Monday, May 2, 2011

Coming Soon to a Neighborhood near You: A Shortage of General Surgeons

There is much hand-wringing about the shortage of primary care physicians. But primary care not the only specialty with deficits. In a few years, all surgical specialties will experience significant decreases in availability. Here is what will be happening with general surgery.

Demand-Side Facts:

The current population of the United States is about 311 million people. Estimates are that by 2020, it will rise to over 340 million.

As baby boomers age, the increase in the population of the elderly will result in more need for general surgeons.

There are already many rural areas that are underserved by general surgeons.

Supply-Side Facts:

The number of general surgeons needed to adequately serve the population is estimated to be at least 7 per 100,000 people.

Currently there are about 18,000 active general surgeons in the US or 5.8 per 100,000 people.

The ratio of general surgeons per 100,000 population has dropped by 26% in the last 25 years.

Medical schools are expanding class sizes and a few new schools are opening but it will take several years for the impact of these changes to be felt.

Residency programs produce about 1050 new general surgeons per year, a rate that has been level for almost 20 years.

The prospects for increasing the number of surgeons being trained are limited. A recent paper in the journal Academic Medicine showed that even if all of the current 246 general surgery training programs expanded as much as they possibly could, the best-case scenario would be an increase to about 1500 new surgeons per year. The cost of funding this increase is estimated at several billion dollars, which have not been allocated. Even if the expansion took place by 2015, it would take 5 years (the length of general surgery residency training) before the extra new surgeons would be available.

At least 30% to 50% of graduating general surgeons take fellowships and ultimately narrow the scope of their practices. These surgeons do not perform all of the procedures that the average general surgeon does.

Almost 50% of medical school graduates are women and up to 40% of surgical residents are women as well. Here is “the elephant in the room” that no one wants to talk about. Although some surveys suggest that women do as many cases as their male counterparts, a recent study presented at the American Surgical Association showed the facts. Information submitted by nearly 5000 general surgeons applying for recertification by the American Board of Surgery during the years 2007-2009 shows that male general surgeons perform an average of 500 cases per year compared to female general surgeons, who do 375 cases per year. And the case mix of women surgeons is skewed with “far more” breast procedures and fewer abdominal and GI cases being done compared to male surgeons.

Recent papers have noted the increasing problem of “burnout” among surgeons. One paper from 2009 reported that 40% of some 7900 respondents to a survey of members of the American College of Surgeons considered themselves “burned out” and 30% had symptoms of depression. This will lead to attrition and/or earlier retirement.

Bottom line. There is already a shortage of general surgeons. The population of the US is growing and the supply of general surgeons is not. It will take money and time to rectify the problem. No one is doing anything about this.

2 comments:

Old Rockin' Dave said...

The existence of the physician assistant profession may affect the outlook somewhat, in that many of the things that general surgeons do can be delegated to appropriately-trained, experienced PAs. This includes first- and second-assisting, dressing changes and suture removal, inpatient rounds and a variety of emergency procedures. Of course that would mean diverting significant numbers of PAs from the primary care role, making the primary care/internal medicine practitioner shortage worse. it also means that surgeons are going to be needed to train and then supervise them.
In any event, none of this is going to matter much in the face of the massive shortage of RNs that is only getting worse; a prediction I saw a few years ago estimated that in our near future we could be short as many as one million nurses. I don't know of any hospital that can function properly with a serious deficiency in trained nurses.

Anonymous said...

THERE IS NO NURSING SHORTAGE IN THE UNITED STATES.

This info constantly put out is pure propaganda. Visit Allnurses.com and search "nursing shortage" or "where are the jobs". Heck, join and post the question. Read about how many nurses are unable to gain employment. This over-saturation of nurses in the US is only complicated by the greed of hospital corporations raising nurse to patient ratios in order to make more money. Those that work today do so in fear due to being saddled with too many acutely ill patients to care for at one time. I'm not joking when I say, become an inpatient at your own risk. If you have a son or daughter thinking of going to college for nursing or, if you are a career changer, you will most likely default in your college loan repayment. New grad nurses by the thousands remain unemployed.

-SCRN

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