A Longitudinal Analysis of the General Surgery Workforce in the United States, 1981-2005
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.
Retrospective longitudinal analysis.
Clinically active general surgeons in the United States.
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.
Number of general surgeons per 100 000 population and the age, sex, and locale of these surgeons.
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.
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.
Available from: Adam L Kushner
- "At 7.8 per 100,000 population, the number of trained surgeons per capita is more than 10 times higher in Santa Cruz than in many sub-Saharan African and central Asian nations    for which data have been published. In fact, the US has only 5.7 general surgeons per 100,000 population, although this number does not include obstetricians and specialists . The relative robustness of surgical systems in Santa Cruz is especially evident compared with data from Sierra Leone and Nigeria, the other countries for which PIPES data have been published  . "
Available from: Kil Yeon Lee
- "For example, it is known that there are 5,078 surgeons in Korea and 16,662 surgeons in the U.S. Calculating the number of surgeons per 100,000 people, there are 10.8 surgeons per 100,000 in Korea and 5.7 in the U.S, and for surgeons per capita, there are more surgeons in Korea. In addition, based on 2009, board-certified surgeons produced per year are 212 in Korea and 909 in the U.S, and, converting it to surgeons produced annually per 100,000, 0.45 in Korea and 0.30 in the U.S; considering population, more surgeons are being produced in Korea [16-19]. "
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ABSTRACT: In order to prepare long-term alternatives to surgical residency training and workforce policies in Korea, objective data are needed; in addition, determination of the status of surgical procedures being performed is also needed.
Cases of surgeries performed by board-certified Korean surgeons for 1 year, from July 2009 to June 2010 were reviewed and analyzed. Variation of the last five years was also investigated against the number of surgery cases of the same item and for data on status of population, medical institutions, and surgeons.
Difficulty in distribution of a given surgery varied according to the classification of medical institution types, and performance of highly difficult surgeries occurred more in tertiary hospitals. The number of surgeries has increased over the last 5 years (28.1%). The number of surgeries among elderly patients (41.5%), high difficulty (41.8%), and tertiary hospitals (34.9%) has especially increased. There has been no increase in the number of diagnosis related group claim cases for the last 5 years (-0.8%). 43.3% of surgeons working at private clinics in Korea did not present surgery as an indicating item of their clinics.
While the demand for surgeons in high risk and highly difficult surgeries is continuously increasing, stagnation is expected in the traditional area. Considering the proportion and current status of surgeons working at private clinics, the need for a realistic reduction in the quota of surgical residents and reconsideration of personnel policies is raised.
Available from: Tassos C Kyriakides
- "Surgery continues to have one of the highest attrition rates of all graduate medical education programs, which is of particular concern since it is predicted that there will be a substantial shortage of general surgeons. Data reported through 2005 show the population of general surgeons across the country has already decreased from 7.68 per 100,000 population in 1981 to 5.69 per 100,000 population in 2005—a decline of almost 26% . Furthermore , it appears implementation of work hour restrictions has paradoxically exacerbated the attrition problem. "
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ABSTRACT: BACKGROUND: Attrition in surgical residency programs continues to be a significant challenge. Ap-proximately 20% of residents who begin a categorical surgery residency fail to complete it. A number of studies speculated reasons for this including work hours, life style, family pressures, and resident feelings of inadequacy including fear of termination. To date no research has been conducted investigating the relation-ship between resident morale and attrition. This study sought to determine if this linkage exists in surgery residents. METHODS: The Morale Assessment in General Practice Index (MAGPI) was administered to 21 PGY 1, 2, 3, and 5 surgical residents to assess level of morale. Non-parametric methods were carried out to assess if there were differences in morale among the four PGY groups. Additionally, analyses of the four factors comprising the MAGPI were also conducted. RESULTS: Although differences did not reach statis-tical significance, analysis of the data reveals that residents demonstrate different trends in their levels of morale based on the amount of time they spend in a residency and in a way that approximates the morale curve described by W. Walter Menninger, M.D. Additionally, two of the four factors comprising the MAGPI also indicate trends similar to that described by the Menninger morale curve. CONCLUSIONS: Although no statistically significant results were achieved, the data reveal trends that approximate shifts in morale similar to those described by the Menninger morale curve, with residents at the PGY 2 and 3 levels present-ing lower morale levels than at the PGY 1 and 5 levels. This may be due in part to the size of the population studied. Future research should be continued in this area with a larger sample size.
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