A longitudinal analysis of the general surgery workforce in the United States, 1981-2005

  • Abstract

    Hypothesis  The overall supply of general surgeons per 100 000 population has declined in the past 2 decades, and small and isolated rural areas of the United States continue to have relatively fewer general surgeons per 100 000 population than urban areas.
    Design  Retrospective longitudinal analysis.
    Setting  Clinically active general surgeons in the United States.
    Participants  The American Medical Association’s Physician Masterfiles from 1981, 1991, 2001, and 2005 were used to identify all clinically active general surgeons in the United States.
    Main Outcome Measures  Number of general surgeons per 100 000 population and the age, sex, and locale of these surgeons.
    Results  General surgeon to population ratios declined steadily across the study period, from 7.68 per 100 000 in 1981 to 5.69 per 100 000 in 2005. The overall urban ratio dropped from 8.04 to 5.85 (−27.24%) across the study period, and the overall rural ratio dropped from 6.36 to 5.02 (−21.07%). The average age of rural surgeons increased compared with their urban counterparts, and women were disproportionately concentrated in urban areas.
    Conclusions  The overall number of general surgeons per 100 000 population has declined by 25.91% during the past 25 years. The decline has been most marked in urban areas. However, more remote rural areas continue to have significantly fewer general surgeons per 100 000 population. These findings have implications for training, recruiting, and retaining general surgeons.

    General surgeons play a pivotal role in the health care systems of the United States, particularly its rural areas.1 They provide surgical backup to rural primary care physicians, ensure the success of rural trauma systems, and contribute to the financial viability of small rural hospitals.2– 6 Urban general surgeons also provide important surgical services, including emergency and trauma care that some surgical subspecialists may not offer.7There is some question as to whether there will be an adequate number of general surgeons to care for an increasingly elderly population, with its attendant increased demand for surgical care.8

    Recent studies9– 11 have indicated that the overall number of general surgeons has remained static since 1994, despite an increase in population of 1% per annum during this period. This fact, coupled with the rise in surgical specialization, the decreased interest of medical students in general surgical careers, and the changes in demographics of medical students and surgery residents, has generated concern that there will soon be a shortage of general surgeons.12– 16 Recent publications by the Institute of Medicine and the American College of Surgeons attest to staffing and availability problems of general, and other, surgeons for emergency services.17,18 Our study group11 found that the general surgeon to population ratio in the more remote rural areas of the United States was almost half that of urban areas. The present study builds on this previous work by adding a longitudinal dimension and describing the trends in the number, distribution, and characteristics of general surgeons in the United States during the 25 years from 1981 to 2005, with particular emphasis on surgeons in small and isolated rural areas. Examination of such trends is crucial to predicting and addressing future workforce problems.

  • Authors:

    Lynge DC, Larson EH, Thompson MJ, Rosenblatt RA, Hart LG

  • Journal/Publisher:

    Arch Surg

  • Edition:

    Apr 2008. 143(4):345-350

  • Link to Article

    Access the article here: Arch Surg

  • Citation:

    Lynge DC, Larson EH, Thompson MJ, Rosenblatt RA, Hart LG. A Longitudinal Analysis Of The General Surgery Workforce In The United States, 1981-2005. Arch Surg. Apr 2008 143(4):345-350

  • Related Studies:

    Distribution and Retention of General Surgeons in Rural Areas of the U.S.