General surgeon shortage expected to reach crisis level in next 5 years
Be prepared: It may last longer than the nursing shortage
A surgeon shortage is predicted to reach crisis proportions in three to five years. While many media and health care professionals are focusing on the nursing shortage, and occasionally on the shortage of anesthesiologists, the surgeon shortage could have dramatic impact on your same-day surgery program. We already are seeing the early signs of a shortage of general surgeons.
"Unequivocally, there will be a shortage," says Kirby I. Bland, MD, Faye Fletcher Kerner professor and chairman of the department of surgery at the University of Alabama at Birmingham.
Because most surgical procedures are performed on an outpatient basis and more procedures continue to move to the ambulatory arena, outpatient surgery may be affected dramatically by the shortage.
"I just think there may be situations where there are longer times to get procedures done and longer delays for elective surgery," says Anthony Meyer, MD, PhD, professor and chairman of the department of surgery at the University of North Carolina at Chapel Hill.
Bland predicts delays could extend beyond elective cases to "important, potentially urgent, complex cases."
In June, Washington County Hospital in Hagerstown, MD, temporarily suspended operation of its Level 2 trauma center. The reason? A shortage of surgeons. A Level 2 trauma center must have a trauma surgeon on site at all times. Two or three of the center’s surgeons retired recently, which meant seven or eight surgeons had to take turns staffing the program, according to a hospital spokesperson.
Smaller communities already are having difficulty recruiting surgeons, Meyer says. "That success’ will be less in the future, with fewer people coming out [of medical school into surgery]," he adds.
Bland also is seeing signs of the shortage. "Every week, I receive requests for one or two slots in general surgery in Alabama," he says.
In comparison to the much-touted nursing shortage, Meyer warns, "If the surgeon shortage is severe, it will take longer to correct, and there is a smaller pool to pick from."
The shortage of general surgeons could result, as it has in Great Britain, in long waiting lists for most elective procedures, says George Sheldon, MD, FACS, professor of surgery and chair emeritus at The University of North Carolina at Chapel Hill and past president of the Chicago-based American College of Surgeons (ACS). "In Great Britain, a wait can be 32 months for fixing a hernia, replacing a hip, and even coronary artery bypass," he says. The delays could mean a delay in diagnosis, Sheldon says. "If, for example, unavailable surgeons and outpatient surgical facilities occur, many biopsies might be delayed, delaying diagnosis and ultimate therapy," he says.
The signs of the surgeon shortage are popping up in the United States. The number of applicants to general surgery residency programs has decreased 30% in the past nine years, according to Bland’s studies published in the March issue of the Archives of Surgery.1 In 2001, for the first time, the National Resident Matching Program had more general surgery positions than the number of students interested in those positions, according to Bland. This trend continued in 2002, he says. In 2005, U.S. students will fill only 76.6% of positions, surgery experts predict.1
The reasons are numerous. More medical students today are married and female, and many want a life beyond the long hours and many demands of a career in surgery. In addition, reimbursement encourages many students to enter primary care. Also, many medical students lack adequate exposure to surgical sciences and surgical mentors, surgery sources say.2
And despite the advances in drugs and technology, large numbers of general surgeons will be needed in the future, sources maintain. They point to the increasing number of the elderly as one indication that the number of needed surgeons won’t decline. "A lot of diseases are connected with older age," Sheldon says.
Take steps now
The therapies are becoming more complex and more team-oriented, he maintains. For example, cancer often is treated by three or four specialties, including surgery. One step same-day surgery managers can take now to prepare for the surgeon shortage is to concentrate on maximizing efficiency, Meyer suggests. Make maximum use of the surgeon’s time, he advises. "If you have three surgeons, make sure that they can get more of their procedures done in the time those three surgeons can be there," Meyer says.
Consider these other suggestions:
• Recruit ahead of time. Anyone who is planning to have increased utilization of the services in a facility must face this shortage, Bland warns. "You should be looking one or two years in advance of the need," he suggests.
• Tout surgery as a career choice. "The message that all health care workers, whether nurses or doctors, need to get out is that medicine is a great way to be of service," Sheldon says. "It’s a great profession to be in. It’s incredibly satisfying." Many physicians are discouraged in the current complex health care system, and young people are not receiving a positive message, he says.
The ACS is bringing medical students to the annual meeting and has sent members to high schools to discuss the profession, Sheldon says. Health fairs can be another positive way to communicate your message, he suggests. Casual conversation can be effective, Sheldon advises. When a young person asks you about your career choice, be prepared to provide a positive response, he emphasizes.
• Mentor. The ACS has a program titled "Resident as a Teacher." At the annual ACS meeting, educators offer a weeklong course on educational skills for surgeons. The society has a Candidate and Associate Society that enhances contact between residents and senior surgeons to facilitate job placement.
If you are able, expose medical students to your surgery programs, Meyer advises. "People are more likely to stay where they train if they can," he says. "If your program is conducive to interested candidates, you’ll probably have a supply of surgeons. . . . That’s a combination of good teaching, good clinical experience, and good role models."
References
1. Bland KL, Isaacs G. Contemporary trends in student selection of medical specialties — the potential impact on general surgery. Arch Surg 2002; 137:259-267.
2. Polk Jr. HC. The declining interest in surgical careers, the primary care mirage, and concerns about contemporary undergraduate surgical education [editorial]. Am J Surg 1999; 178:177-179.
Sources
For more information on the surgeon shortage, contact:
• Kirby I. Bland, MD, Faye Fletcher Kerner Professor and Chairman, Department of Surgery, University of Alabama at Birming-ham, 502 Boshell Building, 1530 Third Ave. S./502 BDB, Birmingham, AL 35294-0012. Telephone: (205) 975-5000 Fax: (205) 975-2199. E-mail: [email protected].
• Anthony Meyer, MD, PhD, Professor and Chair-man, Department of Surgery, The University of North Carolina at Chapel Hill, Department of Surgery, 136 Burnett-Womack Building, CB 7050, Chapel Hill, NC 27599-7050. Telephone: (919) 966-4321. E-mail: [email protected].
• George Sheldon, MD, FACS, Professor of surgery, Chair Emertius, University of North Carolina, Chapel Hill. E-mail: [email protected].
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