The Shortage of Trauma Surgeons in the US

Abstract

Background As the United States (US) population increases, the demand for more trauma surgeons (TSs) will increase. There are no recent studies comparing the TS density temporally and geographically. We aim to evaluate the density and distribution of TSs by state and region and its impact on trauma patient mortality. Methods A retrospective cohort analysis of the American Medical Association Physician Masterfile (PM), 2016 US Census Bureau, and Centers for Disease Control and Prevention (CDC’s) Web-based Injury Statistics Query and Reporting System (WISQARS) to determine TS density. TS density was calculated by dividing the number of TSs per 1 000 000 population at the state level, and divided by 500 admissions at the regional level. Trauma-related mortality by state was obtained through the CDC’s WISQARS database, which allowed us to estimate trauma mortality per 100 000 population. Results From 2007 to 2014, the net increase of TS was 3160 but only a net increase of 124 TSs from 2014 to 2020. Overall, the US has 12.58 TSs/1 000 000 population. TS density plateaued from 2014 to 2020. 33% of states have a TS density of 6-10/1 000 000 population, 43% have a density of 10-15, 12% have 15-20, and 12% have a density >20. The Northeast has the highest density of TSs per region (2.95/500 admissions), while the Midwest had the lowest (1.93/500 admissions). Conclusion The density of TSs in the US varies geographically, has plateaued nationally, and has implications on trauma patient mortality. Future studies should further investigate causes of the TS shortage and implement institutional and educational interventions to properly distribute TSs across the US and reduce geographic disparities.

Understanding Preventable Deaths in the Geriatric Trauma Population: Analysis of 3,452,339 Patients From the Center of Medicare and Medicaid Services Database

“…6,7,43 Our findings that United States' states/territories which experience a larger quantity of geriatric trauma patients generally experience fewer preventable mortalities may be to a greater quantity of trauma centers, and therefore access to care, for patients in highly populated areas. 43 Additionally, these findings could partially be due to these trauma centers having more frequent encounters with geriatric patients and local institutional policies which serve to increase the quality of care for older individuals has the ability to improve geriatric trauma patient outcomes. 44 This notion is further supported when considering that geriatric patients in Arizona were observed to have one of the lowest rates of preventable mortality and could be partly explained by the implementation of their "G60 Program," a set of trauma policies designed to increase survival and decrease longterm disability of geriatric individuals.…”

A national study defining 1.0 full-time employment in trauma and acute care surgery

“…Today, trauma surgeon density in the United States has plateaued. 16 While there are little data in surgery, EM and critical care medicine can both provide insight into what is reasonable work for physicians caring for sick patients. A survey of physicians responsible for creating ICU schedules found that an average FTE worked 24 weeks per year, including 24 weekend days and zero overnight calls.…”

“…Indeed, what is "ideal" for a division may not reflect "ideal" workload for individual surgeons. In the era of ACS shortages and high levels of burnout, this definition is needed more than ever 15,16 Acute care surgery in the United States is at a breaking point with increasing volumes and a shortage of surgeons covering trauma and emergency surgical services. 17 This has not improved over the last 15 years.…”

Regional Population-Based Workforce Shortages in General Surgery by Practicing Surgeon and Resident Trainee

“…Second, as the AAMC State Physician Workforce Profile database used in this analysis was constructed utilizing data from the AMA Physician Masterfile, the self-reporting practices associated with this database may underestimate or overestimate the number of practicing physicians, however as this database has successfully been utilized in surgical research, this inaccuracy is likely minimal. 6 Lastly, due to a lack of demographic data in the AAMC State Physician Workforce Profile, we were unable to sub-stratify our analysis by race/ ethnicity and gender to comment on socio-demographic differences in the fields analyzed. 40 We offer several recommendations moving forward.…”

“…[1][2][3][4][5] Physician shortages impact access to care and negatively impact patient outcomes, as a 2021 study demonstrated increased mortality rates in regions with a lower concentration of trauma surgeons per population. 6 The physician shortage is estimated to have differing effects in the national, regional and state settings, supply and demand models predicting that the Southern and Western US regions will be the most heavily affected by the year 2030, which has been further supported by data from the Health Resources and Services Administration (HRSA) which detail Florida and Texas experiencing the greatest shortages. 7,8 The root of this projected physician shortage can be traced to government funding provided for Graduate Medical Education (GME) residency programs and the numerous changes this funding source has experienced.…”