Surgeon Shortage Has Global Implications

U.S. health care exacts a heavy toll not only in terms of dollars, but also in the demand we exert on the world’s supply of surgeons.

A decline in the number of international medical graduates practicing general surgery in the United States is contributing to a “crisis of urgency” as demand for general surgeons continues to grow, according to a new Vanderbilt study published in the Journal of the American College of Surgeons. That trend, along with an inadequate supply of general surgery graduates, is threatening patient access to quality surgical care, say the authors.

“It appears that our dependence on international surgical residents will increase over the years,” says lead author Dr. Naji Abumrad, chair of the Department of Surgery. “Our challenge is to remain morally and ethically conscious of the fact that these residents represent a significant brain drain to countries where their skills are very much needed.”

Dr. Kyla Terhune: “We have become too reliant on international medical graduates to meet the growing demand for all specialties.”

International medical graduates (IMGs) include both U.S. citizens and noncitizens who graduate from medical schools located outside the U.S. and Canada. The Educational Commission for Foreign Medical Graduates requires IMGs to complete four years of education at a medical school listed in the International Medical Education Directory and to obtain passing scores on the same licensing examinations given to U.S. graduates. IMGs represented 17.4 percent of all general surgeons in 2005, but that number has since dropped to 14.8 percent.

“In the 2009 residency match, if every U.S. senior medical student had been matched to a first-year position in any field, only 70 percent of available positions would have been filled,” says first author Dr. Kyla Terhune, a general surgery resident at Vanderbilt University School of Medicine. “These shortages can have a lasting impact on access to care, particularly in trauma and critical-care situations.”

Particularly threatened by the shortage, Terhune says, are rural areas, where the total number of surgeons has declined by nearly 40 percent since 2005. “We must acknowledge the importance of IMGs—and the fact that we have become too reliant on them to meet the growing demand for all specialties, including general surgery.

“We cannot provide for our citizens through our own medical education system.”

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