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Approximately 1,000 hospitals in the United States perform adult cardiac surgery, and the large majority of those programs are not the major academic centers that handle 500+ cases a year. In California, for example, more than half of all cardiac surgery programs perform fewer than 200 CABGs annually. Nationally, a similar pattern holds, with 1/3 of CABG-performing hospitals performing fewer than 100 cases per year. These programs are typically community hospitals serving smaller cities and rural regions, and they tend to be staffed by a small perfusion team, sometimes just one perfusionist.

The exact percentage of US hospitals operating with a single perfusionist is not publicly tracked, but the available data does make clear that solo and near-solo programs are not uncommon. The 2020 Adult Clinical Perfusion Practice Survey reported team sizes ranging from 1 to 33 perfusionists, with a mean of 6.4.That mean is pulled upward by large academic centers, which means a real share of community programs sit at the low end of 1 to 3.

The one-perfusionist model has real downsides in coverage and sustainability, but it makes practical sense for many smaller and rural programs. At a hospital performing fewer than 200 cardiac surgeries a year, the math can look reasonable, since a second full-time perfusionist is hard to justify on case volume alone. The trade-off is that the single perfusionist becomes the lynchpin of the entire program, and without that person, the community loses cardiac surgery access entirely. Beyond that, the model carries a unique set of challenges that can range from stressful to limiting to catastrophic.

Here are the five most significant realities of the one-perfusionist hospital:

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On-Call Burden

The most immediate reality of a one-perfusionist program is that the single perfusionist is, in effect, on call every hour of every day of the year. Weekends, holidays, overnight hours, and family events all occur against a backdrop of potential pager activation. Even when no emergency case actually materializes, the disruption to sleep, planning, and personal time is constant.

The downstream effects can quickly compound. A perfusionist running an elective CABG the morning after a 2 AM emergency dissection is operating with sleep debt that, in other safety-critical fields, would be a red flag. Standard vacation requires either canceling the elective schedule, arranging external coverage, or negotiating informal support from a nearby facility. Illness creates the same problem: a case of food-poisoning or the flu can shut down the cardiac surgery schedule for several days.

Outside of work, the same pattern affects routine life. Medical appointments, school events, weddings, and funerals all require advance planning that other professionals take for granted. What happens if the perfusionist becomes suddenly unavailable is a question these programs have to actively plan around.

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Equipment and Technical Workload

The perfusionist at a community hospital is rarely responsible only for the heart-lung machine. The role typically extends to the full range of extracorporeal and circulatory support equipment the hospital owns. At larger programs, those responsibilities are distributed across a team, with individual perfusionists specializing in particular devices. At a one-perfusionist program, all of it falls to one person. In practice, this includes:

●    The heart-lung machine itself, with associated readiness checks, calibration, preventive maintenance, and disposables management.

●    The cell saver, used in cardiac, vascular, orthopedic, trauma, and obstetric cases, including intraoperative operation, troubleshooting, and staff training.

●    Intra-aortic balloon pumps, used for cardiogenic shock, high-risk PCI, and post-operative support, with the perfusionist serving as the escalation point even when ICU nurses manage day-to-day operation.

●    ECMO, which requires 24/7bedside availability and is one of the primary reasons most one-perfusionist programs cannot realistically offer an ECMO service.

●    Ventricular assist devices, both short-term (such as Impella and CentriMag) and durable (such as HeartMate3), including implant and explant support.

Aside from direct clinical operation, the perfusionist can additionally be responsible for the supporting infrastructure for each device. That includes vendor relationships, contract reviews, recall management, expiration tracking, biomed coordination, QA documentation, accreditation preparation, and ongoing training for OR and ICU staff. The combined load of all these tasks on a single person is substantial.

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Professional Isolation

Cardiac surgery is a team specialty, and most perfusionists in larger programs work in close collaboration with peers. The one-perfusionist hospital removes that peer structure entirely. There is no in-house colleague to debrief a difficult case with, no second set of eyes during a complex circuit setup, and no internal mentor for clinically or ethically gray situations.

The effect extends to professional development. Attending conferences, completing advanced certifications, or taking dedicated training time all require coverage that is not readily available. Over time, this can produce a gap between the solo perfusionist and the broader field, particularly in newer or evolving areas of practice where techniques tend to spread through peer-to-peer exchange.

The psychological dimension is equally important. The sense of being the entire program can be both a source of pride and a source of significant emotional weight. Patient outcomes, equipment failures, and political tensions all land on one person, with no team to share them with.

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Limited Departmental Voice

A department of one carries less institutional weight than a department of five. Salary negotiations, call pay discussions, equipment purchase requests, and staffing proposals all happen without departmental peers to corroborate the need or support the position.

When the request reaches a decision-maker who does not have direct visibility into what perfusion does, the case can be difficult to make on individual authority alone. Reporting structures often compound this. Many solo perfusionists report to OR directors or cardiac service line administrators who oversee perfusion as one of many responsibilities, rather than to a perfusion-specific leader.

The political dynamics with surgeons also concentrate. A single perfusionist working closely with one or two surgeons can develop deep working relationships that benefit case efficiency and patient outcomes. The same closeness, however, can make the role vulnerable to surgeon turnover and to pressure around add-on cases or scheduling decisions that the perfusionist may not have the standing to push back on.

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Program Limits and Succession Risk

A one-perfusionist program has an evident structural ceiling. ECMO is largely off the table because of the 24/7coverage requirement. Higher-acuity cases and complex add-ons may be transferred out due to a thinner safety margin. Expanding the cardiac service line, adding structural heart procedures, or growing surgical volume all require additional perfusion capacity, which produces a chicken-and-egg dynamic in which the program cannot grow without another perfusionist, and adding another perfusionist is often hard to justify until the program grows.

Longer-term sustainability is the second piece. Recruiting a second perfusionist in a profession of approximately4,300 nationwide can be a multi-year effort, particularly for rural or or smaller community programs that cannot match academic centers on pay, volume, or professional development.

If or when the solo perfusionist retires, relocates, or moves to a different position, the program is often at acute risk of suspension or closure. The dependence of an entire cardiac surgery program on the career trajectory of one individual is a significant institutional vulnerability, and one that most hospitals do not actively plan for until the moment it becomes urgent.

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A Backup Plan is a Smart Strategy

Rather than waiting for disaster to strike, programs need a backup plan established well in advance. The consequences of not having one are too significant to leave to chance. But the solution does not have to mean hiring a second full-time perfusionist before the volume actually justifies it. That cost can be difficult to justify or defend, and for many smaller programs, it simply is not financially realistic.

There is another option, though: partnering with an on-demand perfusion staffing service that can step in for planned time off, illness, professional development, or the unexpected, without a long-term contract or a retainer fee sitting on the books every month. Because the cost only materializes when coverage is actually used, it gives the program flexibility without a fixed financial commitment.

In practice, that means the perfusionist can take a vacation without shutting down the cardiac surgery schedule, attend a conference without asking a surgeon to move cases, and handle a sick day without triggering a week of cancellations. For many one-perfusionist programs, a handful of covered days per year makes the difference between normal operations and a staffing crisis.

Another option is to bring in a part-time or per-diem perfusionist on a recurring basis to build a predictable, low-cost bench. This does not solve every problem the solo model creates, but it directly addresses the coverage ceiling and gives the primary perfusionist a reduction in the weight of being the single point of failure. It also opens the door to conversations about ECMO, higher-acuity cases, and modest program growth that were previously off the table.

At Perfusion Life, we work with programs across the country, from large academic medical centers to small community hospitals described here. Our model is designed specifically to avoid the barriers that make smaller programs hesitant, with no long-term contracts, no retainer fees, and no commitment to volume you don’t have. You pay when you need coverage, and you get a vetted, credentialed perfusionist who can integrate with your team and your surgeons. For programs that have never formalized a backup plan, building one is both straightforward and essential.

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