November was National Lung Cancer Awareness Month. Lung cancer is a devastating disease – approximately 180,000 new cases of lung cancer are diagnosed each year, and more people die from lung cancer than from any other type of cancer. In fact, lung cancer kills more Americans annually than breast, prostate, colon, kidney and liver cancers combined.
Surgery is the most effective treatment – and often a cure – for many lung cancers in the early stages. And for advanced stages of lung cancer, surgery is often combined with radiation and/or chemotherapy. Sometimes surgery is also used to help determine exactly what type and stage of lung cancer a patient has.
In short, surgery is critical to identifying and treating many lung cancers. For this reason, as Congress continues to debate the details of healthcare reform, the Lung Cancer Alliance has joined with the American College of Surgeons and more than 25 other organizations as a partner in Operation Patient Access. We are committed to ensuring that lung cancer patients – and all patients – have continued access to the critical surgical care they need.
We are concerned by the fact that the number of surgeons in the United States continues to decrease. There are currently fewer than two practicing cardiothoracic surgeons – those surgeons who perform lung surgery – for every 100,000 Americans, and a large majority of those surgeons are concentrated in urban areas.
That ratio is expected to shrink even further, as more than half of the current cardiothoracic surgeon workforce is 55 years and older, and a large number are expected to retire over the next decade. In addition, during the past five years, fewer and fewer medical students have applied for training in this specialty, so that 20 to 30 percent of available training positions have not been filled. Between 2002 and 2007, thoracic surgery saw a drop of 24 percent in the number of first year trainees.
At the same time that the number of cardiothoracic surgeons is dropping, the need for their services is rising, as our nation’s population grows older and sicker. Researchers say that by 2025, there could be a 46 percent increase in the demand for cardiothoracic surgeons.
We must address this issue now so that patients in need of lung surgery – or any critical surgery – are not forced to wait for life-saving surgical care. Congress must make the surgeon shortage a priority so that we do not face major surgical access issues that could lead to serious health complications and death.
As the only non-profit organization dedicated solely to patient support and advocacy for people living with lung cancer and those at risk for the disease, the Lung Cancer Alliance recognizes that a key component of advocating for our patients is working to ensure that their access to quality surgical care is not compromised.
This Lung Cancer Awareness Month – in light of the ongoing healthcare reform debate – is an ideal time to recognize the crucial role surgeons play in identifying and treating lung cancer, and saving countless lives.
Healthcare reform efforts must address the growing surgical workforce shortage, so that patients have access to critical surgical care when they need it.
I recently responded online in U.S. News and World Report to Steven Reinberg’s article, “Heart Surgeon Shortage Predicted” (Health Day, July 28, 2009), where he points out, a new study published in the highly regarded medical journal Circulation predicts that our country will face a serious shortage of cardiothoracic surgeons in the next 10 years. In fact the seeds for this looming shortage are already upon us.
I noted in my comments that with our aging population, demand for cardiothoracic surgeons is on the rise, while the number of available surgeons is declining. Nearly half of the cardiothoracic surgeons in the United States today are age 55 or over. Yet, over the last five years, there have been fewer applicants for training in this specialty so that 20 to 30% of the 130 available training positions have not been filled, and an even smaller number of those entering training are graduates of American medical schools. Those post-medical school trainees who might have been interested in becoming heart and lung surgeons are being deterred by high levels of medical school debt, the prospect of at least seven years of post-medical school residency training, progressively declining Medicare reimbursement, and the anticipated high stress and long hours required to fulfill their responsibilities to these patients. Several training programs for cardiothoracic surgeons have been forced to close because of the lack of trainees.
The cardiothoracic surgeon shortage is part of a larger surgeon shortage across the United States that encompasses multiple surgical specialties, rural areas, and some underserved urban areas. The shortage cannot be remedied overnight because it takes years to train new surgeons and decades to build a strong surgical residency program. With older cardiothoracic surgeons thinking about retirement and younger surgeons opting for other specialties, it is essential that any federal health care reform plan address the urgent needs for medical school debt relief and more equitable Medicare reimbursement, in order to ensure that patients continue to have adequate access to life-saving surgical care when they need it. Without enough surgeons, health care for Americans will be at risk for many years to come.
John E. Mayer, Jr., MD, FACS
Professor of Surgery, Harvard Medical School
Senior Associate in Cardiac Surgery
Children's Hospital, Boston
As discussed on my blog, Access Surgery, barriers to access to quality health care are more complex than people realize. There are very intricate reasons why some Americans are denied access - some of which were predictably engineered in the 1940s by established custodians of American
social and urban planning.
Now we have some races who exist in complete isolation, living only among themselves in over 500 of the total 3,200 plus counties in the country. I examined access as a function of opportunity and utilization and found that geography DOES matter. The findings were reported this month in articles in the Journal of the American College of Surgeons(PDF) and Archives of Surgery.
If you are distrustful of our health care system and you have no exposure to the system except through distant strangers, you will be less likely to wish to use those services until it’s too late. This situation has important preventive health implications. These populations do not get screened, they get diagnosed late and die earlier. These issues have received a certain amount of attention as of late by the media.
America has significant health challenges, but without addressing the effect of racial clustering and geography, there is little to believe that health disparities in access to health care in the U.S. can be resolved.
J. Awori Hayanga, MD, MPH Dr. Hayanga is a Surgical Critical Care/Trauma fellow and general surgery resident at the University
of Michigan Medical Center and will soon be heading for a cardiothoracic fellowship at the University
of Washington in Seattle.
The Association of American Medical Colleges (AAMC) recently held its fifth annual Physician Workforce Research Conference in Washington D.C. Researchers, physicians, healthcare educators, and others assembled to discuss topics from productivity of current providers to the impact of workforce shortages in other countries. A special session organized by Dr. George Sheldon, FACS, Director, American College of Surgeons Health Policy Research Institute, and Thomas Ricketts, Ph.D., (administrative director) of the Research Institute, examined the ramifications of a worldwide shortage of surgeons and the international response to this global crisis.
In the past, American health care has relied upon foreign-educated physicians, who did their residency training in America, to remain here to practice. Historically, 25 percent of America’s residency positions are filled by foreign medical graduates (Results and Data 2009: Main Residency Match. National Resident Matching Program (NRMP)). With increasing immigration restrictions placed upon International Medical Graduates (IMGs) here, and less financial and other incentives to remain in the United States to practice after training is completed, fewer foreign physicians opt to stay. Isn’t it ironic at this time of global competition for critical health care providers, that America - the country that has historically attracted and retained foreign physicians - is now losing not only the IMG physicians to other countries, but also American born and trained physicians as well? This out-migration further exacerbates the physician workforce shortage in rural and other underserved communities in the U.S.
It is clear from the data presented during the special surgical session, and others at the AAMC Conference, that the global shortage of qualified physicians and surgeons threatens the ability of all health care systems to provide needed care to its citizens. Obviously, any domestic health care reform that does not address the surgical workforce shortage will likely fail to relieve crowded emergency rooms, eliminate unnecessary, duplicative tests and consultations, and reduce the overall costs of U.S. health care.
Expanding health care insurance coverage to more Americans will be of little value if there are not enough surgeons to provide the necessary care.
Scott E. Maizel, MD, FACS
Member, Board of Governors
American College of Surgeons
The Robert Wood Johnson Foundation cares deeply about access and equity for patients and is taking a leadership role in rebuilding our health care provider workforce, especially in nursing. Our efforts have much in common — after all, the driving force behind Operation Patient Access is the fact that the surgeon shortage is impeding patient access to timely, quality surgical care, especially in many rural areas and inner cities.
Clearly, the shortage of surgeons will only get worse unless we do something about it now. As the Modern Physician story points out, the number of surgeons has stayed flat while the size of the U.S. population has continued to rise. But the situation takes on even greater urgency once it is understood that while many surgeons are on the verge of retirement, there are far too few medical students in training to take their place.
More than four of every 10 surgeons are 55 years old or older, according to a recent report on “The Surgical Workforce in the United States: Profiles and Recent Trends” by the American College of Surgeons Institute for Health Policy Research and the Association of American Medical Colleges. The report also shows in great detail that there are not nearly enough medical students coming up behind them.
Whether it’s nurses or surgeons, the numbers are clear: We have a significant supply problem that needs to be addressed as soon as possible.
Wyoming is the 10th largest state geographically in the United States, as well as the least populous, with only 525,000 people dispersed across 98,000 square miles. Right now, we have only 25 surgeons serving Wyoming residents, leaving nine of our 23 counties without a surgeon.
My organization is in the business of recruiting physicians to Wyoming – and retaining them. It is not an easy job. For example, in the past three years, Wyoming Health Resources Network has posted 12 openings for general surgery; unfortunately, six of these still remain open.
The nature of rural medicine is that communities share services: a surgeon may have a “home base” but satellite out to other communities where it isn’t viable to maintain a surgeon. Professionally, I understand this very well, but in the past few years, I’ve also had some personal experiences as a consequence of the surgeon shortage. In one instance, my son required gall bladder surgery but he lived in a small community which was served by a surgeon from another town who saw patients in surrounding areas as his schedule allowed. After waiting weeks, missing day after day of work due to pain and making many phone calls, my son finally located a hospital with a surgeon on staff that could perform the surgery.
Another family member was scheduled for a Caesarean and a routine hernia operation simultaneously. Her baby came early due to complications, and there was no surgeon on staff to complete the hernia procedure at the time. So what could have been done in a single hospital visit became two trips to the hospital, two separate procedures, two set of expenses, two bouts of recovery, etc. My experiences are not unique – the lack of access to quality surgical care is a reality for many rural communities like mine.
Wyoming understands the difference between “need” and “want.” Every community may want a surgeon, but the reality is many small communities cannot support a full time surgeon. Sharing surgeons between communities is a model that works. But what do we do when there aren’t enough surgeons to share the burden?
Recently, I attended the National Rural Health Association’s annual conference in Miami Beach, Fla., which brought together people from across the country to talk about how health care will look in the future for the 62 million American’s living in rural communities.
Everyone agreed that recruiting to rural areas can be a challenge. Tim Skinner, executive director of the National Rural Recruitment and Retention Network (3RNET) gave a presentation at this meeting on the surgeon shortage. He made two key points: we need more training programs for general surgeons; and programs need to focus on rural populations. He also stated that future planning needs to become the norm. A rural site will need to plan at least two years ahead when searching for a surgeon.
For now, Wyoming is pulling together as a state to ensure the health care needs of its citizens are met. Times are changing, health care is changing, but in the end – access to health care affects all of us. Together we need to present a unified message of need, build relationships to encourage early interest in health care professions, nurture the surgeons we have, and create a welcoming environment for new surgeons.
As an advocate for rural health care access, I have witnessed first hand what was once a looming shortage of health care professionals becoming what is now a tangible crisis. While surgeon workforce issues are not new, many people may not realize the dangerous pace at which the shortage is escalating and the deep impact it can – and will – have, on patients in the United States. Parts of rural America, in particular, are in a tenuous situation and face what could be a “point of no return” if we don’t do something now.
The numbers don’t lie. Twenty-five percent of the population lives in rural America, yet this same population is scattered over 90 percent of the land mass and is afforded health care access to less than nine percent of the physician workforce. The rural population is, per capita, older, sicker and poorer than its urban counterpart. Specific to surgeons, right now our country has just five surgeons per 100,000 people. The problem is only exacerbated in rural areas, which often have as few as three surgeons per 100,000 people. Moreover, half of U.S. surgeons in rural areas are over the age of 50, so we can expect a wave of retirements around the corner with fewer trained surgeons to replace them.
What this shortage means in rural areas is that people suffering traumatic injuries from a car crash, or those needing an emergency appendectomy, or women needing an emergency C-section, are in danger of not getting the help they need when they need it. This is an unacceptable burden for rural communities, which already suffer from greater health disparities as a result of economic, educational, cultural and demographic factors.
And what does this shortage mean for local economies?
In any given rural community, it is usually the hospital or the school that is the largest employer in the area. In fact, if you put one physician in a rural area, that one individual can be responsible for creating as many as 23 ancillary jobs. The hospital can provide as much as 20 percent of that local economy. When surgeons leave or emergency rooms are understaffed, hospitals are forced to shut down and are not only unable to provide critical patient care, but contribute to a major decline in the stability of the local economy.
Meantime, the problem for the aging population--both for the uninsured and under-insured--is even more acute in rural areas. Transporting these patients who need urgent care to another area can cost hundreds of thousands of dollars. I was recently privy to an example of this kind of occurrence in Wilcox, AZ, where a small, 25-bed critical access hospital recently lost its general surgeon. Now, emergency cases have to be flown by helicopter 82 miles away to Tucson, at a cost of $14,000 per trip. These kinds of trips occur about 10 times a month. It simply doesn’t make any cost-effective sense for a local economy to lose a general surgeon.
There are real reasons why it isn’t easy to attract and retain surgeons in rural areas. They are easily isolated and stretched thin with grueling hours and near constant on-call duty requirements. These surgeons handle vast areas and have chaotic travel schedules, because they are treating patients in other rural communities. The lifestyle in and of itself is certainly not for everyone.
Financial concerns also make it difficult for a surgeon to consider rural practice. Sadly, even medical students who want to be rural surgeons will choose other specialties or areas to live, in order to make a larger income and be able to pay off student loan debt.
We cannot ignore the health care needs of these rural communities, and we have to call on Congress to implement a plan of action. We’re not just talking about retaining or creating jobs. In rural America, it’s about saving lives.
“Grow the US National Health Service Corps,” a commentary published in the May 12 edition of the Journal of the American Medical Association (subscription required), supports efforts to expand and remodel the program, including adding general surgeons to the mix of specialties who can participate. The authors, Jonathan F. Saxton, JD, and Michael M.E. Johns, MD, argue that “… the general surgeon is becoming just as endangered as the general internist and primary care teams cannot provide adequate care without access to basic surgically trained team members and resources. By admitting general surgeons, the NHSC could create new models of primary care teams.”
The authors believe that the NHSC should focus on “adopting, modeling and studying the best practices for preventing and managing chronic conditions.” Ultimately, the authors’ hope these changes to the program can bolster its efforts to serve underserved communities and encourage and inspire medical students to choose to practice in specialties suffering from shortages.
My colleague, Dr. Thomas Williams, highlighted Monday at the American Association for Thoracic Surgery (AATS) Conference, the dire situation for the future of cardiothoracic surgery. “Unless there is a dramatic shift in numbers, within the next two decades the number of U.S. thoracic surgeons will be about 40% below the number needed to maintain current thoracic surgery coverage.” His presentation was featured yesterday on the EGMN: Notes from the Road blog at: http://egmnblog.wordpress.com.
Without question there is a looming shortage of cardiothoracic surgeons on the horizon. Over the last five years, there have been so few applicants for training in this specialty that 20-30% of the 130 available training positions have not been filled. Despite the professional attractions of providing life-saving care to the very sick, those who are interested in becoming heart and lung surgeons are being deterred by high levels of medical school debt, the prospect of at least seven years of post-medical school residency training, progressively declining Medicare reimbursement, and the anticipated high stress and long hours required to fulfill their responsibilities to these patients. Since half of currently practicing cardiothoracic surgeons are 55 or older, health care reform MUST address the urgent needs for debt relief and more equitable reimbursement, or patients will soon see their access to life-saving surgical care at risk. The Society of Thoracic Surgeons Government Relations Office is working with the Congress and the new administration on this important issue. Email advocacy@sts.org for more info.
John E. Mayer, Jr., MD
Professor of Surgery, Harvard Medical School
Senior Associate in Cardiac Surgery
Children's Hospital, Boston
Earlier this week I was privileged to attend a U.S. Senate Finance Committee roundtable discussion on “Reforming America’s Health Care Delivery System.” What was evident is that the Senate has a strong focus on primary care and the medical home delivery model, and while that is important, there also needs to be recognition that it is only one piece of what we need to be talking about.
The delivery system redesign is less about a system of care and more about delivery redesign for the shortfalls in chronic care. Improving primary care for chronic diseases is absolutely essential for the health of America. So, if we invest more in primary care, it must come with corresponding cost savings for the entire system and not just the hope that a medical home will provide the solution.
Policymakers and the general public need to understand that surgical patients have looming problems too. If we think in terms of the medical home and chronic diseases, it is important to note that when acute care needs arise in the chronically ill, it is general surgeons who are often the medical home’s “first responders”. Our health system redesign must maintain the viability of our surgeons to meet the needs of the nation.
Speaking on behalf of the American College of Surgeons, I told the committee that more than a decade ago, Congress set limits on graduate medical education in response to numerous predictions of a future glut of physicians. Those predictions were wrong, and now physician shortages, including many areas of surgery, are hitting both urban and rural areas all over the country.
Data from the Dartmouth Atlas shows a 16.3 percent decline in the per capita number of general surgeons between 1996 and 2006 as well as per capita declines of 12 percent in urology, 11.4 percent in ophthalmology, and 7.1 percent in orthopaedic surgery.
As I told the committee, our common goal is to expand patient access, improve quality of care and contain costs. And, in order to achieve those goals, I offered several objectives for their consideration:
Improve trauma care, such as making sure more of our citizens are served by trauma systems that can more effectively and efficiently use scarce and costly community resources
Ensure that public reporting of physician performance is fair, risk-adjusted and accurate, and doesn’t end up threatening access to care in rural and underserved communities
Establish a fair reimbursement structure that recognizes the different roles that different specialties play in caring for the whole patient
We are pleased that policymakers have asked ACS to join them at the table to discuss these important topics and help provide solutions that will ultimately reshape our nation’s health care system. Our ultimate goal is to preserve and improve Americans’ ability to access high quality surgical care and health care services.
Frank Opelka, MD, FACS, is a colorectal surgeon from New Orleans and Vice-Chancellor and Professor of Surgery at the Louisiana State University (LSU) Health Science Center.
Even as our leaders in Washington focus on repairing our economy and financial system, the important health reform discussion continues. For the first time, it appears that we have the opportunity to make real progress toward improving access for patients. Certainly, it’s difficult in 2009 to have a discussion about the future of our economy without discussing health care.
Today, our nation spends about $2.5 trillion on health care, or 17 percent of the gross domestic product (GDP). And one in 55 Americans work in the health care field in some capacity.
Surgeons understand cost is an important issue we must address. But if we treat health care like an infected tooth and just focus on costs, we ignore the fact that health care is a major part of our economy. We could put patient quality and access at grave risk if we look at this simply as a numbers issue.
Efforts to reduce costs and provide access to all Americans must be linked with efforts to improve quality, address workforce shortages and reform payment structures in order to promote quality and value.
Quality: Through our National Surgical Quality Improvement Program (NSQIP), the American College of Surgeons has seen significant improvements in quality and patient safety that have led to considerable cost savings for participating hospitals. Efforts to reduce health care costs should go hand-in-hand with efforts to improve quality and safety.
Workforce Shortage: As you’ve seen throughout this blog and site, we are facing a mounting surgeon shortage. Already, three-quarters of all hospitals report that they do not have enough surgeons to staff their emergency departments. We certainly support access to health care for all Americans, but we cannot forget to address the workforce shortage at the same time.
Payment Structures: In recent decades, insurance payments for many surgical procedures have been declining. An increasing number of surgical practices are struggling to stay in business. The issue is also contributing to the surgeon shortage, as more medical students decide to pursue more dependable areas of practice.
The surgical community is working together with our leaders in Washington as health reform discussions continue, with the goal of ensuring the best possible care for all patients in need.
Director, Health Policy Research Institute, American College of Surgeons
Professor of Surgery and Social Medicine, Department of Surgery, The University of North Carolina at Chapel Hill
How will the surgeon shortage impact rural communities? Operation Patient Access participant Anne Williams, MD, FACS, a general surgeon in the tiny town of Glasgow, Montana, contributed a guest blog to The Health Care Blog describing her feelings as she approaches retirement. As the only surgeon within a 100 mile radius, Dr. Williams serves more than 20,000 residents and twice a month she travels to two other Montana hospitals that are without a surgeon to care for those patients.
Be sure to read Dr. Williams‘ post and share how the surgeon shortage is impacting your community below.
LaMar McGinnis, MD, FACS
President-Elect, American College of Surgeons
Clinical Professor of Surgery, Emory University
In April 2006, Beth Buffington and her daughter were stopped in their vehicle when a drunk driver collided with their car at a speed of approximately 120-130 mph. As a result, Beth’s pelvis rotated clockwise around her spine, leaving her pelvis ring broken in five places and her radius shattered. Beth’s daughter suffered only bruises, but was emotionally impacted by watching her mother being removed from the vehicle.
At the time of the crash, Beth was transported to a local emergency room where the orthopedic surgeon on call assessed that Beth needed more specialized care. “I am grateful that the first surgeon who saw me knew enough to recognize I needed more care and recommended that I be moved to a trauma center,” Beth says.
She was transferred to a trauma center in Atlanta where she was treated by Dr. Dan Schlatterer. “Had I not had such a qualified surgeon, I don’t know where I would be today. He minimized the negative effects of the injury, reconstructing my pelvis based upon what he had left to work with. I’m convinced that I can walk today because of him.”
Beth goes on to mention that Dr. Schlatterer was “not only a fantastic surgeon, but also gracious to me, and to my family.” Beth believes that she is blessed to have recovered to the extent that she has. The crash left her with one leg one-half inch shorter than the other, but she is walking without a limp and continues to recover with each passing month.
Stories like this one are the reason that MADD supports the American College of Surgeons and the Operation Patient Access initiative, to make sure that when a drunk driving victim like Beth needs a surgeon, there will be one – no matter where in the United States she may be when she is hurt, no matter what the nature of her injuries are.
We’ve been hearing about the health care workforce shortage for some time. Regions around the country are facing shortages of nurses, primary care physicians, other health care workers and certain specialists. We certainly understand the concern and urgent need to fill these positions. But, you may be wondering, what’s different for surgeons?
What’s different is that there is no substitute for a surgeon. While internal medicine and family practice physicians and advanced practice nurses often overlap in their roles, surgical specialties do not overlap with other health providers or with each other. An urologist cannot fill in for a neurosurgeon. A cardiothoracic surgeon cannot fill in for an orthopedic surgeon. And only a trained surgeon can perform an operation.
The problem is only growing worse. More surgeons were certified in 1981 than in 2008, by the American Board of Surgery and the American Board of Medical Specialties figures, even though our population has grown by 79 million and health care needs have increased due to the aging population. On top of these problems, a third of general surgeons are over age 55, and there aren’t enough new surgeons to fill these positions when they begin to retire.
In the past 25 years, the number of general surgeons per 100,000 has declined by nearly 26 percent. Since the late 1970s, only about 1,000 new general surgeons have entered the field each year, far fewer than the number needed to meet demand. Compare this number with the 7,090 new physicians entering primary care each year.
What does this situation mean for patients? When your primary care physician is unavailable, you may have to wait longer or visit another practitioner such as a nurse practitioner or physician’s assistant. If you’re in a car accident and your local hospital doesn’t have enough surgeons, you could face critical delays, putting your life at risk.
We’re no longer at the point of questioning whether or not there will be a shortage of surgeons. Today, 75 percent of hospitals report that they don’t have enough surgeons to staff their emergency departments, and half of rural hospitals are at risk of closing because they don’t have a surgeon.
Now we must ask: Will a surgeon be available when you need one?
George F. Sheldon, MD, FACS
Director, American College of Surgeons Health Policy Research Institute
Professor of Surgery and Social Medicine, Department of Surgery, The University of North Carolina at Chapel Hill
Operation Patient Access got off to a great start at the U.S. Capitol this past Tuesday with a well-attended panel discussion that put a public face on the efforts of some 450 surgeons from around the country who came to deliver a serious message to their elected officials about policy changes needed to address gaps in access to quality surgical patient care.
The specific issue we are most concerned about is the shortage of surgeons in the U.S. Over the past 25 years, the number of general surgeons per capita has dropped 25 percent. Presently, one-third of rural hospitals have a surgeon leaving within the next two years. And, more than half of rural general surgeons are older than age 50. This is a critical situation because general surgeons are the men and women who often staff trauma centers where you would be taken if you are seriously injured in a car crash, fall from a ladder, or if you need to have an emergency appendectomy.
But the shortage isn’t limited to just rural America--we’re seeing pockets of shortages in urban and suburban parts of our country.
The problem is exacerbated by the fact that it takes anywhere from 12 to 15 years to train a surgeon, so there isn’t a lot of wiggle room for debate. Changes need to happen now to beef up our pipeline of surgeons, especially with aging Baby Boomers heading into their Medicare years and their possible resulting need for surgical services.
Among the solutions we are proposing: First, increase residency enrollment levels to encourage more students to enter the field and increase funding for graduate surgical education. And, second, expand the National Health Services Corps’ loan and scholarship programs to include surgeons.
I can’t over stress the gravity of this situation. This problem isn’t something that’s affecting patients sometime down the road, it’s happening now. For instance, in Los Angeles there is a waiting list of 3,000 patients for a hernia repair operation. In Bakersfield, CA, there is a three-to- four-month wait for the same procedure. Also, did you know that we are training only five pediatric neurosurgeons in this country? This is truly an unacceptable situation.
If you know anything about surgeons, you know that we are all about action. That’s what Operation Patient Access is all about – a collaboration of surgeons, patients, health care associations and other stakeholders – with a common goal to take action and reverse the tide of shrinking access to quality surgical care.
Dr. LaMar McGinnis, MD, FACS
President-elect, American College of Surgeons
Clinical professor of surgery, Emory University
I know I’m not the first to note that these are extraordinary times. Our nation is facing many challenges as we work to rebuild our financial system and set our economy back on track. We are also facing an unprecedented opportunity to improve our nation’s health care system and improve access to quality care for all Americans.
However, we cannot expect to improve access unless we address the mounting health care workforce shortage in this country. Much has been written about shortages in primary care and nursing, and we share those concerns. But it’s important that policymakers understand that the surgical workforce is also facing shortages in many pockets of the country, and that it’s important to address these problems now because of the years it takes to train new surgeons. In the past 25 years, the number of surgeons per 100,000 people in this country has dropped more than 25 percent, even as the population increased. Rural hospitals are in danger of closing, and our urban trauma centers are overwhelmed. We are reaching a crisis point that threatens the quality of care for our patients.
Today, our surgical community will take this message to Capitol Hill, as part of the Joint Surgical Advocacy Conference. We will tell our elected officials that we must work together to develop workable solutions to address this looming crisis. Today’s event marks the formation of Operation Patient Access: Quality Surgical Care for All, an advocacy platform of the surgical community, hospitals, departments of health and other stakeholders, to bring these issues into focus and call attention to urgently needed policy changes.
What are those changes? Some of the proposals include:
Increasing residency enrollment levels to encourage more students to enter the field and increase funding for graduate surgical education.
Expand the National Health Service Corps, which would allow new surgeons to receive assistance in paying back their medical school loans if they practice in underserved areas.
Place limits on medical malpractice liability claims to help reduce the high medical malpractice premiums that are driving many surgeons out of the field.
Implement alternative payment methods and address the impact the Emergency Medical Treatment and Labor Act (EMTALA) has had on increasing the number of emergency department visits and uncompensated care.
The surgeon shortage cannot be addressed overnight. It takes years to train new surgeons and decades to build a strong residency program, and unlike other medical professions, there are no physician-extenders in surgery. Only a trained surgeon can perform an operation, which is why we must act now to address this growing problem.
Over the next few months, you’ll hear more about Operation Patient Access. I encourage you to visit this blog often for updates and follow the campaign on Twitter at http://twitter.com/OpPatientAccess.
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J. Awori Hayanga, MD, MPH