Role of Community Program Graduates in the Surgical Workforce: Can Recruitment Efforts Be Focused to Fulfill Future Demands for General Surgeons?

摘要

The population growth of America has surpassed the supply of general surgeons leading to a predicted workforce shortage in the near future. Presently, for a population of over 313 million in the United States, there are 26,314 practicing as general surgeons, giving a ratio of 11,745 people per surgeon. The population of the United States continues to grow older and more general surgeons are retiring and leaving open positions left unfilled. Between 2000 and 2010, there was a 7 per cent decrease in the number of practicing general surgeons. This decline is predicted to continue with a shortage of 1875 surgeons by 2020 and 6000 surgeons by 2050. The question as to why these positions are remaining unfilled weighs heavily on the minds of surgical educators. Each year there are over 1000 young surgeons graduating from residency programs. However, the proportion of residents applying for fellowships has increased from 55 to 70 per cent from 1992 to 2006, and is only projected to increase in the future. A number of previous studies have attempted to define a cause for the ever growing trend toward subspecialty training. A recent paper reported that independent/community programs tend to graduate a larger number of general surgeons as compared with academic training programs (52% vs 37%).3 In this study, we sought to identify trends in American Board of Surgery In-Training Examination (ABSITE) scores, United States Medical Licensing Examination (USMLE) scores, resident demographics, and exposure to previous training that would be predictive of a surgeon's chosen career path. If measurable factors can be identified early on in residency training, proper incentive, and mentorship support can be given to the resident in preparation for entry into the general surgery workforce.