Q: What is Operation Patient Access?

A: Operation Patient Access is an effort by America’s surgical community, including surgeons, patients and other providers, to ensure that every patient has access to affordable, high-quality, and safe surgical care when they are in need of it. As federal policymakers examine how to reform this country’s health care system in the midst of the worst economic crisis in decades, there is a growing concern that the current focus on cost controls will dominate discussions and decisions to the extent that access to quality surgical care will be compromised. Operation Patient Access is designed to help policymakers understand that:

• Patient access to quality surgical care is at risk due to well-intentioned policies that had unintended consequences.
• The surgical workforce shortage is getting worse and cannot be fixed overnight due to the many years of post-medical school training required for surgeons.
• The shortage already has begun to hurt patient access to care by endangering rural hospitals and overwhelming city trauma centers and emergency rooms.
• Surgical services are not interchangeable – solutions like the use of nurses, physicians’ assistants, and other allied health personnel may help lessen workforce shortages in other areas of health care but cannot be used for surgical procedures, which must be performed only by qualified surgeons.
• America’s surgical community is committed to working with policymakers to craft workable solutions that address access problems while preserving and improving high-quality surgical care.

Q: What do you mean when you say there is a shortage of surgeons?

A: Three out of four hospitals – 75 percent – say they do not have enough surgeons on call to staff their emergency rooms. General surgeons, who play an important role in staffing trauma centers, have declined significantly on a per capita basis over the last few decades. That is, the total number of general surgeons has remained stagnant -- and has even begun to drop in recent years -- while our nation’s population has kept growing. This crisis is getting worse by the year: One-third of general surgeons are over 55 years old and have begun to think about retirement, while fewer and fewer medical students are in the pipeline to replace them in the operating room.

Q: Why is there a surgeon shortage?

A: The reasons for the surgeon shortage are numerous and complex. A key contributor dates back to the 70’s and 80’s, when several government policy advisory groups forecast – incorrectly, as it turns out – that there would be a surplus of physicians, including some surgical specialties. These forecasts led to policies which resulted in medical schools capping enrollments and limiting surgical training opportunities for residents. As a consequence, there are now too few surgeons to meet the rising demand for surgical services from our growing, aging and chronically ill population. In addition, other factors such as demographic and cultural changes in the physician population, reimbursement policies, liability issues and regulatory changes are increasingly driving surgeons into narrower specialty procedures. To add insult to injury, the shortage is being exacerbated by the imminent retirement of nearly a third of the surgical workforce and because of the long lead time it will take to fix the problem – about 30 years to build a strong residency program and from eight to 12 years to train a surgeon.

Q: How does a shortage of surgeons affect access to health care?

A: We are already seeing the effects of this shortage in the growing number of overwhelmed emergency rooms across the country. Experts predict that two of every five rural hospitals may have to close because they are not able to staff their surgery departments. With the growing number of people needing surgical procedures every year, especially as our population ages, there are fewer surgeons to meet that demand. There is increasing risk that a patient may not be able to find a surgeon when needed – and that is the very definition of lack of access to surgical care.

Q: If I need emergency surgery is there a chance a surgeon won’t be available?

A: Yes, and this risk is increasing annually unless we address and find means to slow or rectify the surgeon shortage. If you’re in a car accident and need emergency surgery, the lack of an available surgeon may well be a life-and-death issue.

Q: Are certain surgical specialties more affected by the shortage than others?

A: One of the hardest hit specialists is the general surgeon, the skilled surgeon who is relied upon by emergency rooms and hospitals in underserved areas of the country to perform a wide range of surgical procedures. Other areas of surgery in which shortages are developing include cardiothoracic surgery, orthopaedic surgery, neurosurgery, urology and obstetrics-gynecology.

Q: Are there areas of the country that are more impacted by a shortage than others?

A: Rural areas are especially hard hit by this shortage, with two in five rural hospitals expected to cut back services or close in the next few years because they cannot staff their surgery departments. Emergency rooms and trauma centers in large cities also are having critical staffing problems due to the shortage.

Q: What can we do about this shortage?

A: There are many things we can do, such as providing more funding for graduate surgical education, reducing liability costs, expanding the National Health Service Corps, and implementing alternative payment methods for health care. Unfortunately, given the long lead time necessary to train a surgeon, it will take years to turn the problem around.

Q: Will the Obama Administration’s health care reform plan improve access and relieve the surgeon shortage?

A: We support the important steps that President Obama proposes regarding the Medicare physician payment system – a system we see as a key contributor to the surgeon shortage. We also support his significant investment in health information technology, which we think can be a significant force in improving quality and reducing the growth of spending in health care – especially in conjunction with initiatives that reward care that improves quality and reduces cost. We look forward to working with the Administration on meaningful reform of the current physician payment system that incentivizes quality and efficiency.