The Coming Shortage of Surgeons: Why They Are Disappearing and What That Means for Our Health (The Praeger Series on Contemporary Health and Living)

220 Pages·2009·1.36 MB·English

by  Thomas E. Williams Jr. M.D. Ph.D., E. Christopher Ellison M.D., Bhagwan Satiani M.D. M.B.A.

T HE COMING SHORTAGE
OF SURGEONS
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T HE COMING SHORTAGE
OF SURGEONS
W hy They Are Disappearing and
What That Means for Our Health
T homas E. Williams, Jr., M.D., Ph.D.; FACS ,
B hagwan Satiani, M.D., M.B.A.; FACS,
and E. Christopher Ellison, M.D.; FACS
F oreword by Thomas R. Russell, M.D.; FACS
Executive Director, American College of
Surgeons
The Praeger Series on Contemporary Health and Living
Julie Silver, M.D., Series Editor
PRAEGER
An Imprint of ABC-CLIO, LLC
C opyright 2009 by Thomas E. Williams, Jr., Bhagwan Satiani, and E. Christopher Ellison
A ll rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted, in any form or by any means, electronic, mechanical, photocopying,
recording, or otherwise, except for the inclusion of brief quotations in a review, without
prior permission in writing from the publisher.
L ibrary of Congress Cataloging-in-Publication Data
Williams, Thomas Edwards, 1935–
The coming shortage of surgeons : why they are disappearing
and what that means for our health / Thomas E. Williams, Jr.,
Bhagwan Satiani, and E. Christopher Ellison ; foreword
by Thomas R. Russell.
p. ; cm. — (Praeger series on contemporary health and living)
Includes bibliographical references and index.
ISBN 978-0-313-38070-9 (hard copy : alk. paper) ISBN 978-0-313-38071-6 (ebook)
1. Surgeons—Supply and demand—United States. I. Satiani, Bhagwan.
II. Ellison, E. Christopher. III. Title. IV. Series: Praeger series on
contemporary health and living.
[DNLM: 1. General Surgery—manpower. 2. Education, Medical,
Graduate—trends. 3. Specialties, Surgical—trends. WO 21 W727c 2009]
RD27.42.W55 2009
338.4'7617—dc22 2009027608
1 3 12 11 10 09 1 2 3 4 5
T his book is also available on the World Wide Web as an eBook.
V isit www.abc-clio.com for details.
A BC-CLIO, LLC
1 30 Cremona Drive, P.O. Box 1911
S anta Barbara, California 93116-1911
T his book is printed on acid-free paper
M anufactured in the United States of America
T o my beloved wife, Margaret Barton Williams, to our daughters, Beth,
Peggy, and Catherine.
And to my best friend and wife, Mira Satiani.
And to my beloved wife, Mary Pat Borgess, to our sons, Jonathan and Eric,
and daughter-in-law Hillary Dorwart, and
to the memory of my father, Edwin H. Ellison, M.D., and
Robert M. Zollinger Sr., M.D.
This page intentionally left blank
C ontents
List of Figures ix
List of Tables xiii
S eries Foreword by Julie K. Silver, M.D. xv
F oreword by Thomas R. Russell, M.D., FACS Executive Director,
American College of Surgeons xvii
P reface xix
A cknowledgments xxi
A cronyms xxiii
1. The Problem 1
2. Demand for a Surgical/Medical Workforce 10
3. Surgical Supply: Residents—The Future Surgeons 22
4. Constraints to Supply: Pertinent Issues 32
5. C alculating Physician Supply: The Model—Assumptions,
Relevant Parameters, and the Algorithm 54
6. Orthopedic Surgery 67
7. Cardiothoracic Surgery 72
8. Otolaryngology 78
9. Obstetrics and Gynecology 85
1 0. General Surgery 93
1 1. Neurosurgery 103
1 2. Urology 108
viii Contents
1 3. T he Last Hurdle: The Balanced Budget Act of 1997
and Graduate Medical Education Funding 114
1 4. I s There a Solution? Numerical Projections,
and Improving Physicians’ Productivity 127
1 5. Challenges and Consequences 144
Epilogue 156
A ppendix 159
N otes 165
I ndex 187
A bout the Authors 193
A bout the Series Editor 195
List of Figures
1.1 U.S. Medical School Applicants 3
1.2 U.S. Population and First-Year Medical School Enrollments, 1980–2005 4
1.3 Fourth-Year Medical Students Selecting General Surgery as
Their Top Choice Specialty 6
2.1 Staying Alive 12
2.2 Heart Failure Hospitalizations 13
2.3 The Nation’s Health Dollar, Calendar Year 2007: Where It Went 14
2.4 The Nation’s Health Dollar, Calendar Year 2007: Where It Came From 15
2.5 Balance Sheet 16
2.6 Population Growth of People over age 65 Years, 2000–2020 17
2.7 Relationship of GDP and Physician Ratio 18
2.8 Physicians per 1,000 People, 1991 and 2001 19
3.1 National Resident Matching Program, 2008 25
3.2 Residencies 27
3.3 American Board Surgical Certificates Awarded 29
4.1 Median Medical Education Debt 34
4.2 Projected Loan Payments as a Percentage of Projected Physician
After-Tax Income 35
4.3 Report Finds Physician Income “Losing Ground” to other Professions 39
4.4 Physician Income 40
4.5 Reimbursements for Open Surgery 41
4.6 Hospital versus Physician Reimbursement 42
4.7 Average CV Physician Compensation per Physician Work RVU,
202–206 43
4.8 Ohio Closed Claims in 2006 Outcome of Malpractice Claims 45
4.9 Annual Physician Premium Payments for Selected Specialties 47