The Impending Shortage and the Estimated Cost of Training the Future Surgical Workforce

The Impending Shortage and the Estimated Cost of Training

Thomas E. Williams, Jr., MD, PhD, FACS; Bhagwan Satiani, MD, MBA, FACS; Andrew Thomas, MD, MBA; E. Christopher Ellison, MD, FACS


Annals of Surgery. 2009;250(4):590-597. 

In This Article

Abstract and Introduction


Objectives: To estimate the workforce needed by 2030 in 7 surgical specialties to serve a population of 364 million people and to quantify the cost associated with training additional surgeons.
Materials and Methods: A review of the certificates granted in otolaryngology, orthopedic surgery, thoracic surgery, obstetrics and gynecology, neurosurgery, urology, and general surgery was conducted. Using a population-based algorithm, we extended the results of Richard Cooper's pioneering work to these fields of surgery. The assumptions were unchanged physician to population ratio, 30 years in practice from completion of residency to retirement, and no revision of the Balanced Budget Act of 1997, and therefore no additional residency positions offered. Per resident expenses were estimated annually at $80,000, including salaries, benefits, and other direct medical education costs.
Results/Conclusions: (1) There will not be enough surgeons in the 7 surgical specialties studied. (2) We will have to train more than 100,000 surgeons by 2030 to maintain access for our citizens at an annual cost of almost $2 Billion and total cost of about $37 billion. (3) To train the extra needed surgical workforce will cost an additional $10 Billion. (4) To do this, the Balanced Budget Act of 1997 must be revised to permit more residents to be trained in the United States or other alternatives explored.


There has been ample discussion in the recent medical literature and media about impending shortages and the country's need for more physicians and particularly primary care physicians. In our earlier work we predicted 500,000 fewer doctors than what the United States would need in 2050.[1] There is now a consensus that a shortage is indeed on the horizon. This has resulted in a response by various organizations to build more medical schools. While that does produce more US medical graduates to replace International Medical Graduates (IMG's) for residency positions in the country, it does not necessarily address coming shortages in surgical specialties. The Balanced Budget Act (BBA) of 1997 capped both medical and surgical resident positions at about 105,000 per year.[2] There was no provision for increasing the number of resident positions as America's population increased or for any other contingencies that may significantly alter the supply and demand equation.

Our population now is about 304,000,000. The Census Bureau estimates that the population will be 364,000,000 in 2030 and 420,000,000 by 2050.[3] How many surgical specialists will be needed to care for the increase in population? How do we influence medical students to choose the surgical specialties given their preference for a "controllable lifestyle"? How much additional money will be needed to train these specialists? Will increasing the number of surgeons provide better access and patient care?

The objective of this population based study was to estimate workforce needs in 7 surgical specialties by the year 2030 and arrive at an estimate of the cost in today's dollars to train this number of surgeons.


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