South Korea’s teaching hospitals are confronting a sharply narrowed pipeline for the physicians who manage anesthesia during heart surgery. A survey covering 68 training hospitals affiliated with all 40 medical schools found that only three hospitals, or 4.4%, had an applicant for a cardiac anesthesia fellowship in 2026. These fellowships provide additional cardiac anesthesia training after physicians qualify as anesthesiology specialists.
The lack of new entrants is coinciding with an aging workforce. At 20% of the hospitals surveyed, every cardiac anesthesia specialist was at least 50 years old. The pattern was even more pronounced among hospitals with 500 beds or fewer, where all specialists in the field were in their 50s or older. These findings describe overlapping hospital groups, so they cannot be combined into a single national total.
Physicians surveyed identified high patient acuity, heavy workloads, poor work-life balance and inadequate compensation as the main reasons for avoiding cardiac anesthesia. The time and effort needed to acquire the specialist skills ranked as a relatively less important deterrent, indicating that working conditions and compensation were stronger barriers than the training itself.
Specialists cover heart surgery alongside other operations
Heart surgery requires complex support, including operation of a heart-lung machine and continuous monitoring of blood flow and cardiovascular function. Yet only three hospitals nationwide assigned cardiac anesthesia physicians exclusively to heart surgery during regular working hours. At the other 65 hospitals, the same physicians also provided anesthesia for noncardiac operations, including general surgery procedures.
Cardiac anesthesia specialists directly covered emergency heart surgery at 27 hospitals, equivalent to 39.7% of those surveyed. Their reported monthly on-call burden ranged from 4.6 to 6.5 shifts. The available evidence does not specify how that range varied by hospital size or region, but it shows that emergency coverage was concentrated among a minority of surveyed institutions.
Regional figures point to an additional distribution problem. Of 754 anesthesiology specialists in Busan, Ulsan and South Gyeongsang, only 93 worked at the region’s 10 university hospitals. Physicians cited in the report also said 57.1% of specialists nationwide were concentrated in the Seoul metropolitan area, while many worked in private clinics providing pain treatment. The survey presenters called for payments reflecting procedural difficulty and risk, separate compensation for emergency and overnight standby duty, guaranteed rest after on-call shifts, common fellowship goals and regional cardiac anesthesia hubs.