Attrition in cardiac surgery: Structural drivers, career pathways, and implications for workforce retention.
11 affiliations
- 1Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
- 2Clinic for Cardiac Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany.
- 3Department of Cardiac Surgery, Hospital Kassel, Kassel, Germany.
- 4Office of the Medical Director, University of Greifswald, Greifswald, Germany.
- 5Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, Justus-Liebig University Giessen, Bad Nauheim, Germany.
- 6Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany.
- 7Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany.
- 8Department of Congenital and Paediatric Heart Surgery, German Heart Center, TUM University Hospital, Munich, Germany.
- 9Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
- 10Department of Thoracic, Cardiac, and Thoracic Vascular Surgery at the University Hospital Würzburg, Würzburg, Germany.
- 11Department of Cardiac Surgery, Central Hospital Bad Berka, Bad Berka, Germany.
Abstract
Objectives
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.Methods
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.Results
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.Conclusions
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.
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BibTeX
@article{koch2026attrition,
title = {{Attrition in cardiac surgery: Structural drivers, career pathways, and implications for workforce retention.}},
author = {Iris Koch and Katharina Huenges and Tamari Tvildiani and Elpiniki Katsari and Ayse Cetinkaya and Nadejda Monsefi and Bastian Schmack and Anna L Meyer and Jan D Schmitto and Arjang Ruhparwar and Julie Cleuziou and Hassina Baraki and Gloria Faerber and Sabine Bleiziffer and Jasmin S Hanke},
journal = {JTCVS open},
year = {2026},
month = jul,
doi = {10.1016/j.xjon.2026.101981},
url = {https://europepmc.org/article/MED/42948088},
note = {CC BY},
}
RIS
TY - JOUR
TI - Attrition in cardiac surgery: Structural drivers, career pathways, and implications for workforce retention.
AU - Iris Koch
AU - Katharina Huenges
AU - Tamari Tvildiani
AU - Elpiniki Katsari
AU - Ayse Cetinkaya
AU - Nadejda Monsefi
AU - Bastian Schmack
AU - Anna L Meyer
AU - Jan D Schmitto
AU - Arjang Ruhparwar
AU - Julie Cleuziou
AU - Hassina Baraki
AU - Gloria Faerber
AU - Sabine Bleiziffer
AU - Jasmin S Hanke
PY - 2026
DA - 2026/07/31
JO - JTCVS open
DO - 10.1016/j.xjon.2026.101981
UR - https://europepmc.org/article/MED/42948088
AB - Objectives 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.Methods 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.Results 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.Conclusions 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.
SN - 2666-2736
ER -