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Increasing specialization of generalist surgeons confounds workforce projections

A growing number of generalist surgeons are narrowing their scope of practice to specialize in certain areas. According to a study supported in part by the Agency for Healthcare Research and Quality (T32 HS00032), this progressive specialization of generalist surgeons, usually through fellowship training after general surgery residency, confounds workforce projections. To more accurately estimate surgical workforce, estimates of the total number of surgeons providing general surgery should exclude subspecialist surgeons whose practices do not encompass the primary components of general surgery. Also, if the trend continues, a larger workforce of surgeons will be needed to provide the multitude of services encompassed by general surgery, suggest the researchers.

Researchers used multiple data sources to examine progressive specialization within general surgery by evaluating trends in fellowship training among general surgeons. Results showed that the proportion of general surgeons pursuing fellowship training has increased from more than 55 percent to more than 70 percent since 1992. The introduction of fellowship opportunities in new content areas, such as breast surgery and minimally invasive surgery, accounted for some of the increase.

Also, over 10 percent of the annual group of general surgeons pursued advanced training in plastic surgery, a very popular and increasingly competitive subspecialty. Meanwhile, interest in more traditional subspecialities such as thoracic and vascular surgery declined. Other evolving popular subspecialties include transplant surgery, trauma or burn surgery, endocrine surgery, hepatobiliary surgery, and bariatric surgery.

More details are in "Progressive specialization within general surgery: Adding to the complexity of workforce planning," by Karyn B. Stitzenberg, M.D., M.P.H., and George F. Sheldon, M.D., F.A.C.S., in the December 2005 Journal of the American College of Surgeons 201, pp. 925-932.

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