Career Outlook for a Perfusion Candidate
Updated as of:  07 Feb 2006

There are questions concerning what perfusion is, what a perfusionist does, and there is as many questions asking what perfusion will be like in the next several years.  My immediate statement to you is; if you have an interest, please take the time to research this profession.   I say again, "Research The Profession!"  Hopefully, I can provide a little insight to your concerns.  Some questions and comments considered are:

Who Usually Becomes a Perfusionist & Should I Consider This MY Career Path?

To choose this as a profession a person must look inside themselves and see if they possess the maturity and responsibility to care for someone else's life.  A serious responsibility not meant to take lightly.  There is a great element of risk associated with this career, it is similar to those as an airline/aircraft pilot or an air traffic controller assumes. There are probably other examples.  Most candidates who enter this career are certified or licensed in some other allied heath field.  The sister discipline is considered respiratory therapy, this and nursing is the larger of the group that usually enters perfusion.  Many respiratory therapists and nurses believe that perfusion will round out their medical discipline, and they will practice skills in both professions.  Far from the truth.  It becomes a liability issue.  Some facilities do allow this, but in my opinion your setting yourself up for trouble.  Performing a critical or complex task that is not within your defined scope of practice or in this case "this discipline your being employed/paid for" will be cause for negligence and hold you and the facility liable for extreme damages should an error or mishap take place.

The type of person who usually becomes a perfusionist has a inherent need for stress in their daily life.  They prefer to be mentally and physically challenged everyday and can perform for a long duration under heavy stress.  Most all perfusionists I have spoken with have a high tolerance for stress and the majority will never suffer a "burnout" after being exposed for many years.  I don't want to mislead at this point, perfusionists are not adrenaline junkies as some might come to think although I never turn down a Starbucks Double-shot.  So, Perfusion is a complex applied science that requires core knowledge in all physiological fields.  What makes a highly skilled perfusionists is his/her ability to draw upon this knowledge and maintain a person's life using extra corporeal machines.  No there's no extra money in it.

In  interviews I have noticed that there is sometimes a financial motivation to enter this career.  It is well known that with tenure in our field some perfusionists command large incomes.  I would like to warn you right now that if the above is the case for you joining us, you are looking in the wrong place and would be better to consider a different career.  I think that is a common agreement among all of us.  Our current distribution of schools that teach perfusion or circulation technology will sometimes not admit a prospective candidate to the selection committee until they have spoken to or observed a perfusionist at work.  And it usually means that they have actually spent a considerable amount of time with a perfusionist. Research this profession, gather some questions, go and watch several perfusionists at different facilities work.

The potential candidate usually has researched this profession very well, gained insight to most aspects of perfusion, and is able to answer some basic questions of the profession.  [ If you have done your homework and can answer most of all the questions above in 'red' lettering then give me a buzz.  I would enjoy a chat and see where you might be headed for school. ]  The informed candidate will have a very realistic concept of what to expect everyday.  They also will be able to handle the mental and physical responsibilities of mortality and morbidity.  Their individual maturity is an asset.  It also is more preferable that the candidate have some type of medical exposure whether it is biomed, another allied health profession, or nursing. 

Career Outlook, The Short and Long View.

The profession right now has a combined strength of a little over 3200 practicing perfusionists.  The profession seems to follow a six  year cycle of fluctuations.  But, I say this knowing that our profession really depends upon those people needing heart surgery.  With this in mind, you should take it upon yourself to research some demographic predictions of the "Baby Boomers".  Those born in 1964 were the last of this group.  At the moment, most heart surgery is being performed on patients that are greater than 52 years of age.  But there are perfusionists that mainly work with pediatric cases, some work with both adult and pediatrics.  I'm writing this to tell you I do have an ear to the rail.  I listen carefully to the caseloads my colleagues are reporting.  The U.S. has reached a plateau of cardiac surgeries, it is showing small fluxuations but it is creeping up at an average rate of 1.99 to 2.29 percent since 1999.  I don't suspect it will move any faster anytime soon.

Currently the perfusion profession is being greatly affected by the focus of managed care.  Managed care has changed a great deal since it first was introduced.  As all other medical professions.  The Centers for Medicare and Medicaid Services and its ideas of cost containment have slowed the growth and financials of this profession profoundly.  The managed care facilities have actually decreased the number of people even considered for heart surgery.  Do yourself a favor and also look into a facility's or health system's "report card".  That way you might possibly find out what hospitals are doing in your area and what the public's opinion about them are. 
Our profession is also affected by our economy, in previous recessions there has been parallel declines due to the fact that many people just can not afford health insurance thus are not seeking medical attention or preventive care.  Because of the economic events that started out our decade, I will go ahead and say that there are major repercussions to the lowering the reimbursement of clinical professionals.  As mentioned before cost containment is now a large issue facing perfusion departments, contract perfusion companies, and hospital administrations.  Get used to the word, "cut-backs".  Perfusionists have observed in the growth of technology in perfusion disposables being used, and the amount of supplies a perfusion team carries to operate.  Administrations just will not let you buy that new venous saturation monitor, they expect you to get by with minor alterations to existing perfusion equipment being used. Expect your biomed techs to come walking into the pump room to replace the circuit boards on your pump modules.  Service contract are way too expensive for them.  But if you don't mind forgetting about that cost of living increase for the next several years they might let you add a myocardial temp probe to your services. Have the biomeds figure out a way to so you can actually use it without a monitor.  And as of tomorrow, you just might be working with one less person on your team.  So get ready for some extra hours.  But don't expect to be compensated for this right now.  Heck, you might not ever see it.  In an administrators' or finance person's eyes you are just a "high paid technician" or just a "pump tech" as I hear now and then.  They really don't know what your position entails on an everyday basis.  Don't worry, your next cardiac patient doesn't know what a perfusionist is either.

As discussed before there exists a large population of those soon entering the second half of their lives.  Without future predictions of a cure for heart disease there will be a need or potential to perform cardiac surgery on these patients if they make it past the 'gatekeepers'.  New technology in our field will ultimately determine how this is done, and will probably determine where and who performs this surgery.  Did you know that our nations' medical students are NOT selecting to enter the field of cardiac surgery!  Fellowships and residents counts have dipped to an all time low for the 2005-'06 reviews.  What will this translate to in the next few years?  If there is a question of need for "perfusion", the answer remains what will a perfusionist be needed for?  I am optimistic that all of what I have learned and continue to learn will not go to waste.  If there is such a strong drive in our aptitudes we will surely continue in performing CPB as a mainstay of cardiac surgery.

Current Job Market and Salaries

The current job market is showing a slight saturation of perfusionists with 10 or more years of experience.  Those with more than 13 years of experience are remaining within their positions and some are actually pursuing secondary interests in addition to perfusion. I am saying this based upon previously read statistics and a composition of surveys reaching back to 1997.  Indicators are showing preference for perfusionists with 2 to 5 years of experience because of cost and additional stress/demands a new graduate has on existing departments.  My colleagues have been telling me that they are stretched to the limit in duties, time, and personnel allotments.  This situation has increased with  perfusion contractors who rely most on providing a facility with as much service (perfusionists) as possible due to fluctuations in caseloads now being seen across the nation.  There are jobs out there for perfusionists, however these jobs are mostly staff positions usually within a group of three or more.  Start-up programs are showing up occasionally.  There are also those small programs that perform around 300 cases a year that keep a small staff of two.  With the economy and health care restrictions in some regions, there has been a huge spike in "lateral jumps" by perfusionists.  There are very few if any perfusionists climbing the ladder to "chief-dom".  A perfusionist looking for a job will have to compromise a lot.  They will possibly be forced to choose an area outside their "wish list".  Maybe in the next few years we might see a small burst of small perfusion groups or an increasing number of hospital based perfusionists but with all this financial belt tightening that is taking place it really won't be profitable for any of us.
Perfusion schools have kept their side in check,  graduations numbers have just been slightly over the economy's need, but the excess is negligible to the majority.  Our profession thrives on new ideas and technology and new graduates.  We are having a difficult time with all three as compared to a decade ago.
       Here is a thought to keep in your mind.  It's very real!  The rising federal deficit, forces the federal policy makers to have CMS cut federal and state programs in addition to hospital and physician reimbursements in a step-wise, increasing fashion each year for x years.   The cut-backs have forced providers to cut services and thus purchases of supplies.  Supply vendors, who also support R&D, and R& D independent firms have slowed new technology growth to 2% or less of their budget.  Many independent R&D firms closed most businesses merged.  They could no longer support the expenses of advancing technology by depending on recoup in services and sales with provider agreements.  Providers demanded the new technology because their patients demanded it from them!  CMS and some insurance would sometimes partially reimburse for new technology, otherwise providers shared cost in other services that could handle price inflations.  But new technology is more effective in most cases and is able to replace combinations of the conventional treatments. Combinations of conventional treatments are almost equal the new technology but cost more.  Vendors which own the R&D stop manufacturing/supporting old patents. Niche vendors who have no R&D continue to sell old/conventional technology.  R&D gets really expensive for vendors now that they compete for the providers' business.  Conventional technology eventually falls to attrition and medical advances. The new technology becomes contemporaneous but it's cost has inflated, health care now shares a greater amount of cost with patients as seen in double-digit increases in premiums and co-pay.  Patients choose not to visit their medical providers until they reach a point when serious and imminent danger exists and the only treatment solution is the "new" conventional treatment that must be paid for by the provider and insurance. Federal reimbursement cuts and the rise in medical device and services has caused Health Care to represent almost 14% of Gross National Product.  The Kaiser Foundation reported in 2004 that a family of 4 with a $45K to $50K per annum income could only afford to keep health insurance on 2 members all the time and provide partial coverage for the third.  But this is a family of four... In my very real story above, it is the fourth member of that family, who is also the wage earner that has no health care coverage.  Who will pay for his treatment and successive care?  Why is your hospital administration not filling positions that co-workers have resigned or quit?  Why are your department managers/directors now managing 2 or 3 other departments as well?  Why doesn't your department use Per Diem staff anymore? Why did it take 5 years to purchase a POC ABG analyzer for the whole surgery department to share when on Thursday last week your CV surgeons had a Vendor Rep in the OR with the new MAZE hardware and disposables.  This morning (Monday), both your cardiac suits have an brand new ablation machine and there is a stack of new disposables right next to the IAB supplies.  What do you mean I don't get overtime pay or shift differentials when I've been working 60 hour weeks and sleeping in the office?  Take a peek at what's coming down the Federal Pipeline: 2007 Medicare Reduction Proposal

Perfusionists' salaries have declined in the past 7 years.  In the last 3 years some have declined more than others.  Pay cuts, cost containment, provider reimbursement reductions, and the declining demand for perfusionists have all contributed to this decrease.  In 1997 starting salaries were ranged at $59,000 to $76,000.  In 1998 there was a range of $45,000 to $68,000.  The 1999 data showed a further decrease at a range of $33,000 to $52,000. The 2000 through 2003 data indicates a plateau in salary range for starting perfusionists at a range of $35,000 to $56,000.  There has been a little increase from 2003 through 2005 data points in salary, we are noticing that the base range is at $38,000 to $68,000 depending upon region and state.  Economic cost of living differentials are major influential factors in determining these ranges.  Negotiate your market value.  Keep in mind that for every position that has been posted in 2005, it had received on average 34 inquiries/day!   Again, it must be noted that there is a large difference in the average salaries and wages commanded by experienced perfusionists.  The most significant reason is the regional area where employed and the additional skills provided to cover hospitals needs.
For those perfusionists that are self-employed, own their contracting business, are senior or chief perfusionist in large programs, their salaries or wages will be a lot higher than the expected norm. 

A Little History and Where Does This Put Us Now?

The past ten years has been very trying to the perfusion profession, we have endured many new technological advances that relate to our field.  Pharmaceuticals, angioplasty, stents, MIDCAB, OPCAB's, these evolutions have taken their toll on our ranks.  There is even research taking place now that contains a perfusion circuit enclosed in it's "black-box", that only requires a medical person who knows how to work a tubing clamps.  Be they what they may, it is better for us to learn and accept these techniques because of our oath to care.  Find strength in knowledge of your skills, it will take years to break up a solid foundation. Considering, the advances in new surgeries that are taking place the call for a perfusionist is LOUD, and will probably be heard for a long time from now (just listen sometime when there is a cardiac emergency).

An object of this profession is to always remain clinically specialized in the surgical theaters.  To perform those needed skills that require a high level of acuity, knowledge, and engineering in order to help a surgeon complete his/her operation.  Most CV surgeons won't admit it, but you are their security blanket.  So you better be paying attention when they scream for help.  Afterwards, don't ask or expect anything more than a nod or a whispered "thanks".  It's this last bit of acknowledgement between you two that demonstrates your professional integrity amongst others.  Perfusionists tend to embrace new technology in their field.  Because of their learned educational "bio-foundations" they can easily adapt and employ them without having to go through extensive training programs like other allied health or nursing disciplines require.  Being able to think and act through the technology available in order to reach a solution is the gift your instructors will give. 

When perfusion began as a established profession in the early '70's it encompassed many duties and procedures outside of just performing cardiopulmonary bypass.  These are now known as our ancillary duties, a few have been relinquished but the majority have remained under our belts.  Hopefully, our profession which is composed of highly skilled medical professionals will once again reclaim these areas.  With new technological advances there will probably be some major integration of services that only a professional with our knowledge can operate the machines to complete these tasks.

The attrition rate for experienced perfusionists is very low right now.  Only a handful each year retire, mostly due to the stress level of the profession or the need to pursue a secondary career path.  By the 3rd quarter of last year, a nationwide poll by the Center for Workforce Development at Rutgers University found that 18% of the workers surveyed (28% of boomers) said they plan to work part-time in retirement because of the need for money.  Nine out of 10 workers would like to retire by age 65 but only 63% said they'd be financially stable.  Most perfusionists are retiring around the age of 60 (but there are those rock solid old timers).  Those perfusionists who want to continue in the field but not remain wholly immersed in the clinical arena usually find themselves still consulting in the medical disciplines.  By word of mouth, I am finding that a lot of perfusionists are returning to school so that they can switch to a non-medical professional career.

Did I answer most of your questions?  Did I create some more to ponder?  To undertake the responsibility of any career you will have to step outside your box.  No will hold your hand while you decide to take this step.  Are you ready?

I know I didn't say anything about schools... Well, that is where you will have to make another decision.  I will ask from a personal stand, if you really want to join us professionally, make the time to come see us and talk to us at work.  I offer myself to always try to answer your questions if I can. My office number is listed below.  We have an optimistic future, I'm sure of it.  I promise that you will have an opportunity to experience a responsibility most others can't even conceptualize.

If you have a burning question about perfusion.  Ask!  We know how strong your curiosity is to know.