This is a comment from "Chris" to my post on Tuesday
I agree that the main focus is economics. In general, one CV surgeon is needed for approximately every 35-50 thousand people. Now, it is impossible to do this if you are the only one as then there is constraint of constant call, etc. So, specialists tend to concentrate together. The other factor that brings these physicians into larger areas is that is where the hospitals are large enough to have a dedicated OR team, ICU and cardiac cath labs with the attending cardiologists. To further apply economics, it would cost more to place these facilities in a rural area that it would cost for an entire hospital. Also, the re-embursement for bypass surgery has greatly dropped and the risk of litigation is high. As a result, it is economically unwise to practice in a small area, with a small patient volume, inadequeate facilities.
Chris – what is the source for your data? Are you aware of statistics that tell us what sort of population is required to support a each class of specialist?
Also, I understand why a CV surgeons would not want to practice alone and face 24/7/365 call. Do you mean then that for two CV surgeons to enjoy an acceptable income (given the investment they have made in their careers) that they would need a population of 75K – 100K of people?
Thanks for taking the time to educate us.