Projecting Surgeon Supply Using a Dynamic Model
Projecting Surgeon Supply Using a Dynamic Model
Objective: To develop a projection model to forecast the head count and full-time equivalent supply of surgeons by age, sex, and specialty in the United States from 2009 to 2028.
Summary Background Data: The search for the optimal number and specialty mix of surgeons to care for the United States population has taken on increased urgency under health care reform. Expanded insurance coverage and an aging population will increase demand for surgical and other medical services. Accurate forecasts of surgical service capacity are crucial to inform the federal government, training institutions, professional associations, and others charged with improving access to health care.
Methods: The study uses a dynamic stock and flow model that simulates future changes in numbers and specialty type by factoring in changes in surgeon demographics and policy factors.
Results: Forecasts show that overall surgeon supply will decrease 18% during the period form 2009 to 2028 with declines in all specialties except colorectal, pediatric, neurological surgery, and vascular surgery. Model simulations suggest that none of the proposed changes to increase graduate medical education currently under consideration will be sufficient to offset declines.
Conclusions: The length of time it takes to train surgeons, the anticipated decrease in hours worked by surgeons in younger generations, and the potential decreases in graduate medical education funding suggest that there may be an insufficient surgeon workforce to meet population needs. Existing maldistribution patterns are likely to be exacerbated, leading to delayed or lost access to time-sensitive surgical procedures, particularly in rural areas.
The search for the optimal number and specialty mix of physicians to care for the United States population has been underway for more than 30 years. Projections of physician supply and need drive decisions to expand or contract medical school classes, fund postgraduate residency programs, set reimbursement levels in Medicare and Medicaid, and invest in capital projects. The balance between specialty and primary care supply has been a focus of much of the analysis, but studies specific to surgery are equally numerous.
The accuracy of physician workforce projections are often called into question, as is the validity of the data sources that populate them.
The success of physician workforce projections is not necessarily how accurate the predictions were, but whether they provoked the implementation of new policies to change trends that prevailed at the time of the prediction. Projections of physician oversupply by the Graduate Medical Education National Advisory Committee (GMENAC) in the early 1980s resulted in restraint in the expansion of physician training. GMENAC's conclusions were endorsed by the Association of American Medical Colleges, the Institute of Medicine, and other organizations. Continued analysis and supply projections, however, changed thinking. In 2003, the Association of American Medical Colleges and other groups reversed the oversupply positions, and successfully recommended growth in medical school enrollment and new medical schools. These ongoing projections could be considered successful in that they were used to support policy action.
Workforce policy decisions are made on a continual basis by a variety of governmental, private, and public organizations. They generally depend on fixed projections derived from a static set of assumptions and with data from a single point in time. Currently, there is no ongoing process for estimating and refining physician projections. Rather, there have been multiple self-contained and specialty-specific projections, many of which were developed to support a specific policy agenda rather than as a tool to be used by decision makers to simulate the effect that proposed policy inventions could have on the future workforce.
This article describes a dynamic projection model of surgeon supply that forecasts head count and full-time equivalent supply of surgeons by age, sex, and specialty for the United States until 2028. Unlike static projection models currently available, this method can be altered and refined as key factors change, data and metrics improve, and policy scenarios such as funding for graduate medical education change allowing for more accurate projections. The model's capacity for real-time updating provides a unique contribution to workforce projection methodologies.
Abstract and Introduction
Abstract
Objective: To develop a projection model to forecast the head count and full-time equivalent supply of surgeons by age, sex, and specialty in the United States from 2009 to 2028.
Summary Background Data: The search for the optimal number and specialty mix of surgeons to care for the United States population has taken on increased urgency under health care reform. Expanded insurance coverage and an aging population will increase demand for surgical and other medical services. Accurate forecasts of surgical service capacity are crucial to inform the federal government, training institutions, professional associations, and others charged with improving access to health care.
Methods: The study uses a dynamic stock and flow model that simulates future changes in numbers and specialty type by factoring in changes in surgeon demographics and policy factors.
Results: Forecasts show that overall surgeon supply will decrease 18% during the period form 2009 to 2028 with declines in all specialties except colorectal, pediatric, neurological surgery, and vascular surgery. Model simulations suggest that none of the proposed changes to increase graduate medical education currently under consideration will be sufficient to offset declines.
Conclusions: The length of time it takes to train surgeons, the anticipated decrease in hours worked by surgeons in younger generations, and the potential decreases in graduate medical education funding suggest that there may be an insufficient surgeon workforce to meet population needs. Existing maldistribution patterns are likely to be exacerbated, leading to delayed or lost access to time-sensitive surgical procedures, particularly in rural areas.
Introduction
The search for the optimal number and specialty mix of physicians to care for the United States population has been underway for more than 30 years. Projections of physician supply and need drive decisions to expand or contract medical school classes, fund postgraduate residency programs, set reimbursement levels in Medicare and Medicaid, and invest in capital projects. The balance between specialty and primary care supply has been a focus of much of the analysis, but studies specific to surgery are equally numerous.
The accuracy of physician workforce projections are often called into question, as is the validity of the data sources that populate them.
The success of physician workforce projections is not necessarily how accurate the predictions were, but whether they provoked the implementation of new policies to change trends that prevailed at the time of the prediction. Projections of physician oversupply by the Graduate Medical Education National Advisory Committee (GMENAC) in the early 1980s resulted in restraint in the expansion of physician training. GMENAC's conclusions were endorsed by the Association of American Medical Colleges, the Institute of Medicine, and other organizations. Continued analysis and supply projections, however, changed thinking. In 2003, the Association of American Medical Colleges and other groups reversed the oversupply positions, and successfully recommended growth in medical school enrollment and new medical schools. These ongoing projections could be considered successful in that they were used to support policy action.
Workforce policy decisions are made on a continual basis by a variety of governmental, private, and public organizations. They generally depend on fixed projections derived from a static set of assumptions and with data from a single point in time. Currently, there is no ongoing process for estimating and refining physician projections. Rather, there have been multiple self-contained and specialty-specific projections, many of which were developed to support a specific policy agenda rather than as a tool to be used by decision makers to simulate the effect that proposed policy inventions could have on the future workforce.
This article describes a dynamic projection model of surgeon supply that forecasts head count and full-time equivalent supply of surgeons by age, sex, and specialty for the United States until 2028. Unlike static projection models currently available, this method can be altered and refined as key factors change, data and metrics improve, and policy scenarios such as funding for graduate medical education change allowing for more accurate projections. The model's capacity for real-time updating provides a unique contribution to workforce projection methodologies.
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