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U.S. surgeon supply projected to drop 18% by 2028

Major Finding: The overall availability of surgeons in the United States will have decreased 18% by 2028 if current trends continue, with exceptions for some specialties.

Data Source: Databases maintained by the American Medical Association and several other organizations.

Disclosures: The study was sponsored by the American College of Surgeons. None of the authors declared conflicts of interest.


 

FROM ANNALS OF SURGERY

The supply of surgeons in the United States will decrease by nearly one-fifth by 2028, likely resulting in shortages in all but a handful of specialties, a study has shown.

Currently proposed changes to increase surgeon training will not be enough to offset the number of surgeons who will retire, predicted Erin P. Fraher, Ph.D., of the department of surgery at the University of North Carolina at Chapel Hill, and colleagues. If this trend continues, the overall supply of full-time-equivalent surgeons will have decreased 18% between 2009 and 2028, with declines in all specialties except colorectal, pediatric, neurologic, and vascular surgery.

Such a drop could result in a workforce insufficient to meet the needs of the U.S. population – particularly in light of the expanded access to and increased usage of health care services projected for the future. It could also exacerbate problems related to the geographic distribution of surgeons, the investigators cautioned, "leading to delayed or lost access to time-sensitive surgical procedures, particularly in rural areas" (Ann. Surg. 2012 [doi:10.1097/SLA.0b013e31826fccfa]).

These projections are lower than those forecast in a 2008 report by the U.S. Health Resources and Services Administration for general, cardiothoracic, orthopedic, urologic, plastic, ophthalmologic, and obstetrics/gynecologic surgeons. However, they are brighter than previously published projections for vascular and pediatric surgeons (J. Vasc. Surg. 2009;50:946-52; J. Pediatr. Surg. 2009;44:1677-82). Predictions of a decline in cardiothoracic surgeons are consistent with some earlier findings (Circulation 2009;120:488-94).

For the current research, the investigators used a stock-and-flow model, which calculates current numbers of physicians, projected numbers of physicians graduating from medical school, and physicians reentering the workforce, and subtracts from these anticipated deaths, retirements, and career breaks. They then adjusted the resulting head count to full-time-equivalent work participation rates of surgeons by age, sex, and specialty.

Data were drawn from databases maintained by the American Medical Association, the American Board of Medical Specialties, the National Resident Match Program, the San Francisco match for plastic surgery and ophthalmology, the American Urological Association, the Health Resources and Services Administration, and the North Carolina Health Professions Data System.

Unlike static projection models, this model allows for real-time updating to take into account changes in data and policy decisions, which enhances the accuracy of its workforce projections, according to the investigators.

Surgeons’ participation in patient care declines somewhat after age 60, they noted, making age a key factor in determining full-time equivalents for each specialty. Another factor considered in modeling was the "feminization" of various specialties. By 2019, Dr. Fraher and colleagues predicted, half of general surgery residents will be female, compared with 95% of obstetrics and gynecology residents and 28% of orthopedic surgery residents.

Furthermore, an estimated 25% of general surgery cases that have traditionally been performed by surgical specialists will, in the future, need to be made up by general surgeons, the investigators said.

The most important driver of future supply estimates, they said, "is whether anticipated declines in full-time equivalent rates will occur as expected and whether these full-time equivalent decreases will be offset, at least partially, by productivity gains."

Dr. Fraher and colleagues called their findings "a snapshot of trends that may or may not develop depending on whether there are changes in graduate medical education training pathways, in the length of training, and in attrition from residency programs."

Current proposals to either cut or increase graduate medical education funding under Medicare focus largely on increasing the supply of primary care physicians, but results from this model suggest that it is equally important to ensure an adequate supply of surgeons in the future, the authors said. They emphasized that current published recommendations to boost graduate medical education by the Council of Graduate Medical Education, Congress, and others, if implemented, would not avert declines in surgical workforce supply during the period forecasted.

Dr. Fraher and colleagues’ study was sponsored by the American College of Surgeons. None of its authors declared conflicts of interest.

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