Medical students and surgical residents have a wonderful spectrum of choice in deciding their future course of specialization: - a choice they may find daunting. Heart surgery is but one of those choices, and congenital heart surgery a yet smaller 'niche'.

Why consider a career in congenital heart surgery (CHS)?  The opportunity to prevent a newborn's premature death in exchange for that baby’s '3 score & ten' years of life seems reason enough.  The satisfaction of helping the child and the child’s family is a tremendous reward and responsibility.
 
Not all of our patients are critically ill.  The anxiety level of parents whose child is well but faces surgery to prevent the certainty of later complications from a congenital heart defect is a problem of a different magnitude. Our compassion and understanding is required to council the family before providing the best possible care for their child.

Our past success in treating infants and children has led to an increasing population of adults that now constitute more than 50% of the patients living with congenital heart disease.  The challenges these adults present are new to us and demand novel and better solutions.  They add to the spectrum of CHS, which now includes every age from newborn to octogenarian.  Importantly, CHS is a growing specialty with an increasing number of patients.

There may be a misconception that the era of pioneering in CHS is finished and the future will be less exciting.  To the extent that new operations will be less likely, now that many options have been explored, that is true.  The pioneering surgeons of 60 years ago had to learn and incorporate into CHS the new sciences of blood transfusion, biochemistry, applied physiology, cardiac anatomy, pathology and embryology.  None of these sciences were well developed when CHS began.  To-day's congenital cardiac surgeons will need to incorporate the sciences of molecular biology, genetics, stem-cell research & tissue engineering, experimental embryology, computer technology, statistical analysis and enhanced diagnostic imaging.  Incorporating these challenging and exciting new areas of science into CHS is tremendously exciting with amazing potential to affect the outcomes of our patients.

The specialty of CHS demands that patient care be available 24 hours per day, 7 days per week, and 365 days per year. It is increasingly unrealistic for a solo congenital heart surgeon to meet this level of care our patients should expect and need.  The organization of CHS is changing towards more centralization.  Consolidation of existing facilities into larger units with higher patient volumes and resources, both financial and personnel, is a very positive trend.  A ‘critical mass’ of both patient volumes and expert personnel is vital to ensure consistent & excellent patient outcomes. Centralization of CHS will permit optimal patient care and importantly will also provide a better life-style for the surgeon. Most of this centralization, although not all, will be into University-affiliated institutions where teaching and research opportunities are available.  The opportunity for an academic career will appeal to most congenital heart surgeons.

Congenital heart disease is rare in the general population (8 per 1,000 live births). Its relative rarity dictates that progress in the specialty requires pooling of one’s experience with those of other CHS units, both nationally and internationally.  One of the hidden secrets of CHS is that it is global in perspective and is an opportunity to know other surgeons from around the world on a very personal level.  Only 1/3rd of the Planet's population has access to tertiary cardiac care, so the opportunities for expansion of CHS are enormous.