Skip to main content
SpringerLink
Log in
Book cover

Principles and Practice of Geriatric Surgery pp 153–170Cite as

Providing Surgical Care to an Aging Population: Implications for the Surgical Workforce

  • Chapter
  • First Online:

Abstract

The demographic trends underlying the “aging population” have already been discussed in Chap. 12. As a result of increasing life expectancy and the aging of the baby boomers, the United States (US) population will see a dramatic increase in the number of older individuals. Between 2010 and 2030, those aged 65 years and older are projected to rise by 78%, an absolute increase of over 30 million individuals. These unprecedented changes in the demographics of the US population will lead to significant growth in the demand for surgical treatment.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Dennison C, Pokras R (2000) Design and operation of the National Hospital Discharge Survey: 1988 redesign. Vital Health Stat 1 39:1–42

    PubMed  Google Scholar 

  2. http://quickfacts.census.gov/qfd/states/00000.html. Accessed 20 Dec 2008

  3. http://www.cms.hhs.gov-MedicareFeeforSvcPartsAB-Downloads-DRGDesc05.pdf. Accessed 20 Dec 2008

  4. Reported figures based on original analysis of data from the 2005 Florida State Ambulatory Surgery Database

    Google Scholar 

  5. Reported figures based on original analysis of data from the 2006 National Hospital Discharge Survey

    Google Scholar 

  6. Kuo YF, Sharma G, Freeman JL, Goodwin JS (2009) Growth in the care of older patients by hospitalists in the United States. N Engl J Med 360(11):1102–1112

    Article  PubMed  CAS  Google Scholar 

  7. Ballarin R, Spaggiari M, Di Benedetto F et al (2009) Do not deny pancreatic resection to elderly patients. J Gastrointest Surg 13(2):341–348

    Article  PubMed  Google Scholar 

  8. Menon KV, Al-Mukhtar A, Aldouri A et al (2006) Outcomes after major hepatectomy in elderly patients. J Am Coll Surg 203(5):677–683

    Article  PubMed  Google Scholar 

  9. Shimada H, Shiratori T, Okazumi S et al (2007) Surgical outcome of elderly patients 75 years of age and older with thoracic esophageal carcinoma. World J Surg 31(4):773–779

    Article  PubMed  Google Scholar 

  10. Etzioni DA, Liu JH, O’Connell JB et al (2003) Elderly patients in surgical workloads: a population-based analysis. Am Surg 69(11):961–965

    PubMed  Google Scholar 

  11. Chang GJ, Skibber JM, Feig BW, Rodriguez-Bigas M (2007) Are we undertreating rectal cancer in the elderly? An epidemiologic study. Ann Surg 246(2):215–221

    Article  PubMed  Google Scholar 

  12. Schrag D, Cramer LD, Bach PB, Begg CB (2001) Age and adjuvant chemotherapy use after surgery for stage III colon cancer. J Natl Cancer Inst 93(11):850–857

    Article  PubMed  CAS  Google Scholar 

  13. Schrag D, Gelfand SE, Bach PB et al (2001) Who gets adjuvant treatment for stage II and III rectal cancer? Insight from surveillance, epidemiology, and end results – Medicare. J Clin Oncol 19(17):3712–3718

    PubMed  CAS  Google Scholar 

  14. Siu LL (2007) Clinical trials in the elderly – a concept comes of age. N Engl J Med 356(15):1575–1576

    Article  PubMed  CAS  Google Scholar 

  15. Baicker K, Chandra A (2004) Medicare spending, the physician workforce, and beneficiaries’ quality of care. Health Aff (Millwood) Suppl Web Exclusives:W184–W197

    Google Scholar 

  16. Cooper RA (2009) States with more health care spending have better-quality health care: lessons about Medicare. Health Aff 28:w103–w115

    Article  Google Scholar 

  17. Cooper RA (2009) States with more physicians have better-quality health care. Health Aff 28:w91–w102

    Article  Google Scholar 

  18. American College of Emergency Physicians (2006) On-call specialist coverage in U.S. Emergency Departments: ACEP survey of emergency department directors. American College of Emergency Physicians (Emergency Medicine Foundation). http://www3.acep.org/WorkArea/showcontent.aspx?id=33266. Accessed Apr 2006

  19. Menchine MD, Baraff LJ (2008) On-call specialists and higher level of care transfers in California emergency departments. Acad Emerg Med 15(4):329–336

    Article  PubMed  Google Scholar 

  20. Mohanty SA, Washington DL, Lambe S et al (2006) Predictors of on-call specialist response times in California emergency departments. Acad Emerg Med 13(5):505–512

    Article  PubMed  Google Scholar 

  21. Shively EH, Shively SA (2005) Threats to rural surgery. Am J Surg 190(2):200–205

    Article  PubMed  Google Scholar 

  22. Fuhrmans V (2009) Surgeon shortage pushes hospitals to hire temps. Wall St J:A1

    Google Scholar 

  23. Brown D (2009) Shortage of general surgeons endangers rural Americans. Washington Post:A1

    Google Scholar 

  24. Fischer JE (2007) The impending disappearance of the general surgeon. JAMA 298(18):2191–2193

    Article  PubMed  CAS  Google Scholar 

  25. Lynge DC, Larson EH, Thompson MJ et al (2008) A longitudinal analysis of the general surgery workforce in the United States, 1981–2005. Arch Surg 143(4):345–350, discussion 351

    Article  PubMed  Google Scholar 

  26. Doty B, Zuckerman R, Finlayson S et al (2008) General surgery at rural hospitals: a national survey of rural hospital administrators. Surgery 143(5):599–606

    Article  PubMed  Google Scholar 

  27. Cofer JB, Burns RP (2008) The developing crisis in the national general surgery workforce. J Am Coll Surg 206(5):790–795, discussion 795–797

    Article  PubMed  Google Scholar 

  28. Finlayson SR (2005) Surgery in rural America. Surg Innov 12(4):299–305

    Article  PubMed  Google Scholar 

  29. http://www.aha.org/aha/resource-center/Statistics-and-Studies/fast-facts.html. Accessed 20 Jan 2009

  30. DeLia D (2006) Annual bed statistics give a misleading picture of hospital surge capacity. Ann Emerg Med 48(4):384–388

    Article  PubMed  Google Scholar 

  31. Jeffers JR, Bognanno MF, Bartlett JC (1971) On the demand versus need for medical services and the concept of “shortage”. Am J Public Health 61(1):46–63

    Article  PubMed  CAS  Google Scholar 

  32. McNutt DR (1981) GMENAC: its manpower forecasting framework. Am J Public Health 71(1081279592):1116–1124

    Article  PubMed  CAS  Google Scholar 

  33. Etzioni DA, Liu JH, Maggard MA, Ko CY (2003) The aging population and its impact on the surgery workforce. Ann Surg 238(2): 170–177

    PubMed  Google Scholar 

  34. Cooper RA, Getzen TE, McKee HJ, Laud P (2002) Economic and demographic trends signal an impending physician shortage. Health Aff (Millwood) 21(121896737):140–154

    Article  Google Scholar 

  35. Reinhardt UE (2003) Does the aging of the population really drive the demand for health care? Health Aff (Millwood) 22(6):27–39

    Article  Google Scholar 

  36. Strunk BC, Ginsburg PB, Banker MI (2006) The effect of population aging on future hospital demand. Health Aff (Millwood) 25(3):w141–w149

    Article  Google Scholar 

  37. Poisal JA, Truffer C, Smith S et al (2007) Health spending projections through 2016: modest changes obscure part D’s impact. Health Aff (Millwood) 26(2):w242–w253

    Article  Google Scholar 

  38. Catlin A, Cowan C, Heffler S, Washington B (2007) National health spending in 2005: the slowdown continues. Health Aff (Millwood) 26(1):142–153

    Article  Google Scholar 

  39. Smith C, Cowan C, Heffler S, Catlin A (2006) National health spending in 2004: recent slowdown led by prescription drug spending. Health Aff (Millwood) 25(1):186–196

    Article  Google Scholar 

  40. Dill MJ, Salsberg E (2008) The complexities of physician supply and demand: projections through 2025. AAMC, Washington, DC

    Google Scholar 

  41. Salsberg E, Rockey PH, Rivers KL et al (2008) US residency training before and after the 1997 Balanced Budget Act. JAMA 300(10):1174–1180

    Article  PubMed  CAS  Google Scholar 

  42. American Association of Medical Colleges Statement on the Physician Workforce (2006). http://www.aamc.org/workforce/workforceposition.pdf. Accessed 26 Aug 2008

  43. AAMC (2008) Medical school enrollment plans: analysis of the 2007 AAMC survey. AAMC, Washington, DC

    Google Scholar 

  44. Dunn MR, Miller RS, Richter TH (1998) Graduate medical education, 1997–1998. JAMA 280(9):809–812, 836–845

    Article  PubMed  CAS  Google Scholar 

  45. Council on Graduate Medical Education (1994) Fourth report: recommendation to improve access to health care through physician workforce reform. U.S. Health Resources and Services Administration, Rockville, MD

    Google Scholar 

  46. Pew Health Professions Commission (1995) Critical challenges: revitalizing the health professions for the twenty-first century. The Third Report of the Pew Health Professions Commission. U.C.S.F. Center for the Health Professions, San Francisco

    Google Scholar 

  47. Institute of Medicine (2008) Resident duty hours: enhancing sleep, supervision, and safety. Institute of Medicine, Washington, DC

    Google Scholar 

  48. Dorsey ER, Jarjoura D, Rutecki GW (2005) The influence of controllable lifestyle and sex on the specialty choices of graduating U.S. medical students, 1996–2003. Acad Med 80(9):791–796

    Article  PubMed  Google Scholar 

  49. Hyman NH (2009) Attending work hour restrictions: is it time? Arch Surg 144(1):7–8

    Article  PubMed  Google Scholar 

  50. Liebhaber A, Grossman JM (2007) Physicians moving to mid-sized, single-specialty practices. Tracking Report, Center for Studying Health System Change, Washington, DC

    Google Scholar 

  51. Colleges Center for Workforce Studies (2006) Physician specialty data: a chart book. Center for Workforce Studies, American Association of Medical Colleges, Washington, DC

    Google Scholar 

  52. Rittenhouse DR, Mertz E, Keane D, Grumbach K (2004) No exit: an evaluation of measures of physician attrition. Health Serv Res 39(5):1571–1588

    Article  PubMed  Google Scholar 

  53. Kletke PR, Polsky D, Wozniak GD, Escarce JJ (2000) The effect of HMO penetration on physician retirement. Health Serv Res 35(5 Pt 3):17–31

    PubMed  CAS  Google Scholar 

  54. Stitzenberg KB, Sheldon GF (2005) Progressive specialization within general surgery: adding to the complexity of workforce planning. J Am Coll Surg 201(6):925–932

    Article  PubMed  Google Scholar 

  55. Anderson GF, Frogner BK (2008) Health spending in OECD countries: obtaining value per dollar. Health Aff (Millwood) 27(6):1718–1727

    Article  Google Scholar 

  56. Hussey PS, Anderson GF, Osborn R et al (2004) How does the quality of care compare in five countries? Health Aff (Millwood) 23(3):89–99

    Article  Google Scholar 

  57. Address delivered to the annual meeting of the Retirement Research Consortium, 7 August 2008.

    Google Scholar 

  58. Himmelstein DU, Woolhandler S, Wolfe SM (2004) Administrative waste in the U.S. health care system in 2003: the cost to the nation, the states, and the District of Columbia, with state-specific estimates of potential savings. Int J Health Serv 34(1):79–86

    Article  PubMed  Google Scholar 

  59. Weiner JP (1994) Forecasting the effects of health reform on US physician workforce requirement. Evidence from HMO staffing patterns. JAMA 272(3):222–230

    Article  PubMed  CAS  Google Scholar 

  60. AAMC (2008) The complexities of physician supply and demand: projections through 2025. AAMC, Washington, DC

    Google Scholar 

  61. http://www.socialsecurity.gov/policy/docs/chartbooks/fast_facts/2003/fast_facts03.html#chart36. Accessed 30 Mar 2009

  62. Berenson R, Hash M, Ault T et al (2008) Cost containment in medicare: a review of what works and what doesn’t. AARP Policy Institute, Washington, DC

    Google Scholar 

  63. http://thomas.loc.gov/medicare/. Accessed 30 Mar 2009

  64. Wennberg J, Gittelsohn A (1973) Small area variations in health care delivery. Science 182(117):1102–1108

    Article  PubMed  CAS  Google Scholar 

  65. Wennberg J, Gittelsohn A (1982) Variations in medical care among small areas. Sci Am 246(482199381):120–134

    Article  PubMed  CAS  Google Scholar 

  66. Birkmeyer JD, Sharp SM, Finlayson SR et al (1998) Variation profiles of common surgical procedures. Surgery 124(599040741): 917–923

    Article  PubMed  CAS  Google Scholar 

  67. Grumbach K (2002) The ramifications of specialty-dominated medicine. Health Aff (Millwood) 21(1):155–157

    Article  Google Scholar 

  68. Chassin MR, Galvin RW (1998) The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. JAMA 280(11):1000–1005

    Article  PubMed  CAS  Google Scholar 

  69. Sanghavi D (2008) Plenty of guidelines, but where’s the evidence? New York Times, 9 December 2008

    Google Scholar 

  70. Keyhani S, Kleinman LC, Rothschild M et al (2008) Overuse of tympanostomy tubes in New York metropolitan area: evidence from five hospital cohort. BMJ 337:a1607

    Article  PubMed  Google Scholar 

  71. Petersen LA, Normand SL, Leape LL, McNeil BJ (2003) Regionalization and the underuse of angiography in the Veterans Affairs Health Care System as compared with a fee-for-service system. N Engl J Med 348(2222658539):2209–2217

    Article  PubMed  Google Scholar 

  72. Jemal A, Thun MJ, Ries LA et al (2008) Annual report to the nation on the status of cancer, 1975–2005, featuring trends in lung cancer, tobacco use, and tobacco control. J Natl Cancer Inst 100(23):1672–1694

    Article  PubMed  Google Scholar 

  73. Chen AY, Daley J, Pappas TN et al (1998) Growing use of laparoscopic cholecystectomy in the national Veterans Affairs Surgical Risk Study: effects on volume, patient selection, and selected outcomes. Ann Surg 227(198105850):12–24

    Article  PubMed  CAS  Google Scholar 

  74. Escarce JJ, Chen W, Schwartz JS (1995) Falling cholecystectomy thresholds since the introduction of laparoscopic cholecystectomy. JAMA 273(2095264520):1581–1585

    Article  PubMed  CAS  Google Scholar 

  75. Etzioni DA, Mack TM, Beart RW Jr, Kaiser AM (2009) Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Ann Surg 249(2):210–217

    Article  PubMed  Google Scholar 

  76. Maggard MA, Yermilov I, Li Z et al (2008) Pregnancy and fertility following bariatric surgery: a systematic review. JAMA 300(19):2286–2296

    Article  PubMed  CAS  Google Scholar 

  77. Liu JH, Etzioni DA, O’Connell JB et al (2003) Inpatient surgery in California: 1990–2000. Arch Surg 138(10):1106–1111, discussion 1111–1112

    Article  PubMed  Google Scholar 

  78. Hooper CR (2008) Adding insult to injury: the healthcare brain drain. J Med Ethics 34(9):684–687

    Article  PubMed  CAS  Google Scholar 

  79. Wright D, Flis N, Gupta M (2008) The ‘Brain Drain’ of physicians: historical antecedents to an ethical debate, c. 1960–79. Philos Ethics Humanit Med 3:24

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Mayo Clinic Arizona, Mayo Clinic College of Medicine, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA

    David A. Etzioni

Authors
  1. David A. Etzioni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Clifford Y. Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David A. Etzioni .

Editor information

Editors and Affiliations

  1. School of Medicine, Department of Surgery, Yale University, New Haven, 06520, Connecticut, USA

    Ronnie Ann Rosenthal

  2. Downstate Medical Center, State University of New York, Clarkson Ave. 450, Brooklyn, 11203, New York, USA

    Michael E. Zenilman

  3. , Chairman, Department of Surgery, Sinai Hospital, 2401 West Belvedere Avenue, Baltimore, 21215, Maryland, USA

    Mark R. Katlic

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Etzioni, D.A., Ko, C.Y. (2011). Providing Surgical Care to an Aging Population: Implications for the Surgical Workforce. In: Rosenthal, R., Zenilman, M., Katlic, M. (eds) Principles and Practice of Geriatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-6999-6_12

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-6999-6_12

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-6998-9

  • Online ISBN: 978-1-4419-6999-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation