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Projecting Surgeon Supply Using a Dynamic Model

Fraher, Erin P. PhD*; Knapton, Andy MSc; Sheldon, George F. MD*; Meyer, Anthony MD*; Ricketts, Thomas C. PhD

doi: 10.1097/SLA.0b013e31826fccfa
Original Articles

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.

This study forecasts that between 2009 and 2028, there will be an average 18% reduction in the supply of surgeons with declines in all specialties except colorectal, pediatric, neurological and vascular surgery. The model estimates that proposed changes to increase GME currently under consideration will be insufficient to offset the decline.

*Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

National Health Service Workforce Review Team, Winchester, England

Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Reprints: Erin P. Fraher, PhD, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, CB #7590, 725 MLK Blvd, Chapel Hill, NC 27599. E-mail: erin_fraher@unc.edu.

Disclosure: This study was supported by the American College of Surgeons. The authors declare no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins.