Projecting Surgeon Supply Using a Dynamic Model

Objective:To develop a projection model to forecast the head count and full-time equivalent supply of surgeons by age, sex, and specialty in the United States from 2009 to 2028. Summary Background Data:The search for the optimal number and specialty mix of surgeons to care for the United States population has taken on increased urgency under health care reform. Expanded insurance coverage and an aging population will increase demand for surgical and other medical services. Accurate forecasts of surgical service capacity are crucial to inform the federal government, training institutions, professional associations, and others charged with improving access to health care. Methods:The study uses a dynamic stock and flow model that simulates future changes in numbers and specialty type by factoring in changes in surgeon demographics and policy factors. Results:Forecasts show that overall surgeon supply will decrease 18% during the period form 2009 to 2028 with declines in all specialties except colorectal, pediatric, neurological surgery, and vascular surgery. Model simulations suggest that none of the proposed changes to increase graduate medical education currently under consideration will be sufficient to offset declines. Conclusions:The length of time it takes to train surgeons, the anticipated decrease in hours worked by surgeons in younger generations, and the potential decreases in graduate medical education funding suggest that there may be an insufficient surgeon workforce to meet population needs. Existing maldistribution patterns are likely to be exacerbated, leading to delayed or lost access to time-sensitive surgical procedures, particularly in rural areas.

[1]  C. Ko,et al.  The Aging Population and Its Impact on the Surgery Workforce , 2003, Annals of surgery.

[2]  T. Konrad,et al.  Using the American Medical Association physician masterfile to measure physician supply in small towns. , 2000, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[3]  A. Peitzman,et al.  Challenging issues in surgical critical care, trauma, and acute care surgery: a report from the Critical Care Committee of the American Association for the Surgery of Trauma. , 2010, The Journal of trauma.

[4]  P. Ross,et al.  A formidable task: Population analysis predicts a deficit of 2000 cardiothoracic surgeons by 2030. , 2010, The Journal of thoracic and cardiovascular surgery.

[5]  R. Bell,et al.  A National Study of Attrition in General Surgery Training: Which Residents Leave and Where Do They Go? , 2010, Annals of surgery.

[6]  R. Burd,et al.  Pediatric surgery workforce: supply and demand. , 2009, Journal of pediatric surgery.

[7]  T. Ricketts.  How many physicians? How much does it matter? , 2009, Journal of the American Medical Association (JAMA).

[8]  James F Cawley,et al.  Predictive Modeling the Physician Assistant Supply: 2010–2025 , 2011, Public health reports.

[9]  B. Satiani,et al.  The impact of employment of part-time surgeons on the expected surgeon shortage. , 2011, Journal of the American College of Surgeons.

[10]  Michael J. Dill,et al.  Physician workforce projections in an era of health care reform. , 2012, Annual review of medicine.

[11]  T. Biester,et al.  General Surgery Workloads and Practice Patterns in the United States, 2007 to 2009: A 10-Year Update from the American Board of Surgery , 2011, Annals of surgery.

[12]  E. Larson,et al.  Physician assistants in orthopedic practice. A national study. , 2011, Journal of allied health.

[13]  B. Satiani,et al.  Predicted shortage of vascular surgeons in the United States: population and workload analysis. , 2009, Journal of vascular surgery.

[14]  Roderick S Hooker,et al.  Gaps in the supply of physicians, advance practice nurses, and physician assistants. , 2011, Journal of the American College of Surgeons.

[15]  Matthew J. Thompson,et al.  A longitudinal analysis of the general surgery workforce in the United States, 1981-2005. , 2008, Archives of surgery.

[16]  T. Ricketts,et al.  Getting the science right on the surgeon workforce issue. , 2011, Archives of surgery.

[17]  D. Auerbach,et al.  Comparison of physician workforce estimates and supply projections. , 2009, JAMA.

[18]  G. Sheldon.  The Evolving Surgeon Shortage in the Health Reform Era , 2011, Journal of Gastrointestinal Surgery.

[19]  Douglas Wood,et al.  Shortage of Cardiothoracic Surgeons Is Likely by 2020 , 2009, Circulation.

[20]  K. Stitzenberg,et al.  Progressive specialization within general surgery: adding to the complexity of workforce planning. , 2005, Journal of the American College of Surgeons.

[21]  Rebecca Voelker,et al.  Experts say projected surgeon shortage a "looming crisis" for patient care. , 2009, JAMA.

[22]  T. Getzen,et al.  Economic and demographic trends signal an impending physician shortage. , 2002, Health affairs.

[23]  K. Grumbach,et al.  The challenge of defining and counting generalist physicians: an analysis of Physician Masterfile data. , 1995, American journal of public health.

[24]  P. Stern.  Workforce analysis in orthopaedic surgery: how can we improve the accuracy of our predictions? , 2007, The Journal of the American Academy of Orthopaedic Surgeons.

[25]  P. T. Williams,et al.  Quality of the Family Physician Component of the AMA Masterfile , 1996, The Journal of the American Board of Family Medicine.

[26]  Bhagwan Satiani,et al.  The Impending Shortage and the Estimated Cost of Training the Future Surgical Workforce , 2009, Annals of surgery.

[27]  Marc E Mitchell,et al.  Changing demographics of residents choosing fellowships: longterm data from the American Board of Surgery. , 2008, Journal of the American College of Surgeons.

[29]  R. Cooper.  States with more physicians have better-quality health care. , 2008, Health affairs.

[30]  E. Marshall.  Report of the Graduate Medical Education National Advisory Committee to the secretary. , 1982, Journal of the American Optometric Association.

[31]  E. Fisher,et al.  Benchmarking the US physician workforce. An alternative to needs-based or demand-based planning. , 1996, JAMA.

[32]  G. Sheldon.  A Longitudinal Analysis of the General Surgery Workforce in the United States, 1981-2005—Invited Critique , 2008 .

[33]  C. Reed,et al.  Factors affecting interest in cardiothoracic surgery: Survey of North American general surgery residents. , 2009, The Journal of thoracic and cardiovascular surgery.

[34]  E. P. Schloss.  Beyond GMENAC--another physician shortage from 2010 to 2030? , 1988, The New England journal of medicine.