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The Estimated Cost of Training the Future Surgical Workforce

The Estimated Cost of Training the Future Surgical Workforce. Thomas E. Williams, Jr., MD,PHD, Bhagwan Satiani, MD,MBA, Andrew Thomas, MD,MBA, and E. Christopher Ellison, MD The Ohio State University Medical Center Departments of Surgery and Internal Medicine

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The Estimated Cost of Training the Future Surgical Workforce

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  1. The Estimated Cost of Training the Future Surgical Workforce • Thomas E. Williams, Jr., MD,PHD, Bhagwan Satiani, MD,MBA, Andrew Thomas, MD,MBA, and E. Christopher Ellison, MD • The Ohio State University Medical Center • Departments of Surgery and Internal Medicine • DISCLOSURE:This effort was partially supported by a grant from Columbus Medical Association Foundation

  2. HISTORY Surplus Shortage • 1910 Flexner • 1959 Bane • 1975 SOSSUS [ Rural Shortage] • 1981 GMENAC • 1986 COGME, IOM, PEW, AAMC, AMA • 1994 COGME • 1995 PEW • 2004 Cooper • 2006 HRSA • 2008 Dill & Salsberg, AAMC

  3. PHYSICIAN SHORTAGES

  4. Medical School Enrollments – no increases between 1980 and 2005 MEDICAL SCHOOL ENROLLMENTSPER 100,000 POPULATION • 227,000,000 300,000,000

  5. BALANCED BUDGET ACT Post Graduate Positions capped in 1997 by BBA No revision of the BBA so far

  6. SUPPLY AND DEMANDAging Population

  7. INCREASED WORK LOAD FOR THESE SEVEN SPECIALTIES OBGYN also

  8. Objectives • To estimate the workforce needed by 2030 in seven surgical specialties to serve a population of 364 million people • To quantify the cost associated with training additional surgeons.

  9. Assumptions • Unchanged physician to population ratio • 30 years in practice from completion of residency to retirement, • No revision of the Balanced Budget Act of 1997 and therefore no additional residency positions offered. • Per resident expenses were estimated at $80,000 including salaries, benefits, and other direct medical education costs.

  10. Methods • A review of the certificates granted in otolaryngology, orthopedic surgery, thoracic surgery, obstetrics and gynecology, neurosurgery, urology, and general surgery was conducted. • Population estimates of U.S Census bureau • Population-based algorithm • Baseline Supply + New Entrants (U.S & IMG’s) - Attrition

  11. RESULTS: UROLOGY WORKFORCE

  12. RESULTS SHORTAGES

  13. Cost of training surgical specialists at present certification levels

  14. Cost of training surgical specialists at certification levels needed Incremental Cost: $10B

  15. LIMITATIONS • Validity of US Census numbers • Surgical demand of the aged • Shortened training programs • Specialization • Misdistribution of surgeons • Impact of the economy • Disruptive technology

  16. CONCLUSION • There will not be a sufficient number of trained surgeons to care for the American people as early as 2030. • The shortage will grow to almost 30,000 surgeons by 2030. • Cost of $ 36.9 B • Current cost $ 26,8B • Incremental cost $ 10.1B

  17. CHALLENGES - CREATING THE RESIDENCIES GOAL – REVISION OF BBA OF 1997

  18. CHALLENGES • Convince policymakers of consequences of shortages • Revise the BBA of 1997 • Find alternative funding • Apply H.R 2583 The Physician Work Enhancement Act of 2008 to Surgery • Non-governmental • Recruitment • Life style • Rural Practice

  19. IMPACT OF SHORTAGEACCESS TO CARE • WILL PORTSMOUTH, OHIO HAVE THESE SERVICES ??? • APPENDECTOMY • BROKEN ARMS • DELIVERY of BABIES • INCREASES IN • TIME TO APPOINTMENTS • TRAVEL TIMES

  20. WILL IT COME TO THIS ?? SOURCE: NEJM RATIONING OF SURGICAL SERVICES

  21. # Job solicitations Recruiting hard Salary/bonus offers Hospital employment SHORTAGES Source: Advisory Board (2007)

  22. THORACIC SURGERY

  23. HEALTH CARE $$$ Source: Modern Healthcare

  24. LIMITATIONS OF STUDY • POPULATION BASED • VARIABLES NOT CONSIDERED: • WORKLOAD • GENDER, • AGING OF POPULATION & SURGEONS • NON-PHYSICIAN CLINICIANS • LIFESTYLE • EARLY RETIREMENTS • EFFICIENCY & DISRUPTIVE TECHNOLOGY • SALARIED PRACTICE ?? • TIME • BIDDING WARS • COST FIGURES ‘NOMINAL’ (UNADJUSTED FOR INFLATION)

  25. COOPER

  26. % Growth in surgical residents Source: AAMC

  27. SURGICAL WORKFORCES

  28. GENERAL SURGERY 364M 340M 24,775 21,000 6.81 7.5

  29. NEEDED VERSUS SUPPLYTHORACIC SURGEONS

  30. RESULTS: UROLOGY WORKFORCE

  31. SUMMARYPossible Cure for the Shortage • Increase training positions • Funding • Interest trainees in small town USA • Role models • Rural tracking or training programs • Incentives for rural practice • Increase interest of X and Y generation and women in surgery

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