title: Recruitment to UK cardiothoracic surgery in the era of public outcome reporting.
abstract: OBJECTIVE
  Since 1999 important widely publicized issues have affected morale in UK cardiothoracic (CT) surgery. Because more surgeons are needed, we sought to investigate whether these events have affected recruitment and demographic change in the specialty between 1999 and 2014.
  
  
  METHODS
  We collected information on UK consultant CT surgeons using the SCTS public portal, the GMC Specialist Register and the NHS Annual Workforce Census via the Health & Social Care Information Centre. We analysed the demographics of UK CT surgeons with regard to country of primary medical qualification and ethnicity between 1999 and 2014. We compared the changes with other surgical specialties, cardiology and respiratory medicine.
  
  
  RESULTS
  There has been a worrying decline in UK medical graduates entering the specialty and a 4-fold increase (282%) in consultant appointments from Europe. Whilst consultant numbers expanded by 83% overall, 59% of congenital heart surgeons, 46% of thoracic surgeons and 36% of adult cardiac surgeons are overseas graduates. It is found that 5% are female. Currently, only 32% of trainee surgeons are UK graduates. Of those receiving UK Certificate of Completion of Training in 2013, only 18% were UK graduates compared with 68% in 2000. Comparison with other specialties shows fewer UK graduates in CT surgery with the exception of Obstetrics and Gynaecology (52%). In cardiology, 77% are UK graduates with only 8% from Europe.
  
  
  CONCLUSIONS
  Repeated negative messages have had a detrimental influence on recruitment. Because 55% of UK medical graduates, but less than 5% of CT surgeons are female, recruitment problems may worsen. Action is needed to restore interest in the specialty.
authors: John Radcliffe Hospital, Oxford, UK stephen.westaby@ouh.nhs.uk.
authors: Stephen
authors: S
authors: Westaby
authors: John Radcliffe Hospital, Oxford, UK.
authors: Kamran
authors: K
authors: Baig
authors: Papworth Hospital, Cambridge, UK.
authors: Ravi
authors: R
authors: De Silva
authors: Plymouth Hospitals NHS Trust, Plymouth, UK.
authors: Jonathan
authors: J
authors: Unsworth-White
authors: Royal Brompton Hospital, London, UK.
authors: John
authors: J
authors: Pepper
mesh_terms: D030881:Disclosure; D005260:Female; D006801:Humans; D008297:Male; D010560:Personnel Selection; D011641:Public Relations; D066231:Surgeons / Q000706:statistics & numerical data*; D013903:Thoracic Surgery / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006113:United Kingdom
keywords: Mortality; Public reporting; Recruitment; Surgeon-Specific; Training