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Current status of young cardiac surgeons in Japan

Current status of young cardiac surgeons in Japan. Kan Nawata Naoto Miyagi, Hiroo Takayama, Shin Takabayashi JAYCS : Japanese Association of Young Cardiac Surgeons. Cardiovascular Surgery in Japan Annual report by the Japanese Association for Thoracic Surgery. Number of Cases. Calendar Year.

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Current status of young cardiac surgeons in Japan

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  1. Current status of young cardiac surgeons in Japan Kan Nawata Naoto Miyagi, Hiroo Takayama, Shin Takabayashi JAYCS: Japanese Association of Young Cardiac Surgeons

  2. Cardiovascular Surgery in Japan Annual report by the Japanese Association for Thoracic Surgery Number of Cases Calendar Year

  3. The number of Japanese CV surgeons • Certificated by the Japanese Board of Cardiovascular Surgery (since Jan. 2002) • 316 Main Hospitals (>100 cases per year) • 127 Satellite Hospitals (>50 cases per year) • Approx. 2,000 certificated cardiovascular surgeons (including vascular surgeons) + More than 1,000 uncertified CV surgeons !

  4. Why so many CV surgeons in Japan? • No regulation about the whole number of CV surgeons in Japan • Many hospitals where cardiac and aortic surgeries are performed • No regulation regarding opening a new cardiovascular surgery program in Japan • Better accessibility from the patients’ viewpoint • Fewer co-medical professionals • No Physician Assistants • Postoperative management by young CV surgeons • Endless miscellaneous duties

  5. Unsolved issues in Japan #1: Regionalizaton mortality rate Hospital annual CABG volume 5 • Because of no regulation regarding opening a new cardiovascular surgery program in Japan, non-high quality low volume programs exist in large numbers

  6. Unsolved issues in Japan #2: Status of Labor • Status of working conditions regarding Japanese CV surgeons (by questionnaires) ↓ These conditions are unfavorable not only for cardiac surgeons but also for patients who receive medical care 6

  7. Young CV surgeons in Japan confront • Non-high quality low volume programs in some hospitals • Consultant surgeons who are still eager to operate by themselves • Long training at the bottom of the heap • Relatively low income • Uncertainty over their career path • A considerable number of Japanese CV surgeons go abroad for more clinical experience. • Is it acceptable as one of the developed countries?

  8. On the other hand,

  9. How are the operative outcomes? Japan SCORE • Good operative outcomes for the smaller number of cases experienced per year JTCVS 2008;135:1306-12

  10. Unadjusted 30-day mortality rates by CABG procedural volume in Japan Number of Isolated CABG Admissions In Japan, all categories over 41 CABG procedures per year were 30-day mortality rates under 2.0% 10

  11. Risk-adjusted 30-day mortality rates by CABG procedural volume in United States JTCVS 2008 Jun;135(6):1202-9

  12. Expert Commentary for Japanese Cardiovascular Surgery JTCVS 2008 Jun;135(6):1202-9 12 Given the consistently low volume of most Japanese CABG programs, their overall results will come as a surprise to many. Perhaps there are lessons from this extreme example that might be applicable to less extreme but smaller programs in other countries.

  13. How are the operative outcomes? • Good operative outcomes for the smaller number of cases experienced per year • Detailed operative records with schemas • Pre- and post-operative discussions (with cardiologists, nurses and anesthetists) • Postoperative management by CV surgeons Learn much from views and discussions in spite of less opportunity as the operator

  14. Discussion tool for high risk cardiovascular surgeries

  15. Advantage of Japan 15 • Surgeons’ collaboration in operating room • Communication style in conference • Operation records using drawing schemas • Personalized patient management (by dedicated young CV surgeons) • Inexpensive insurance for medical malpractice • Easy access to cardiovascular surgeries • Health-insurance system that covers all of its citizens

  16. However,

  17. Young Japanese CV surgeons • Are not satisfied with the current status in Japan • Need to share the technical tips and pitfalls • Want to share information about the international status of the same professionals • Are eager for more opportunities of clinical practice as the operator, not as the intensivists • Want a little better work-life balance, if possible Inspired by the last ISMICS International Fellow and Residents Meeting, three young Japanese CV surgeons took the gloves off for ‘INNOVATION’.

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