Equity in the cardiothoracic surgical workforce: addressing training gaps and workforce distribution in Africa- a narrative review.

Abstract

Cardiothoracic surgery (CTS) remains one of the least diverse surgical specialties, marked by significant gender and racial disparities. Despite increased medical school enrollment and the inclusion of more women and underrepresented minorities in the medical workforce, the number of locally trained cardiothoracic surgeons remains disproportionately low, particularly in regions with limited access to specialized care. This lack of diversity is compounded by systemic barriers such as limited exposure to the specialty, a shortage of mentors and role models, and the persistence of gender bias and discrimination. These factors contribute to a workforce that does not adequately reflect the demographic diversity of the patient population, further hindering access to quality care. To address these challenges, this article outlines several policy recommendations aimed at improving equity in CTS training and workforce development. Key strategies include increasing awareness and exposure to CTS among medical students, expanding training opportunities, and establishing regional centers of excellence. Gender equity should be prioritized through the implementation of zero-tolerance policies for discrimination and harassment, and financial incentives should be introduced to retain cardiothoracic professionals locally. Additionally, mentorship, collaboration, and international partnerships can enhance surgical skills and knowledge sharing across regions. Public health policies focusing on improving access to cardiothoracic services, particularly in underserved communities, are critical for reducing disparities. Enhanced community awareness campaigns, improved data collection, and strengthened healthcare infrastructure are vital to ensure equitable access to care. Ultimately, achieving equity in CTS requires collaborative efforts between governments, academic institutions, healthcare providers, and international partners, aimed at building a resilient and diverse cardiothoracic workforce capable of meeting the needs of diverse populations.