Study Suggests Impending Shortage of General Surgeons

By Charles Bankhead
http://www.medpagetoday.com/

SEATTLE, April 22 — The general surgery workforce shrank by more than 25% between 1981 and 2005, potentially setting the stage for a severe shortage in the specialty, investigators here reported.

The decline was steeper in urban areas (27%), but rural areas already had fewer general surgeons before a 21% decrease, Dana Christian Lynge, M.D., of the University of Washington, and colleagues, wrote in the April issue of Archives of Surgery.

“The 25% reduction in the relative number of general surgeons in the United States that we report suggests that the United States may be facing a severe shortage of general surgeons,” the authors said.

“The U.S. medical system has shown the ability to adjust to changing workforce demands by increased use of [international medical graduates] and ‘physician extenders,'” they added. “However, none of these practitioners or phenomena will completely fill the vital role currently filled by the general surgeon in the nation’s healthcare system.”

Recent studies have indicated that the general surgery workforce has remained static since 1994, whereas the U.S. population has increased by 1% annually during the same period, the authors noted.

In a previous study, Dr. Christian Lynge and colleagues found that more remote rural areas of the U.S. had a general surgeon-to-population ratio that was 50% lower than the ratio in urban areas. The current study added to that investigation by including a longitudinal dimension and describing various trends affecting the general surgery workforce.

The authors reviewed the American Medical Association’s Physician Masterfiles from 1981, 1991, 2001, and 2005, and identified all clinically active general surgeons in those years. The primary outcomes were the number of general surgeons per 100,000 population, and the age, sex, and locale of the surgeons.

Overall, the general surgeon-to-population ratio decreased from 7.68 per 100,000 in 1991 to 5.69 per 100,000 in 2005 (25.9%).

In urban areas, the ratio decreased from 8.04 to 5.85 per 100,000 (27.24%), and the rural ratio decreased by 21.07%, from 6.36 to 5.02 per 100,000.

The average age of rural surgeons increased during the period reviewed, as the proportion of surgeons ages 50 to 62 increased from 39.5% in 1991 to 52% in 2005. In contrast, the proportion of urban surgeons in that age group increased from 42.2% to 45.1%.

Increasingly, female general surgeons were concentrated in urban areas. In 1991 women accounted for 1.6% of urban general surgeons compared with 1% in rural areas. By 2005, women constituted 14.4% of the general surgery workforce in urban areas versus 8.9% in rural areas.

He noted that “for the first time, less than 80% of the postgraduate year 1 residents were graduates of U.S. medical schools.” An 80-hour work week, sex and generational issues, the aging population, technology, and other issues have played a role in the decline of the general surgery workforce, George F. Sheldon, M.D., of the University of North Carolina in Chapel Hill, said in an invited commentary.

Moreover, he said, about 80% of general surgeons receive fellowship training that increasingly focuses on specialization.

General surgery is not the only area of surgery feeling the pinch, Dr. Sheldon continued. The once-highly competitive fellowships in cardiac and vascular surgery now have a shortfall of applicants.

“The most popular fellowship is residency [in] ‘minimally invasive’ [surgery], which is not an American Board of Medical Specialties specialty,” Dr. Sheldon noted.

Primary source: Archives of Surgery
Source reference:
Christian Lynge D, et al “A longitudinal analysis of the general surgery workforce in the United States, 1981-2005” Arch Surg 2008; 143: 345-350.

Additional source: Archives of Surgery
Source reference:
Sheldon GF. “A Longitudinal Analysis of the General Surgery Workforce in the United States, 1981-2005 — Invited critique.” Arch Surg. 2008; 143: 351.