Projecting Surgeon Supply Using a Dynamic Model
Projecting Surgeon Supply Using a Dynamic Model
The model estimates an 18% reduction in head count and a 16% decrease in full-time equivalents for the 20-year period from 2009 to 2028 (Fig. 2). The most rapid decrease occurs in the first 5 years as the number of retiring surgeons substantially exceeds new entrants. Headcount declines more rapidly than full-time equivalents over the forecast period because, although an increasing number of women are projected to enter the workforce who will provide fewer clinical hours, on average, younger surgeons of both sexes work more hours in patient care than surgeons who are nearing retirement age.
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Figure 2.
Headcount and full-time equivalent forecast.
The model's full-time equivalent supply projections were compared with the Health Resources and Services Administration's (HRSA) Physician Supply Model released in 2008 (Table 2). The stock and flow model forecasts a decline in full-time equivalent for all surgical specialties except colorectal, pediatric, and vascular surgery—all increasingly popular specialties branching from general surgery training. Neurosurgery is forecasted to be in balance over the period. The most significant difference between the 2 models is in obstetrics/gynecology; the Physician Supply Model forecasted an increase whereas the stock and flow model projects a decline. The largest decrease in full-time equivalent is projected to be in thoracic surgery with an estimated workforce size in 2025 that is 75% of the current workforce. The forecast for full-time equivalent supply in ophthalmology and urology is also significantly lower than Physician Supply Model estimates.
Figure 3 shows the effect that proposed changes to graduate medical education are forecasted to have on the future number of surgeons actively practicing. The model forecasts that proposed changes to increase graduate medical education under consideration will be insufficient to offset the decline. Without any changes to graduate medical education, the number of surgeons in the workforce is projected to decline by 18% by 2028. Implementing the recommendations from the Council of Graduate Medical Education's 16th report beginning in 2012, would result in a 17% reduction in workforce supply. Implementing the Deficit Reduction Commission's proposal would reduce the workforce by more than one fifth (-22%) from current levels. For comparative purposes, the Nelson, Shumer, Reid bill (S. 1627, 112th), which called for a 15% increase in residency slots supported by Medicare, was also modeled and still resulted in a 14% reduction from current supply.
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Figure 3.
Graduate medical education scenarios.
Results
The model estimates an 18% reduction in head count and a 16% decrease in full-time equivalents for the 20-year period from 2009 to 2028 (Fig. 2). The most rapid decrease occurs in the first 5 years as the number of retiring surgeons substantially exceeds new entrants. Headcount declines more rapidly than full-time equivalents over the forecast period because, although an increasing number of women are projected to enter the workforce who will provide fewer clinical hours, on average, younger surgeons of both sexes work more hours in patient care than surgeons who are nearing retirement age.
(Enlarge Image)
Figure 2.
Headcount and full-time equivalent forecast.
The model's full-time equivalent supply projections were compared with the Health Resources and Services Administration's (HRSA) Physician Supply Model released in 2008 (Table 2). The stock and flow model forecasts a decline in full-time equivalent for all surgical specialties except colorectal, pediatric, and vascular surgery—all increasingly popular specialties branching from general surgery training. Neurosurgery is forecasted to be in balance over the period. The most significant difference between the 2 models is in obstetrics/gynecology; the Physician Supply Model forecasted an increase whereas the stock and flow model projects a decline. The largest decrease in full-time equivalent is projected to be in thoracic surgery with an estimated workforce size in 2025 that is 75% of the current workforce. The forecast for full-time equivalent supply in ophthalmology and urology is also significantly lower than Physician Supply Model estimates.
Figure 3 shows the effect that proposed changes to graduate medical education are forecasted to have on the future number of surgeons actively practicing. The model forecasts that proposed changes to increase graduate medical education under consideration will be insufficient to offset the decline. Without any changes to graduate medical education, the number of surgeons in the workforce is projected to decline by 18% by 2028. Implementing the recommendations from the Council of Graduate Medical Education's 16th report beginning in 2012, would result in a 17% reduction in workforce supply. Implementing the Deficit Reduction Commission's proposal would reduce the workforce by more than one fifth (-22%) from current levels. For comparative purposes, the Nelson, Shumer, Reid bill (S. 1627, 112th), which called for a 15% increase in residency slots supported by Medicare, was also modeled and still resulted in a 14% reduction from current supply.
(Enlarge Image)
Figure 3.
Graduate medical education scenarios.
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