What the public data actually says about APP ratios in cardiac surgery

MedAxiom's 2025 survey is the most current credible benchmark for cardiovascular APP staffing. Here is what it shows, and what it does not.

There is no single national benchmark for APP-to-cardiac-surgeon ratios. The data set programs actually budget against is MedAxiom's 2025 Cardiovascular Provider Compensation and Production Survey Report (released October 2025), which now aggregates APP-to-physician ratios alongside compensation and production by subspecialty. MGMA's published advisory on APP models for cardiovascular and thoracic surgery programs sits alongside it as the qualitative reference.

What the published guidance shows

MGMA's advisory describes APPs as foundational to perioperative care, daily rounds, and surgical assistance, with staffing scaled to coverage model rather than to a single fixed ratio. MedAxiom's 2025 report frames the same point in survey form: APP-to-physician ratios vary widely across private and integrated practices, and the report associates stronger reported operational performance with teams designed around the coverage requirement. MedAxiom's January 2025 commentary on the 2024 APP report makes the leadership case explicit: APP leadership structure correlates with program performance.

Drivers that move the ratio

Three structural factors consistently drive higher APP headcount in the published surveys: 24/7 in-house coverage requirements, dedicated cardiac ICU APP teams (a model the Critical Care Explorations 2026 workforce study profiles in detail), and active transplant or MCS programs. Programs without those coverage models may report different staffing patterns. Headcount varies and should not be treated as a universal benchmark.

First-assist is a separate FTE pool

MedAxiom and MGMA both treat first-assist roles as functionally distinct from inpatient APP coverage. Bundling them into one ratio is a common scoping error that obscures real inpatient capacity.

Why this matters at hiring time

Cardiac APPs increasingly read the public MedAxiom and ACC summaries before interviews. Being able to describe the coverage model clearly, alongside published survey context, tends to make interviews more productive.