COLUMBUS — The combination of several factors is leading to a shortage of surgeons in the United States, and to physicians in general. A soaring population and fixed number of medical students has led to a prediction of a shortage of 200,000 physicians by 2025, causing delayed access to health care for Americans.
The problem, said Bhagwan Satiani, M.D., MBA, begins with the number of physicians entering the pipeline.
“We’ve had about 17,000 medical students entering class every year for around 10 years,” said Satiani, a professor of clinical surgery in the division of vascular diseases and surgery at Ohio State University. “[Various] commissions pretty much convinced the government early in the 1990s that there were too many doctors.”
The result, he said, was passage by Congress of the Balanced Budget Act of 1997, which capped the number of residents the government would pay for at 105,000. The number of residents actually graduating is slightly higher because medical colleges pick up the tab for some.
“But the formula never took into account the growing population,” he said. “The main reason [for the shortage] is the population has grown and the number of physicians coming out is still the same.”
Satiani said research has determined that the adequate ratio of general surgeons is 4.7 per 100,000 in population.
“Almost 25 percent of rural counties have less than this,” he said. “It’s 2.7.”
In 1992, about 50 percent of students graduated each year went into specialties. In 2005, that number increased to 70 percent.
“So 30 percent of those left every year are going into general surgery,” said Satiani. “Those are the residents who do trauma, gyn, orthopedic.
“We figure by 2030 we’ll need 27,300 general surgeons,” said Satiani, who, along with co-authors Thomas E. Williams Jr., M.D., Ph.D., and E. Christopher Ellison, M.D., details these findings in “The Coming Shortage of Surgeons : Why are they disappearing and what we can do about it,” by Praegar Publishers due out in October 2009. “We’ll be 2,500 general surgeons, or 9 percent, short. The rural counties are going to hurt even worse.
“Our projections are very conservative,” he added.
In addition to the decreased number of physicians going into surgery, several other factors come into play in the surgeon shortage. Today, 35 percent of physicians are 55 years of age or older. In 1985, that number was 27 percent.
“General surgeons are getting older,” said Satiani. “The number of inpatient surgeries has tripled because the population has gotten older. The number of females in medical school is half and half. In general surgery, 25 percent are female.”
He said females tend to retire sooner and generally work less hours due to family commitments.
The solutions to the coming shortage are several, according to Satiani.
In the last few years, the number of medical students has increased, with 18,000 in 2008 and 19,795 projected for 2013.
“So you increase the number of medical students coming in, but then where do they go? You can graduate more students, but where are they going to train? The number is fixed at 105,000,” he said. “So you need to change the Balanced Budget Act. You need to expand the 105,000 budget ceiling.”
This, however, will come at a price.
“It will take $500 million a year to train the extra surgeons [in seven sugical specialities] we think as a total you need to fill the gaps,” said Satiani. “The budget issue is the No. 1 thing everybody is working on; $500 million is a lot of money.”
A second solution is amending medical student loan programs. According to Satiani, in 2008, the mean debt for a medical student was $150,000. Physicians have to begin repaying loans when they get out of medical school, with the exception of a few fields of medicine.
“We’re saying extend that to include general surgery,” said Satiani. “Extend the loan deferments until they complete their residency.”
A third solution is to encourage surgeons older than 55 to keep working through job sharing. This will decrease the workload, the amount of stress, and, hopefully, the number of early retirements.
This option needs malpractice reform, in terms of reducing the malpractice premium for those working only part time.
“Without [malpractice reform], the cost of someone working part time, they’re working for free,” said Satiani.
The loan deferments and malpractice reform will aid in the retention of surgeons.
“You’ve already spent the money training the ones who are here,” he said. “Those people are still in the pipeline; we can still affect them.”
Satiani said if reforms were to go into effect now, it would take nine years before the results are felt.
“[The Obama] administration wants to give full health insurance to 40 million people,” said Satiani. “Where are they going to go? There’s not enough physicians.”
He cited research that shows that in the United States, for 60 percent of those complaining of joint pain, it takes longer than two weeks to see an orthopedic surgeon. In Canada, for those needing a hip replacement, it takes 50 weeks from the time they initially seek care to the time they have been rehabilitated and are walking again.
“I think this country is going to be hurting,” he said. “The shortage is already here.”
See Wednesday’s edition for comments from Bruce White, CEO of Knox Community Hospital, on the coming shortage of surgeons.
