There is much hand-wringing about the shortage of primary care physicians. But primary care is not the only specialty with deficits. In a few years, all surgical specialties will experience significant decreases in availability. Here is what will be happening with general surgery:

Demand-Side Facts

The current population of the United States is about 311 million people. Estimates are that by 2020, it will rise to over 340 million.

As Baby Boomers age, the increase in the population of the elderly will result in more need for general surgeons.

There are already many rural areas that are underserved by general surgeons.

Supply-Side Facts

The number of general surgeons needed to adequately serve the population is estimated to be at least 7 per 100,000 people.

Currently, there are about 18,000 active general surgeons in the US, or 5.8 per 100,000 people.

The ratio of general surgeons per 100,000 population has dropped by 26% in the last 25 years.

Medical schools are expanding class sizes and a few new schools are opening, but it will take several years for the impact of these changes to be felt.

Residency programs produce about 1,050 new general surgeons per year — a rate that has been level for almost 20 years.

The prospects for increasing the number of surgeons being trained are limited. A recent paper in the journal Academic Medicine showed that even if all of the current 246 general surgery training programs expanded as much as they possibly could, the best-case scenario would be an increase to about 1,500 new surgeons per year. The cost of funding this increase is estimated at several billion dollars, which have not been allocated. Even if the expansion took place by 2015, it would take 5 years (the length of general surgery residency training) before the extra new surgeons would be available.

At least 30% to 50% of graduating general surgeons take fellowships and ultimately narrow the scope of their practices. These surgeons do not perform all the procedures that the average general surgeon does.

Almost 50% of medical school graduates are women, and up to 40% of surgical residents are women as well. Here is “the elephant in the room” that no one wants to talk about. Although some surveys suggest that women handle as many cases as their male counterparts, a recent study presented at the American Surgical Association showed the facts. Information submitted by nearly 5,000 general surgeons applying for recertification by the American Board of Surgery during the years 2007-2009 shows that male general surgeons perform an average of 500 cases per year, compared with female general surgeons, who handle 375 cases per year. And the case mix of women surgeons is skewed with “far more” breast procedures and fewer abdominal and GI cases being done, compared with male surgeons.

Recent papers have noted the increasing problem of “burnout” among surgeons. One paper from 2009 reported that 40% of some 7,900 respondents to a survey of members of the American College of Surgeons considered themselves “burned out” and 30% had symptoms of depression. This will lead to attrition and/or earlier retirement.

Bottom line: There is already a shortage of general surgeons. The population of the US is growing and the supply of general surgeons is not. It will take money and time to rectify the problem. No one is doing anything about this.

Skeptical Scalpel is a practicing surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For 2 years, he has been blogging at and tweeting as @SkepticScalpel. His blog has had more than 230,000 page views, and he has over 3,200 followers on Twitter.