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New Trend Data Shows Access to Surgical Care at Risk in US

American College of Surgeons Health Policy Research Institute issues advance findings of study on migration of surgeons

NEWS FROM THE AMERICAN COLLEGE OF SURGEONS | FOR IMMEDIATE RELEASE

WASHINGTON, DC (March 24, 2009): The American College of Surgeons Health Policy Research Institute will highlight new research today that indicates the shortage of general surgeons has raised concerns about the access to care for underserved and rapidly aging populations in pockets of both rural and urban areas of the United States. Findings from the new, unpublished study, “Migration of Surgeons,” will be shared today at a panel discussion on the issue of patient access to quality surgical care, put on by Operation Patient Access, a new campaign formed by surgical groups and other key health care stakeholders.

The report found that surgeons are moving to areas with already established medical communities, which could lead to local shortages, particularly in areas of the Northeastern and Midwestern United States. While the federal government offers various incentives to influence primary care physicians to practice in underserved areas, general surgeons are not part of the program. Only recently has the supply of surgeons and the effect of their migration patterns been studied.

“Our data shows that over the past decade surgeons moved more frequently than all other physicians and tended to relocate to areas with higher concentrations of established physicians. This is the opposite of that seen for physicians in general, who were more likely to move to areas with less competition,” said Thomas C. Ricketts, PhD, MPH, Co-Director of the American College of Surgeons Health Policy Research Institute and professor, University of North Carolina Gillings School of Global Public Health. “If this trend continues, the need for surgeons in rural and urban underserved areas, especially in the Northeast and Midwest, may increase significantly.”

Drawing on data gathered in prior studies, researchers developed a series of multivariate regression models that evaluated the odds that a surgeon would move during a 10-year period, from 1996 to 2006. The researchers examined the characteristics of the surgeons, as well as the characteristics of the departure and destination counties. The study excluded residents in training, surgeons not in active practice, and surgeons over the age of 70 in 2006.

Of the 94,630 physicians who were established surgeons in clinical practice between 1996 and 2006, 32.1 percent moved to another county during this time period. In contrast, other studies showed that 26.8 percent of all physicians moved over a 10-year period.

Moves by surgeons were not primarily to an adjacent county, and the average distance of a move was 593 miles. Interstate moves were largely from the Northeast and parts of the Midwest to the South and West. The counties to which surgeons moved have a slightly higher ratio of total physicians to population, are slightly less dense, are three times more likely to be more rural than the departure county and have lower income levels, a lower proportion of Hispanic residents, a lower unemployment rate, and lower poverty levels than their departure counties.

The analysis found that the likelihood of moving varied by surgical subspecialty. More than half of all surgical critical care practitioners moved, although this group was small in number. Of the larger subspecialty groups, thoracic and neurological surgeons were more likely to move (41.5 percent and 38.5 percent, respectively) than urologists and ophthalmologists (27.4 and 26.2 percent, respectively). Older surgeons moved farther: for each additional year of age, the distance increased by eight miles.

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About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 79,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.

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