Cardiac Surgery: How Do Short Vacation Breaks by Surgeons Affect Patient Outcomes?

Marco D. Huesch, MBBS, Ph.D., Assistant professor at the USC Sol Price School of Public Policy Adjunct professor with Duke’s School of Medicine and Fuqua School of Interview with:
Marco D. Huesch, MBBS, Ph.D.
Assistant professor at the USC Sol Price School of Public Policy
Adjunct professor with Duke’s School of Medicine and Fuqua School of Business. What are the main findings of the study?

Answer: This study asked whether ‘learning by doing’ works backwards too, as ‘forgetting by not doing’. In an nutshell, the answer is ‘no’ among the Californian cardiac surgeons I examined with short breaks of around a month. Were any of the findings unexpected?

Answer: The noted British surgeon James Paget pointed out more than a century ago that a physician “that ceases to gain knowledge is always losing it.” I hypothesized that at the patient-level, having a surgeon who had not performed cardiac bypass surgery in the calendar month before the month of the patient’s operation, would be associated with slightly longer stays and slightly worse in-hospital and 30-day mortality. However, this was not supported by my analysis of nearly 60,000 patients over a three-year period in California. What should clinicians and patients take away from your report?

Answer: My findings suggest that either down time does not have significant adverse impacts on surgeon performance, or such down time has countervailing effects. In the latter interpretation, any adverse impact on manual dexterity or familiarity with operating room team members through absence may be balanced by the generally positive impacts of vacation time. In the former interpretation, well-practiced technical and planning tasks retain their familiarity or may be quickly recovered on re-appearance in the operating room. Those are both reassuring findings for patients and their clinicians, which ideally future research can continue to confirm. What recommendations do you have for future research as a result of this study?

Answer: There are many problems in healthcare that are complex to deal with; conversely there are many more far simpler problems. If human capital – the degradable experience that a medical professional builds through practice – actually decays in some noticeable way after breaks in practice, then this would be a relatively simple and uncontroversial problem to deal with. Changes in staffing, in training, in coverage and in scheduling could address such a problem relatively easily. Future research should build on this small study of mine, and other studies (noticeably by Jason Hockenberry in Atlanta), to explore such human capital dynamics and their effect on patient outcomes.


Huesch, M. D. (2013), The Impact of Short Breaks From Cardiac Surgery on Mortality and Stay Length in California. Journal for Healthcare Quality. doi: 10.1111/jhq.12018

Last Updated on March 28, 2014 by Marie Benz MD FAAD