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


Table 1 shows the specialties subjected to analysis and the minimum amount of years in residency for those particular specialties. The longest period of training is 7 years in as much as TS have to do 5 years in GS and then the additional 2 years to become certified in TS. The other training periods are: NS, 6 years; OBGYN, 4 years; ENT, 5years; GS, 5 years; ORTHO, 5 years; URO, 5 years. Table 1 also shows the number of certificates given per year by surgical specialty. The most certificates were given in OBGYN followed by GS.

Table 2 shows the estimated surgical workforce which was determined by multiplying the population in 2005 by the ratio of surgeons per 100,000 people in the United States, which is currently between 1.09 in NS to 27.1 in OBGYN for 100,000 women.

Table 3 shows the number of surgeons needed and in practice in 2030. According to the aforementioned assumptions and calculations, we note shortages in all of the surgical specialties including in this analysis. Overall, there is a gap of 29,138 surgical specialists. This ranges from a low of 228 in NS to a gap of 13,636 in OBGYN.

Table 4 shows the number of surgeons that will be trained at the current BBA cap and the associated cost. If the number of training positions is not increased, then the total number of trainees completing residency programs for the 7 surgical specialties between 2011 and 2030 is 72,700. Considering the total years of required training, the total cost is $26.88 Billion.

Table 5 shows the total number of surgeons that should be trained between 2011 and 2030 to avoid the projected gap. This is calculated by adding the shortage to the number of Board certifications in each field over a twenty year period. That number ranges between 2700 in NS to almost 38,000 in OBGYN. The number per class as shown in our calculation ranges from 136 in NS to almost 1900 in OBGYN. The total amount of trainee years per specialty ranges from 399 in TS to more than 7527 in OBGYN. The combined number of certificates issued during this 20 year period would be 101,838, an increase of 29,738 compared with training positions under the current cap. The total cost to train this increased number of surgical specialists would be $36.984 Billion. The estimated incremental cost to avoid a surgeon shortage in these 7 specialties is therefore $10.104 Billion.


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