-certified thoracic surgeons who have demonstrated interest in advancing the practice of thoracic and cardiovascular surgery through continuing professional contributions and scientific publications. Applicants must be in practice within the geographic limits of the Association (Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming, and the provinces of Alberta and British Columbia) for at least three years following completion of postgraduate training.

The American College of Surgeons

In addition, thoracic surgeons are encouraged to become a Fellow of the American College of Surgeons. Participation in the College during residency training and early practice is possible through the valuable Candidate and Associate Fellow Membership programs.  

Journals

Two major American journals are devoted exclusively to thoracic surgery: Annals of Thoracic Surgery and  Journal of Thoracic and Cardiovascular Surgery. Many important articles also appear in the Asian Cardiovascular and Thoracic Annals and  European Journal of Cardiothoracic Surgery.

Access to these  journals, and other valuable information for thoracic surgeons and  residents, is available through the CardioThoracic Surgery Network (CTSNet). CTSNet is a collaborative effort of the major cardiothoracic organizations around the world to provide a comprehensive, web-based repository of information for surgeons. More than 40 organizations participate in CTSNet and have formed a unique electronic community of cardiothoracic surgeons. Thousands of surgeons access this information resource daily from computers in their offices and homes to research cases, communicate with colleagues, explore the field's journals, investigate devices, find out about meetings, engage in lively discussions, and conduct private electronic meetings.

The National Resident Matching Program (NRMP) provides all the up-to-date information about participating thoracic surgery residency programs. NRMP Help Desk Specialists are available to take calls at (202) 828-0566 from 8:30 AM to 5:30 PM Eastern time.

The  ABTS website offers online applications for certification and information about In-training  Examinations.

The  CTSNet represents the most important portal for the thoracic surgeon. The major thoracic journals and organizations can all be accessed through this site. Lay information about thoracic surgical diseases also is  available.