US sees decline in number of general surgeons

“General surgeons play a pivotal role in the health care systems of the United States,” according to background information in the article. Rural general surgeons provide surgical backup to primary care physicians and help keep small rural hospitals financially viable, while urban general surgeons provide important surgical services, including emergency and trauma care that some surgical subspecialists may not offer. “There 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.”

Dana Christian Lynge, M.D., and colleagues at the University of Washington, Seattle, analyzed the number of general surgeons per 100,000 population using the American Medical Association’s Physician Masterfiles from 1981, 1991, 2001 and 2005. Surgeon’s age, sex and locale were also noted.

The number of active general surgeons fluctuated from 17,394 in 1981 to 17,922 in 2001 to 16,662 in 2005. The ratio of general surgeons to the population declined from 7.68 surgeons per 100,000 people in 1981 to 5.69 surgeons per 100,000 people in 2005. With the U.S. population increasing from 226 million to 292 million, the national general surgeon to population ratio declined by 25.91 percent during those 25 years, with a greater decrease in urban areas (27.24 percent) and a 21.07 percent decline in rural areas.

The number of women general surgeons increased substantially from 1981 to 2005, but they were disproportionately concentrated in urban areas. The average age of rural surgeons increased compared with surgeons practicing in urban areas.

Although other medical practitioners and health care clinicians can help the U.S. medical system adjust to the decline in general surgeons, they cannot completely fill the role of general surgeons, the authors note. Ways to address this decline should be considered by surgeons, their professional organizations and organizations that control the number of general surgeons trained annually. “These might include increased funding of residency positions, and exploring and addressing the issues surrounding training, remuneration and lifestyle that seem to have made general surgery less attractive than other specialties to medical students, especially women,” the authors conclude. Medical schools and surgical residencies should also “ensure that general surgical residents are sufficiently exposed to rural surgical practice through rural training tracks and rural-based residencies.”

Source: JAMA and Archives Journals