1988 Thomas G. Wharton Memorial Lecture

“The Cause and Cure for the Shortage of Perfusionists

Raymond C. Stofer, D.V.M.

Former Director of Perfusion Training,
Stanford University,
Palo Alto, California

We shall examine the major causes of this shortage problem first. We shall not be kind in our examination.

There are three reasons for this shortage:
1) aging;
2) a congenital virus greedoslo; and
3) a congenital virus apathyosus.

Aging is a natural occurrence over which we have no control. The profession of perfusion has now been in existence long enough that the time has come for many of us to retire and leave vacancies for young people. We who are retiring want you all to remember that you must never falter in your work and to remember always that you are responsible for the lives of your patients.

The second cause is the virus greedosio which is born in all of us at birth. Some people have good immune systems which suppresses the virus to a low level. Others allow much greed to dominate their lives. At the present time persons who become trained and certified as perfusionists and who then engage in the profession are often shifted into higher income levels than they have previously encountered. Some of these people have expressed the hope that the profession would never become overcrowded and that they could continue to enjoy the fruits of higher income from here to eternity. Unfortunately, many become so busy making money they have little time to devote to their societies such as AmSECT and The American Academy. The President of AmSECT in a recent editorial encouraged members to address the OJT problem. He did not give any suggestions as to how this should be done.

The third reason that there is a shortage of perfusionists is the virus apathyosus which is congenital and also controlled by special immune systems. After AmSECT was created the American Medical Association told AmSECT it must set about to certify and standardize the quality of perfusion, and if AmSECT failed to do this then the AMA would do it for them. The result was that AmSECT then created the American Board of Cardiovascular Perfusion which was charged with certifying perfusionists by examination and with the accrediting of perfusion training programs. The American Board did indeed accredit training programs but they did very little if anything at all to promote the establishment of new programs. Then the accreditation of programs was taken over by CAHEA. CAHEA is the Committee on Allied Health Education and Accreditation which was created by the American Medical Association. Its purpose is to set up a scheme of standards of training for all allied health training programs which train such personnel as medical technologists, radiolo

gy technicians, perfusionists, etc. Like all paper-pushing agencies, CAHEA straps a busy program director with several pounds of worthless paper work. A good example of this being the inventorying of all the books and journals in the medical school library which cover any subject that might have any thing to do with perfusion. The only requirement that CAHEA has that makes any sense at all is that of ensuring that the program is properly funded so that students will not be suddenly stranded in the middle of the course.

By an agreement with AmSECT, CAHEA, and the Society of Thoracic Surgeons there was then created a Joint Review Committee for Perfusion Education (JRCPE) which is charged with the actual accrediting of all programs. To become accredited a program must pay a $500 fee, fill out pounds of forms from CAHEA and then sit by and wait for a site visit from the JRCPE. The Chairperson of the JRCPE is a member of AmSECT and is a perfusionist. The Chairperson upon receiving the money and the request for a site visit then calls upon two or more perfusionists in the area closest to the proposed site visit to make the actual site visit. Outside of having been through a training program these site visitors need know nothing about how a training program works. Their task is to follow guidelines set up by CAHEA as to the so-called requirements.

The JRCPE has clearly demonstrated a picture of apathy entitled, “You can’t get there from here.” I offer proof of this fact that when I was a director of a training program and did indeed pay the required fee and make proper application by filling out all the forms and carrying out all the chores for a site visit, no site visit ever transpired. Needless to say, the program was never accredited by CAHEA, and I was forced to retire. Did the Chairperson of the JRCPE ever inquire as to why the program was not site visited or accredited? No, he let old apathy take care of the matter. How pathetic that anyone would accept the responsibility of chairmanship on the part of AmSECT and then fail to do the job. Worse yet, there is nothing in the protocol of CAHEA that guarantees that any training program that is accredited will turn out high quality perfusionists. Further, CAHEA has done nothing to promote the establishment of new programs. That is not in their job description.

A Program Directors Council came into existence at the expense of one of the companies who makes perfusion equipment. They invited and paid all the expenses of program directors to attend two day sessions. The company sponsored these meetings for two years and during these meetings there was a great exchange of ideas between program directors. to do a case invite your hospital administrator to sit in on the Every single program director left these sessions and put new ideas into use, and the students were made the beneficiaries. The company doing the sponsoring decided other vendors should get into the act but unfortunately this proposal died on the vine. A few years later the Program Directors Council was revitalized on its own. Now this sounds great except during the few years I attended the Council there was never time for an exchange of ideas between program directors. The Council became bogged down in petty chores. I finally asked the Secretary of the Council to remove my name from their mailing list. This was done but never was there a word of inquiry as to why I left the Council. Nor did the Chairperson of the Council inquire as to why I had left the Council. Apathy has some real winners and some of them wear big badges at meetings. Apathy feeds on gossip and hearsay not real truths.

AmSECT officials and members decry OJT training. Let us face the facts of life. When surgeons are hit in the pocket book because they cannot do open-heart surgery cases be-cause no perfusionists are available, then they will do what-ever they have to do to correct the situation. Often I have heard this remark, “I don’t care who runs the pump just so long as they don’t pump air into my patients.”

Let us discuss the cure for this problem and examine what can be done for the shortage of perfusionists. Here are some starters:

Make real efforts to establish new training programs. AmSECT and this Academy should make a concerted effort to gain the support of the Society of Thoracic Surgeons to publicize, educate and promote training programs. (Apathy get out of the way.) Who would these people select to educate? Answer: Medicare, health insurance carriers, hospital administrators, nurses, doctors and their own members.

Now it may seem strange to have their own members on the list. I venture to say that not more than ten percent of the surgeons doing open-heart surgery today have ever once sat with a perfusionist during a case.

Many hospital administrators know very little about what it is exactly that perfusionists do. They are learning that some perfusionists are being paid more than they are. Who can most easily get to administrators and educate them as to what it is you do as a perfusionist? The next time you are scheduled

case with you. Of course he or she will probably be too busy to come, but keep right on handing out the invitation. Sooner or later that person will put apathy aside and show up. Be sure you make an effort to explain in detail what you are doing and why you are doing it. Who knows, you may gain a real friend and some real support for your work.

The insurance company that covers your hospital has a person who calls at the hospital on a regular basis. Make an effort to meet this person and invite that person to sit in on a case with you. Let that person know you have a background of formal training as a perfusionist. Tell this insurance representative that it is to his company’s advantage to set aside some money to help train first-class perfusionists. It most certainly is a real financial saving to a health insurance carrier to have well trained perfusionists taking care of their patients. They really do not like to pay out all that money for malpractice suits. Dispel forever the notion that you must play a low key in patient care because you might get sued. Attorneys who handle malpractice cases know who you are and what you do and what your vulnerabilities are.

AruSECT and The Academy should give serious consideration to spending money for public relations about who perfusionists are and what they do and how they are trained. Such a public relations program should consist of: 1) articles in newspapers and magazines; writers are always looking for new material to write about; and 2) television appearances of perfusionists wherever and whenever possible without actually buying time.

Become active participants in public relations yourselves. Here are some more suggestions for what you as individuals can do to help the situation:
1) get your surgeon’s secretary to sit in on a case with you. He/She can spread more good words about that person who runs the heart-lung machine than you can imagine;
2) have people in ICU, medical records, the blood bank, radiology technicians, the cath lab people, dog lab personnel come up and sit in on cases with you; and
3) two or three of you get together and videotape a perfusion and then get copies of the tape to people who do not come to the operating room.

I will end this cure business by saying to each and everyone of you,
“Set aside apathy and greed and do yourself a big favor.”
God bless you all, you are indeed beautiful people.