Due to an aging population, demand for surgery will increase nearly 50 percent for some specialties by the year 2020. The new study, featured in the August 2003 issue of the Annals of Surgery, predicts shortages for most surgical specialties.
Researchers found that surgeries performed predominantly on older adults, such as cataract and heart surgery, will have the highest increase in demand by the year 2020; ophthalmology led with a 47 percent increase in demand, closely followed by cardiothoracic surgery with a 42 percent increase.
UCLA lead author Dr. David A. Etzioni said that almost 60 percent of the surgical procedures analyzed were more commonly performed on adults aged 65 and older, compared to other age groups. The study also showed that by the year 2020, the largest population surge will be in the 65 and older age group -- increasing by 53 percent.
"We need to develop more effective ways to address the medical and surgical needs of older adults, as well as provide strategies to support surgeons," said Etzioni, a Robert Wood Johnson Clinical Scholar in the Division of General Surgery at the David Geffen School of Medicine at UCLA.
Historically, according to Etzioni, studies pointed to the need for more primary care physicians. In recent years, however, that trend may be changing as research is starting to support the need for more specialists. "With expanding technology and increasing numbers of older patients, we are seeing a need for more specialists in surgery and geriatric medicine," he said.
Etzioni said that already there isn't enough time to train new surgeons to avoid a shortage, since it takes eight to 14 years to train surgeons. He noted that other strategies may help surgeons use their time more efficiently, such as receiving assistance with time-consuming paperwork or having operating rooms run more effectively. He added that more research needs to be done to identify areas that may help surgeons.
UCLA researchers developed a workforce model using national surveys of medical and surgical services to establish a profile of age-specific rates of surgical use. Data was taken from the 1996 National Survey of Ambulatory Surgery and the National Hospital Discharge Survey. Census forecast data was used from the Census Bureau.
Researchers found that demand for ophthalmology led all surgical areas, with a 15 percent increase by the year 2010, and 47 percent increase by 2020, due primarily to cataract surgeries, which comprise 55 percent of the procedures performed by ophthalmologists. Cardiothoracic surgery followed closely with a 42 percent growth in demand by 2020 -- 70 percent of the workload for these surgeons is for patients over age 65.
General surgery, which included vascular, abdominal, gastrointestinal, hernia, breast and pediatric surgery, demonstrated a 13 percent growth by the year 2010, increasing to 31 percent by 2020. Urology surgeries, which include procedures involving the kidney, prostate and bladder, will increase 35 percent by 2020. Orthopedics, which includes surgery of the knee, shoulder and other joints, will increase 28 percent by 2020. Neurosurgery will increase 28 percent in 2020.
The smallest increase -- 14 percent -- will occur in otolaryngology, which involves procedures of the ear, nose and/or throat. Many of the patients needing these services are under age 15, which is a population group that will have little growth in coming years.
Etzioni added that with improving technology -- including minimally invasive surgery -- procedures are becoming easier and more appealing to a wider range of patients, which will also increase demand for services.
"Dr. Etzioni's work is incredibly important and highlights several critical issues that health-care systems and providers -- including surgeons and non-surgeons -- need to address now and in the future," said Dr. Clifford Y. Ko, the senior author and an assistant professor in the Division of General Surgery at the David Geffen School of Medicine at UCLA. "Such issues include caring for an older population who tend to have more co-existent diseases, improving the organization and efficiency of systems, and providing consistently high-quality care."
The study was funded by the Robert Wood Johnson Foundation and is part of UCLA's Clinical Scholars Program, which prepares graduates to play an active role in shaping and evaluating policies and programs to improve health care. The program prepares physicians to act as health services research leaders and agents for change in a variety of settings and to help improve quality of care for underserved groups.
Journal
Annals of Surgery