The U.S. has "remained inherently dependent" on international medical school graduates to sustain its ranks of general surgeons, but the number of graduates from foreign programs practicing here is declining—setting up a potential “crisis of urgency” that could exacerbate a projected general-surgeon shortage, concluded a report in the Journal of the American College of Surgeons.
Although the report's authors calculated that the number of general surgeons has risen slightly—from 17,394 in 1981 up almost 2% to a current level of 17,727—it has not kept pace with U.S. population growth. The report cites a study that found there were 7.68 general surgeons per 100,000 U.S. residents in 1981 and only 5.69 per 100,000 in 2005—a decline of almost 26%.
The number of general-surgeon training positions has increased only 1.3% in five years, to 1,065 residency slots in 2009, according to the report. Additionally, five slots went unfilled at the time of the 2009 residency match—athough 1,079 U.S. senior medical students had applied for general-surgery training.
The authors also predict that resident work-hour limits could lead to requiring a 30% increase in the resident workforce to meet the same work output. The report noted that the percentage of foreign medical school graduates in general surgery has decreased to only 14.8% from 17.4% of general surgeons in 2005 and that the overall number of general surgeons working in small, rural practices has fallen almost 39% since 2005.
Until the number of general surgeons graduating annually from U.S. medical schools increases, the nation is dependent on graduates of foreign medical schools, the report concludes. But those graduates are now facing resistance to their applications, potential political and bureaucratic barriers, and uncertainty in their ability to travel.
“This might jeopardize the resident workforce, create resentment among fellow residents and risk an individual's required training time,” the report says. “We are now at a critical point where we cannot provide for our own citizens through our medical education system.”