General surgeon shortage growing in U.S.

(Reuters Health) - The shortage of general surgeons in the U.S. is projected to get worse as the number of these doctors entering the workforce each year fails to keep pace with population growth, a U.S. study suggests.

Researchers predict shortages based on their estimates of population growth by 2050 and the number of medical schools and hospital-sponsored general surgery trainee positions in the U.S.

By 2050, there will be a deficit of 7,047 general surgeons nationwide, researchers calculated. That’s higher than the shortage of 6,000 they projected a decade ago based on the pace of population growth and new surgeons entering the job market at that point in time.

“Leaders in surgery have predicted a pending shortage in the general surgery workforce for more than 10 years,” said lead study author Dr. E. Christopher Ellison of the Ohio State University College of Medicine in Columbus.

“The impact of the general surgeon shortages on patients is measured in the timeliness of care and the consequences of delays in care,” Ellison said by email.

To maintain acceptable access to surgical care, there should be about 7.5 general surgeons for every 100,000 people, researchers note in the journal Surgery.

In fact, the number of general surgery resident positions and the number of residents who complete their training have been rising in the U.S. But these increases have been insufficient to maintain the ideal number of surgeons for the population.

If anything, the projected shortage is an underestimate, the authors say.

“We have not considered the impact of the aging population on the surgeon’s workload,” Ellison said. “Patients 65 years and older are more likely to need general surgery services, and as that segment of the population increases, there will be a corresponding increase in the demands for general surgeons.”

Because most general surgeons practice in metropolitan areas, the impact of the shortage will be more keenly felt by rural communities, Ellison added.

In calculating the projected shortage, researchers assumed that some young trainees will choose subspecialties like vascular surgery or transplant surgery instead of general surgery. They also assumed that general surgeons would choose to work for 30 years before retiring.

It’s possible the researchers have over- or under-estimated how many general surgeons will enter the profession each year and how many years they will remain on the job. It’s also possible that population growth estimates might change again, altering the projected shortage.

“Because there are high fixed costs to developing a general surgical practice in a more remotely populated area, we observe fewer practices in these areas. I wouldn’t call this a shortage per se, but I do think it’s a problem that as a society we need to figure out solutions to,” said Dr. Anupam Jena, a researcher at Harvard Medical School and a physician at Massachusetts General Hospital in Boston who wasn’t involved in the study.

Solutions might include identifying ways for rural patients who need surgical care to be promptly evaluated and treated at medical centers several hours away, Jena said. Or, it might involve encouraging graduates of both American and foreign medical training programs to work in remote parts of the country.

“We need to identify better ways to provide surgical care in regions where that care is difficult to obtain, either because the distance that needs to be traveled is prohibitive or because the existing surgical care in the region isn’t high quality,” Jena said. “These projections shed some light on how big an issue this problem is likely to be in the next 30 years.”

SOURCE: Surgery, online August 8, 2018.