A contemporary reassessment of the US surgical workforce through 2050 predicts continued shortages and increased productivity demands

Oslock, Wendelyn M.; Satiani, Bhagwan; Way, David P.; Tamer, Robert; Maurer, James K.; Hawley, Jana M.; Sharp, Kyle L.; Williams, Thomas E.; Pawlik, Timothy M.; Ellison, E. Christopher; Santry, Heena P.

doi:10.1016/j.amjsurg.2021.07.033

Cited by 64 publications

(31 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We also used bed number as a measure of hospital capacity, which is the most commonly used measure in E2SFCA models of hospital access; however, it does not account for average hospital bed occupancy . Second, the presence of surgical capabilities did not necessarily equate to continuous service availability by surgeons, particularly at small rural hospitals that frequently experience workforce shortages and high staff turnover . The results of this study, therefore, provided an optimistic view of potential spatial access to surgical care in the US.…”

Section: Discussionmentioning

confidence: 99%

“…[45][46][47] Second, the presence of surgical capabilities did not necessarily equate to continuous service availability by surgeons, particularly at small rural hospitals that frequently experience workforce shortages and high staff turnover. [48][49][50][51] The results of this study, therefore, provided an optimistic view of potential spatial access to surgical care in the US. In reality, disparities may have been even greater than reported in this study, and additional factors including patient insurance and existing patient-physician relationships may have been associated with hospital choice and realized access.…”

Section: Limitationsmentioning

confidence: 98%

“…Table 1 shows population characteristics of each access category. Compared with high-access CBGs, low-access CBGs had a higher median (IQR) age (44 [38][39][40][41][42][43][44][45][46][47][48][49][50] years vs 38 [33][34][35][36][37][38][39][40][41][42][43][44][45] years), lower proportion of Black, Hispanic, and other racial and ethnic minority designation, and higher proportion of nonpoor CBGs (57% vs 53%). Low-access areas had a higher proportion of rural CBGs (36%) vs high-access areas (5%); however, nearly half (49%) of low-access CBGs were classified as metropolitan areas.…”

Section: Small Area Analysis Of Disparitiesmentioning

confidence: 99%

See 2 more Smart Citations

Disparities in Spatial Access to Emergency Surgical Services in the US

et al. 2022

View full text Add to dashboard Cite

ImportanceHospitals with emergency surgical services provide essential care for a wide range of time-sensitive diseases. Commonly used measures of spatial access, such as distance or travel time, have been shown to underestimate disparities compared with more comprehensive metrics.ObjectiveTo examine population-level differences in spatial access to hospitals with emergency surgical capability across the US using enhanced 2-step floating catchment (E2SFCA) methods.Design, Setting, and ParticipantsA cross-sectional study using the 2015 American Community Survey data. National census block group (CBG) data on community characteristics were paired with geographic coordinates of hospitals with emergency departments and inpatient surgical services, and hospitals with advanced clinical resources were identified. Spatial access was measured using the spatial access ratio (SPAR), an E2SFCA method that captures distance to hospital, population demand, and hospital capacity. Small area analyses were conducted to assess both the population with low access to care and community characteristics associated with low spatial access. Data analysis occurred from February 2021 to July 2022.Main Outcomes and MeasuresLow spatial access was defined by SPAR greater than 1.0 SD below the national mean (SPAR &lt;0.3).ResultsIn the 217 663 CBGs (median [IQR] age for CBGs, 39.7 [33.7-46.3] years), there were 3853 hospitals with emergency surgical capabilities and 1066 (27.7%) with advanced clinical resources. Of 320 million residents, 30.8 million (9.6%) experienced low access to any hospital with emergency surgical services, and 82.6 million (25.8%) to advanced-resource centers. Insurance status was associated with low access to care across all settings (public insurance: adjusted rate ratio [aRR], 1.21; 95% CI, 1.12-1.25; uninsured aRR, 1.58; 95% CI, 1.52-1.64). In micropolitan and rural areas, high-share (&gt;75th percentile) Hispanic and other (Asian; American Indian, Alaska Native, or Pacific Islander; and 2 or more racial and ethnic minority groups) communities were also associated with low access. Similar patterns were seen in access to advanced-resource hospitals, but with more pronounced racial and ethnic disparities.Conclusions and RelevanceIn this cross-sectional study of access to surgical care, nearly 1 in 10 US residents experienced low spatial access to any hospital with emergency surgical services, and 1 in 4 had low access to hospitals with advanced clinical resources. Communities with high rates of uninsured or publicly insured residents and racial and ethnic minority communities in micropolitan and rural areas experienced the greatest risk of limited access to emergency surgical care. These findings support the use of E2SFCA models in identifying areas with low spatial access to surgical care and in guiding health system development.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 98%

Section: Small Area Analysis Of Disparitiesmentioning

confidence: 99%

See 1 more Smart Citation

Disparities in Spatial Access to Emergency Surgical Services in the US

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Healthcare disparities have been well-documented within the United States [ 11 , 12 , 13 ]. The United States is approaching a critical shortage of surgeons, with resultant decreased patient access to surgical specialists [ 14 ]. Using data from the American Board of Thoracic Surgery and US Census Bureau, Moffatt-Bruce et al expect the number of cardiothoracic procedures to increase by 61% and the caseload of the average surgeon to increase by 121% from 2010 to 2035 [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Disparities in Access to Thoracic Surgeons among Patients Receiving Lung Lobectomy in the United States

et al. 2023

View full text Add to dashboard Cite

Objective: Lung lobectomy is the standard of care for early-stage lung cancer. Studies have suggested improved outcomes associated with lobectomy performed by specialized thoracic surgery providers. We hypothesized that disparities would exist regarding access to thoracic surgeons among patients receiving lung lobectomy for cancer. Methods: The Premier Hospital Database was used to identify adult inpatients receiving lung lobectomy from 2009 to 2019. Patients were categorized as receiving their lobectomy from a thoracic surgeon, cardiovascular surgeon, or general surgeon. Sample-weighted multivariable analysis was performed to identify factors associated with provider type. Results: When adjusted for sampling, 121,711 patients were analyzed, including 71,709 (58.9%) who received lobectomy by a thoracic surgeon, 36,630 (30.1%) by a cardiovascular surgeon, and 13,373 (11.0%) by a general surgeon. Multivariable analysis showed that thoracic surgeon provider type was less likely with Black patients, Medicaid insurance, smaller hospital size, in the western region, and in rural areas. In addition, non-thoracic surgery specialty was less likely to perform minimally-invasive (MIS) lobectomy (cardiovascular OR 0.80, p < 0.001, general surgery OR 0.85, p = 0.003). Conclusions: In this nationally representative analysis, smaller, rural, non-teaching hospitals, and certain regions of the United States are less likely to receive lobectomy from a thoracic surgeon. Thoracic surgeon specialization is also independently associated with utilization of minimally invasive lobectomy. Combined, there are significant disparities in access to guideline-directed surgical care of patients receiving lung lobectomy.

show abstract

“…The Halstedian apprenticeship training model in surgery has undergone significant revolution in recent decades 1. Evolving patient expectations regarding the role of surgical trainees in their care,2 an emphasis on theatre efficiency,3 increased demands on the surgical workforce4 and concerns regarding perceived operative competence and confidence of graduating trainees,5–7 have led to a re-evaluation of the training paradigm. The implementation of work-hour restrictions,8 9 and the requirement to train and retain a diverse workforce10 present opportunities to rethink the way in which surgeons are trained.…”

Section: Introductionmentioning

confidence: 99%

Training to proficiency in surgery using simulation: is there a moral obligation?

2022

View full text Add to dashboard Cite

A deontological approach to surgical ethics advocates that patients have the right to receive the best care that can be provided. The ‘learning curve’ in surgical skill is an observable and measurable phenomenon. Surgical training may therefore carry risk to patients. This can occur directly, through inadvertent harm, or indirectly through theatre inefficiency and associated costs. Trainee surgeon operating, however, is necessary from a utilitarian perspective, with potential risk balanced by the greater societal need to train future independent surgeons.New technology means that the surgical learning curve could take place, at least in part, outside of the operating theatre. Simulation-based deliberate practice could be used to obtain a predetermined level of proficiency in a safe environment, followed by simulation-based assessment of operative competence. Such an approach would require an overhaul of the current training paradigm and significant investment in simulator technology. This may increasingly be viewed as necessary in light of well-discussed pressures on surgical trainees and trainers.This article discusses the obligations to trainees, trainers and training bodies raised by simulation technology, and outlines the current arguments both against and in favour of a simulation-based training-to-proficiency model in surgery. The significant changes to the current training paradigm that would be required to implement such a model are also discussed.

show abstract

A contemporary reassessment of the US surgical workforce through 2050 predicts continued shortages and increased productivity demands

Cited by 64 publications

References 42 publications

Disparities in Spatial Access to Emergency Surgical Services in the US

Disparities in Spatial Access to Emergency Surgical Services in the US

Disparities in Access to Thoracic Surgeons among Patients Receiving Lung Lobectomy in the United States

Training to proficiency in surgery using simulation: is there a moral obligation?

Contact Info

Product

Resources

About