shortage of surgeons – Thoracic Surgery

As Florida’s population booms, surgeon shortage becomes acute

As the Florida legislature and medical community considers the impending physician shortage, many of the critical concerns regarding the on-going shortage of surgeons remain unaddressed

Now that Florida is the third most populated state (behind first ranking California and # 2 Texas) in the United States with a census of almost 20 million residents, the ongoing shortage of surgeons is predicted to become more dire over the next ten years.

the thoracic surgeon: a disappearing breed?

The problem is multi-factorial: Training, debt, compensation (financial and otherwise)

In a recent article by Donna Gehrke – White at the Sun Sentinel, the need for over 7,000 additional physicians (in a variety of specialties) highlights some of the difficulties in training and retaining specialty physicians in American medicine. Lengthy training regimens coupled with high student loan debt as well as feelings of frustration and ‘burnout‘ plague a medical landscape that is already burdened with concerns over the fragile state of American health care, escalating healthcare costs and the impact of Obamacare and other recent federally mandated changes to the health care system.

“More schools” are not the answer

While Florida is responding to the impending crisis by opening new residency programs, this doesn’t address some of the more crucial concerns – high vacancy rates in existing programs, the exorbitant costs of a surgical education, and a growing dissatisfaction with current working conditions.

How about better loan repayment programs/ debt forgiveness? Or greater access to patients (and less time dealing with paperwork/ EMR and reimbursement issues)? Instead of lengthening/ shortening training programs and relying on computerized models, maybe consider improving the quality of American surgical training by separating the specialty into two separate tracks (like most countries)?

Florida’s shortage of thoracic surgeons: 14?

While the estimated shortage of thoracic surgeons in Florida is only projected to be 14, existing problems in retaining surgical residents and low specialty board pass rates and echos both nationwide and global shortage concerns. With an aging population, rising rates of esophageal cancer and earlier detection (of surgically treatable) cancers, these numbers may not tell the whole story.

Additional Recommended Reading:

Gordon, D. (2014) 15 things to know about the physician shortage. Becker’s Hospital Review (on-line).

Seaman, A. M. (2012). Surgeon’s pressures may worsen shortage. Reuters. As we’ve noted previously, this is not a new concern, and the latest studies and reports only confirm this data. In fact, this report from the Robert Wood Johnson Foundation from 2011, highlights the fact that surgeon shortages are impacting emergency departments ability to provide emergency life-saving treatment.

Aliwadi, G. & Kron, Irving (2008). The challenges facing thoracic surgeons. Vascular disease management. This 2008 article highlights some of the difficulties in attracting and retaining medical students and surgical residents to the cardiothoracic surgery specialty. While mainly geared at cardiac surgery – and the issues raised by interventionalists and catheter based interventions, it also touches on some of the educational issues that affect both cardiac and general thoracic surgeons.

Thoracic surgeon shortage in Australia

When you need surgery, How long will you wait? (and will there be anyone to perform the operation?) The on-going surgeon shortage now affecting South Australia.

There is more evidence of the changing demographics of healthcare and an aging population and its effects world-wide on cardiothoracic surgery as the Australian newspaper, Herald Sun published reports of lengthy patient waiting lists for surgical procedures including procedures categorized as “urgent.”

Long lines and waiting lists

More concerning, is the report of the number of patients who have died waiting for surgery*.

The report, which focuses on the Southern region of Australia highlights the shortage of specialty surgeons and the growing numbers of patients affected by these shortages.

Critics of the Australian government have also voiced concerns over the Surgeon Workforce project which aims to partially alleviate these shortages by using foreign-trained surgeons and imported labor. This comes at a time when Australia actually has an oversupply of general practice or internal medicine physicians.

The shortage of well-trained surgeons is affecting all surgical specialties but the cardiac and thoracic surgery specialties are particularly hard hit due to the lengthy, rigorous (and often costly) training regimen in many countries.

In the United States, this process is also exacerbated by an antiquated, sometimes arbitrary or i mpractical practice for residency placement that discourages international medical students. This, along with other concerns (legitimate as well as political) that govern the regulations that permit overseas graduates to practice in the United States restricts the possibility of reducing the growing shortage in a similar manner.

The lengthy educational process is not the only factor. Many medical students cite the strenuous work schedules, diminished job satisfaction and physically challenging surgical lifestyles as reasons medical students are choosing other specialties which are seen as being equally or more lucrative but allowing more work-life balance.

Similar shortages have been reported in Canada, the United States and the United Kingdom.

* Many international readers have asked if this is what is affecting the Americans Veteran’s Administration hospital system. Not really, (or if so, only partially). Th VA Scandal is a tragic example of the bureaucratic red tape that is becoming far too frequent for Americans seeking medical services.

Surgeon shortage to hit rural areas the hardest

the latest predictions on the impending shortage of surgeons in the United States

Unsurprisingly – rural area hospitals face additional challenges in attracting and retaining specialty surgeons in comparison to big cities/ metropolitan areas. However, as reported by Patrice Welding at Thoracic Surgery News in a report on the annual meeting of the Central Surgical Association, this may be viewed as a boon for the surgeons themselves as hospitals may devise new and enhanced incentives to attract surgeons to their facilities. The surgical specialties most likely to benefit from this strategy include (as previously reported), obstetrics and gynecology, orthopedic surgery, general surgery, otolaryngology, urology, neurosurgery, and thoracic surgery.

The article which quotes Dr. Thomas E. Williams, Jr. predicts that hospitals and institutions may break out into a ‘bidding war’ over surgeons.

While this is dire news for rural hospitals and the estimated 56 million patients served by these facilities, it comes as a relief for current thoracic surgery fellows and new thoracic surgeons who have faced an increasingly bleak economic landscape over the last few years.

Of course, more sanguine experts note that the impact of the impending shortage has been reported for several years – with little impact on the current job market for new graduates.

The United States isn’t the only nation to be suffering from a shortage of surgeons, particularly in thoracic surgery. So, maybe this is one of the questions we should be asking.

Dr. Thomas E. Williams Jr. is one of the main researchers on the impending shortage in the United States and published a book based on his findings in 2009, entitled, “The coming shortage of surgeons: why they are disappearing and what that means for our health“. (Praeger, ISBN #978-0313380709). His work has also be published in multiple journals, and presented in meetings and conferences across the country.

Williams, T. E & Ellison, E. C. (2008). Population analysis predicts a future critical shortage of general surgeons. Surgery, 144 (4): 548-556, October 2008.