Study Reveals There Will Not Be Enough Surgeons to Meet Needs of Aging Population

LOS ANGELES -- When you need a qualified surgeon in the coming years, will there be one available? Maybe not, according to a new study by University of California, Los Angeles (UCLA) researchers.

Due to an aging population, demand for surgery will increase nearly 50 percent for some specialties by the year 2020. The new study, featured in the August 2003 issue of Annals of Surgery, predicts shortages for most surgical specialties.

Researchers found that surgeries performed predominantly on older adults, such as cataract and heart surgery, will have the highest increase in demand by the year 2020; ophthalmology led with a 47 percent increase in demand, closely followed by cardiothoracic surgery with a 42 percent increase.

University of California, Los Angeles lead author Dr David A. Etzioni said that almost 60 percent of the surgical procedures analyzed were performed more commonly on adults ages 65 years and older compared to people in other age groups. The study also showed that by the year 2020, the largest population surge will be in the 65 and older age group-increasing by 53 percent.

"We need to develop more effective ways to address the medical and surgical needs of older adults, as well as provide strategies to support surgeons," said Dr Etzioni, a Robert Wood Johnson Clinical Scholar in the Division of General Surgery at the David Geffen School of Medicine at UCLA.

Historically, according to Etzioni, studies indicated a need for more primary care physicians. In recent years, however, that trend may be changing, and research is starting to support the need for more specialists. "With expanding technology and increasing numbers of older patients, we are seeing a need for more specialists in surgery and geriatric medicine," he said.

Etzioni said that already there is not enough time to train new surgeons to prevent a shortage because it takes eight to 14 years to train them. He noted that other strategies may help surgeons use their time more efficiently, such as receiving assistance with time-consuming paperwork or having ORs run more effectively. He added that more research needs to be performed to identify areas that may help surgeons.

Researchers developed a workforce model using national surveys of medical and surgical services to establish a profile of age-specific rates of surgical use. Data were taken from the 1996 National Survey of Ambulatory Surgery and the National Hospital Discharge Survey. Census forecast data also were used from the U.S. Census Bureau.

Researchers found that demand for ophthalmology led all surgical areas, with a 15 percent increase by the year 2010 and 47 percent increase by 2020, due primarily to cataract surgeries, which comprise 55 percent of the procedures performed by ophthalmologists. Cardiothoracic surgery followed closely with a 42 percent growth in demand by 2020-70 percent of the workload for these surgeons is for patients older than age 65.

General surgery, which included vascular, abdominal, gastrointestinal, hernia, breast, and pediatric surgery, demonstrated a 13 percent growth by the year 2010, increasing to 31% by 2020. Urology surgeries, which include procedures involving the kidney, prostate, and bladder, will increase 35 percent by 2020. Orthopedics, which includes surgery of the knee, shoulder, and other joints, will increase 28 percent by 2020. Neurosurgery will increase 28 percent by 2020.

The smallest increase-14 percent-will occur in otolaryngology, which involves procedures of the ear, nose, or throat. Many of the patients needing these services are less than 15 years of age, which is a population group that will have little growth in coming years.

Etzioni added that with improving technology-including minimally invasive surgery-procedures are becoming easier and more appealing to a wider range of patients, which also will increase demand for services.

"Etzioni's work is incredibly important and highlights several critical issues that health care systems and providers-including surgeons and nonsurgeons-need to address now and in the future," said Dr Clifford Y. Ko, the senior author and an assistant professor in the Division of General Surgery at the David Geffen School of Medicine at UCLA. "Such issues include caring for an older population who tend to have more coexistent diseases, improving the organization and efficiency of systems, and providing consistently high-quality care."

The study was funded by the Robert Wood Johnson Foundation and is part of UCLA's Clinical Scholars Program, which prepares graduates to play an active role in shaping and evaluating policies and programs to improve health care. The program prepares physicians to act as health services research leaders and agents for change in a variety of settings and to help improve quality of care for underserved groups.