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

Materials and Methods

Six assumptions were made to arrive at an estimate of the need for surgeons in the 7 specialties.

  1. The current physician to population ratios would be maintained for each of the specialties for the twenty year period between 2011 and 2030. In other words, the ratio of surgeons to 100,000 population would remain unchanged.

  2. The BBA of 1997 would not be revised in this period of time from 2011 to 2030 and that the number of postgraduate training positions would remain constant. Every graduate would complete her board certification and go into practice.

  3. The current cost of Direct Medical Education at $80,000 per clinical trainee per year, as published by Richard Cooper in 2008 would remain constant.[4]

  4. Each surgeon would practice an average of 30 years from Board Certification to retirement, death, or disability.

  5. The number of years in training for each specialty would remain unchanged during this period of time.

  6. The care model would not change.

To estimate the number of surgical specialists trained each year, we reviewed the number of certificates granted by the American Boards of Surgery as published by the American Board of Medical Specialties[5] for the following-obstetrics and gynecology (OBGYN), otolaryngology (ENT), orthopedic surgery (ORTHO), thoracic surgery (TS), general surgery (GS), neurosurgery (NS), and urology (URO) (Fig. 1). We averaged the numbers granted per year, except for TS, which we estimated at 100 residents per year because of decreasing numbers of applicants in this specialty (Table 1).

Figure 1.

Board certificates granted each year.

The number of surgeons in the surgical workforce was estimated in each of those specialties in 2005 and we extrapolated this to give us the total number of those practicing surgeons per 100,000 in the US population except in the case of OB/GYN where it was for 100,000 women (Table 2).

Workforce Calculation

Work force was determined using the calculations previously reported.[2]

  1. Surgeons needed in 2030 = the number of surgeons per 100,000 population times 364,000,000 except OB/GYN where the number was per 185,000,000 women; mentioned in Column 2 of Table 3.

  2. Surgeons in practice = the surgeons in the workforce minus the retirees (including those who are disabled or die) plus the newly board certified surgeons each year. The result of this calculation Surgeons in Practice is in Table 3, Column 3. We assumed a linear or straight line series of retirements which we illustrate in Figure 2.

  3. Surgical shortage was determined by the formula: Shortage = Surgeons Needed - Surgeons in Practice; Column 4 of Table 3.

  4. Total to be trained from 2011 to 2030 with cost of training surgical specialists at present certification levels (Table 4, Column 3). (Certifications per year) is multiplied by 20 years to arrive at (total to be trained 2011 to 2030, Column 4). Number of years in residency (Column 1) is then multiplied by Column 4 to get (total trainee years, Column 5). Finally, the total cost at $80,000 per trainee year (Column 6) is the product of $80,000 and Column 5.

  5. Total to be trained from 2011 to 2030 = (Shortage, Table 3, Column 4) + 20 years (Certifications per year, Table 1, Column 3). The results are shown in Table 5, Column 2.

  6. The number per class equals the total to be trained 2011 to 2030 divided by 20; mentioned in Table 5, Column 3.

  7. We calculated the trainee years per class by the following formula. Trainee years per class = number per class times years to train according to the minimum years per training by the surgical boards. Trainee years per class = (number per class, Table 5, Column 3) × (years in residency, Table 1, Column 2).

  8. Cost per class was determined using the following formula. Per class cost = trainee years per class times $80,000, (Table 5, Column 5).

  9. Total cost of training from 2011 to 2030 is the per class cost multiplied by 20 years; see (Table 5, Column 6).

  10. The ratio of surgeons to 100,000 of population if we do not increase the workforce was determined by dividing surgeons in practice, (Table 3, Column 3), by the population in 2030, 364,000,000 with 185,000,000 women, and multiplied by 100,000 (Table 6).

Figure 2.

Workforce calculations of practicing urologists.


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