Over the past few years, applications for training fellowships for transplant physicians has been on a decline, even as the need for them is increasing.
By DAVID WEILLOCTOBER 17, 2019
As the need for organ transplants grows, the number of transplant physicians dwindles
At any given time in the U.S., about 120,000 people are waiting for the call that they�ve been matched with a donor for a new lung, heart, liver, or kidney. That number will continue to rise, but the number of doctors to take the 2 a.m. call that a donor has been found for their patient and perform the transplant is dwindling..
About eight years ago, while directing the lung transplant program at Stanford University, I began noticing a sharp decrease in the number of applicants for the transplant fellowship program � a requirement to become a transplant physician � even though we had the oldest and best-established lung transplant training program in the world. Typically, I�d see five to six applicants a year, but in recent years I haven�t seen any. In my current role as a consultant to major transplant centers around the country, I�ve learned that this wasn�t specific to Stanford, and there has been a noticeable decline in the number of physicians committing to the transplant field, regardless of organ type.
Most Americans probably aren�t aware of the decline in the number of individuals training to become transplant physicians and how it will affect the future of medicine. Neither are the 2020 presidential hopefuls, all of whom have policies they believe best provide health care coverage for Americans without acknowledging or calling attention to the fact that soon there may not be enough doctors to do the work once more people are insured. We need a plan for that.
Our most vexing challenges in medicine right now are twofold: attracting young people to the field and keeping them there. These challenges are even more acute in transplantation. I have 12 months to teach fellows to be proficient at organ transplantation. It�s not enough time, so I work them hard. Throughout the history of medicine, training has been characterized as a �grand bargain� in which trainees make personal sacrifices with the expectation of a better life once they are practicing physicians. But that�s a deal many don�t accept anymore.
Physician wellness is a major factor. Up to half of physicians experience anxiety, depression, insomnia, and poor interpersonal relationships. Things may be worse for transplant physicians, as many view this field as unstructured with few boundaries to the physical work and, more importantly, one that requires a huge emotional commitment. In essence, transplantation is seen as a sure path to physician un-wellness. So, while many think about training in the field, most ultimately pursue other options.
Fifteen years ago, a lung transplant center would be considered large if it performed 40 transplants a year. Now the largest centers perform nearly 100 lung transplants a year (sometimes more) without concomitant increases in staffing. Harried transplant physicians care for an increasing number of patients, all the while under pressure from hospital administrators to do more transplants and pressure from regulatory bodies and insurance companies to produce better outcomes.