Not unlike the plight in primary care, the overall number of general surgeons per 100,000 population has declined by 26 percent over the past 25 years. Given the present production level and retirement rate of general surgeons, the per capita supply of the general surgery workforce is expected to decline further over the next 15 years, according to the American College of Surgeons.
But it's not just the appeal of higher-paying surgical subspecialties that is drawing doctors out of the pool. Because of limited funding to residency programs, there aren't enough slots available to train all of the doctors who want to pursue general surgery.
"This shortage already poses a threat to hospitals in poor urban areas and rural hospitals that are generally dependent on surgical services for their survival," said George Sheldon, MD, FACS, a professor of surgery and social medicine in the Department of Surgery at the University of North Carolina and director of the ACS Health Policy Research Institute. "Among the ways to solve this problem are to develop new educational sites and new educational models. Above all, we need federal action to 'unfreeze' the funding for residency positions."
Based on a 2009 web survey, Anthony G. Charles, MD, MPH, FACS, lead author of an AAMC presentation on the residency shortage, estimated that general surgery residency slots could potentially be increased to train up to 1,515 general surgery residents per year--a 33 percent expansion over the existing 1,137 approved chief resident slots. Given the five-year training intervals, it would take at least five years for this increase to have an impact on the shortage problem.
Meanwhile, would-be nursing students in Florida face a similar conundrum, as the Florida Center For Nursing reports that 44 percent of qualified applicants to the state's nursing schools were turned away in the 2007-2008 academic year, according to the Tampa Bay Business Journal.
And again echoing some of the problems in primary care, the newspaper also revealed that nurse retention is just as detrimental to the state's supply as recruitment, as the Florida Center For Nursing reports that nearly 60 percent of the nurses added to the state's workforce over the past two years have left the profession.
"This is a concern for Florida because there are significant costs, both in terms of patient safety and economic costs, when we continue to have such considerable levels of turnover," said Mary Lou Brunell, executive director of the center, adding that nurse turnover costs exceeded $1.4 billion annually.