The number of general surgeons in the United States has declined more than 25 percent in the past 25 years, according to a report released April 21, 2008 in the JAMA/Archives journal Archives of Surgery.

According to the article, the general surgeons are integral to the US health system: while rural general surgeons provide a surgical support system to primary care physicians and keep small rural hospitals financially viable; urban general surgeons provide specialty services such as emergency and trauma services that other subspecialist surgeons cannot provide.

Dana Christian Lynge, M.D., and colleagues at the University of Washington, Seattle, examined the number of general surgeons per 100,000 Americans using the American Medical Association’s Physician Masterfiles taken in 1981, 1991, 2001, and 2005. They additionally noted the age, sex, and locale of the surgeons.

In 1981, the total number of active general surgeons began at 17,394, jumped by 2001 to 17,922, then dropped to 16,662 in 2005. The ratio of general surgeons to 100,000 people also declined, from 7.68 in 1981 to 5.69 in 2005. As the US population increased from 226 million to 292 million, the national general surgeon to population ratio declined by 25.91 percent in those 25 years.

A greater decrease was seen in urban areas (27.24 percent) in contrast to rural areas (21.07 percent.) The number of female general surgeons increased enormously from 1981 to 2005, but they were largely urban in concentration. In comparison with the urban surgeons, the average age of rural surgeons increased.

The authors point out that, while there are other medical professionals and health care clinicians who can help adjust to this decline, they cannot completely fill the role of the general surgeon. For instance, they say: “There is some question as to whether there will be an adequate number of general surgeons to care for an increasingly elderly population, with its attendant increased demand for surgical care.” Methods to accommodate to this decline should be considered by surgeons, professional organizations, and the organizations that control the education of general surgeons.

Some examples of actions are given by the authors: “These might include increased funding of residency positions, and exploring and addressing the issues surrounding training, remuneration and lifestyle that seem to have made general surgery less attractive than other specialties to medical students, especially women.” Additionally, medical schools and surgical residency programs should place a focus on some rural techniques, to “ensure that general surgical residents are sufficiently exposed to rural surgical practice through rural training tracks and rural-based residencies.”

The authors conclude that the demand for general surgeons will continue to be great. “A growing and aging population, especially in rural areas, will continue to require a workforce of well-trained general surgeons who can provide a wide spectrum of surgical services.”

A Longitudinal Analysis of the General Surgery Workforce in the United States, 1981-2005

Dana Christian Lynge, MD; Eric H. Larson, PhD; Matthew J. Thompson, MBChB, MPH; Roger A. Rosenblatt, MD, MPH; L. Gary Hart, PhD
Arch Surg. 2008;143(4):345-350.
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Written by Anna Sophia McKenney