Elsevier

Surgery

Volume 144, Issue 4, October 2008, Pages 548-556
Surgery

Central Surgical Association
Population analysis predicts a future critical shortage of general surgeons

https://doi.org/10.1016/j.surg.2008.05.019Get rights and content

Background

The nation's population grew from 227,000,000 to 282,000,000 between 1980 and 2000. By 2050, the population will be 420,000,000, an increase of 50%. Between 1980 and 2005, there was no increase in medical school enrollments. The funding of all postgraduate positions including general surgery was capped at 1996 levels, and so there have been few additional residency positions added. Based on a population analysis, we predict there will be a shortage of general surgeons in the United States by 2010.

Methods

Calculations were made with regard to the net supply of surgeons for each decade. The projected population for each decade was determined by US Census Bureau figures. The assumptions for these calculations were as follows: (1) the ratio of general surgeons per 100,000 population will remain the same as the year 2000 (7.53/100,000); (2) the number of postgraduate training positions will remain constant; (3) general surgeons will practice 30 years from board certification to retirement; (4) there will be 1000 board certifications a year; and (5) these projections are restricted to allopathic training programs.

Results

As early as 2010, we predict a potential shortage of 1,300 general surgeons growing to 1,875 in 2020 and 6,000 in 2050.

Conclusions

According to simple population calculations, if the number of surgical trainees is not increased and the care model remains constant, there will not be a sufficient number of allopathic-trained general surgeons to care for the American people. The government must take proactive steps to increase the funding for surgery trainees to prevent this shortage and maintain the level of access and service to continue the provision of high quality care for the US population.

Section snippets

Workforce analysis

The projection of the supply of general surgeons and the potential excess or shortfall is based on 4 elements: (1) the projection of surgeons needed based on population analysis; (2) the projection of attrition of surgeons due to retirement, disability, and death; (3) the number of new surgeons entering the workforce after completion of residency training; and (4) the total number of surgeons in clinical practice.

Assumptions

In this study, there are 6 assumptions or conditions used in predicting the future

Calculation of the number of surgeons needed

For an estimate of the general surgeons the following formula is used:

Estimated US population × 7.53/100,000 = No. of surgeons needed

The results are shown in Table I. In 2010, the projected number of surgeons needed is 23,175; in 2020, the number is 25,200; in 2030, 27,300; in 2040, 29,400; and in 2050, 31,500. This finding demonstrates the need for about 200 additional general surgeons per year.

Calculation of surgeons leaving the workforce secondary to retirement

With regard to retired surgeons (including disabilities and/or death), the projections are shown in

Estimates and projections

As Uwe Reinhardt,9 the healthcare economist at Princeton University, states “[It is a] daunting enterprise to estimate the physician surplus or shortage one or two decades into the future. Any of the variables in the equation can change over time, sometimes in unforeseen ways,” There are 3 approaches, or algorithms, to predict the future supply of physicians: (1) an economic, or trend, model; (2) a population model; and (3) estimating physicians needed by work effort studies.

Cooper, in his

Conclusions

According to simple population calculations, if the number of surgical trainees is not increased and the care model remains constant, there will not be a sufficient number of allopathic-trained general surgeons to care for the American people as early as 2010. The shortage will grow in each subsequent decade to 6,000 by 2050. The surgical profession will need to take steps to increase the appeal of general surgery to medical students. The government must take proactive steps to minimize the

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    Supported in part by a grant for the artwork from the Columbus Medical Association Foundation.

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