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Invited Critique
April 2008

A Longitudinal Analysis of the General Surgery Workforce in the United States, 1981-2005—Invited Critique

Arch Surg. 2008;143(4):351. doi:10.1001/archsurg.143.4.351

Lynge et al provide more documentation on the evolving and serious shortfall in the number of general surgeons. Although specific details and emphasis are provided by many workers in the field, a simplistic overview of the problem is useful. Although 25% fewer general surgeons exist today than 30 years ago, the population of the United States has increased by 25 million people each decade. In the Study of Surgical Services in the United States (SOSSUS), 6.9 surgeons per 100 000 population was found in 1974. The SOSSUS based predictions on the projected population in 2000 of 250 million when it is actually 300 million. In 1995, we found1 that a slight increase over the SOSSUS value to 7.1 general surgeons per 100 000 population existed. My current calculations are that using the American Medical Association (AMA) database, the current national figure would be 6 per 100 000, but because the AMA data set, a self-designated specialty survey, overestimates, the current number is closer to 5 per 100 000.2 The SOSSUS emphasized that these data are best based on the board-certified cohort of surgeons. Between 1980 and 1990, a little less than 10 000 general surgeons were certified, and the number certified annually since has been approximately 1000 each year. This year's general surgery National Resident Matching Program match has 1072 categorical positions and only 2 unfilled. However, for the first time, less than 80% of the postgraduate year 1 residents were graduates of US medical schools.

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