Aging of America: Implications for the Surgical Workforce

  • Olga Jonasson
  • Francis Kwakwa


Aging of the American population will have a major impact on the surgical workload for most surgical specialties. During the next two decades it is estimated that the total population will grow by nearly 13%, even though the proportion of the population under the age of 20 will decline.1 The dramatic rise in the number of persons 65 years old and older is documented in many population studies,23 as is the increase in the number of the very old, 85 years and older.2


Aortic Aneurysm Familial Adenomatous Polyposis General Surgeon Minimal Access Thoracic Aortic Aneurysm 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Abt Associates. Reexamination of the Adequacy of Physician Supply Made in 1980 by the Graduate Medical Education National Advisory Committee for Selected Specialties. Final Report. BHPr, DHHS. Publ. No. HSRA 240–89–0041, 1991.Google Scholar
  2. 2.
    Aging America: Trends and Projections. An information paper to the Special Committee on Aging, United States Senate 101st Congress 2nd Session, Committee print S.PRT 101–80, February 1990. 1994.Google Scholar
  3. 3.
    Projections of the Population of the United States, by Age, Sex, and Race: 1983 to 2080. Washington, DC: US Department of Commerce, Series P-25, No. 952,1984.Google Scholar
  4. 4.
    Marder WD, Kletke PR, Silberger AB, Willke RJ. Physician Supply and Utilization by Specialty: Trends and Projections. Chicago: American Medical Association, 1988.Google Scholar
  5. 5.
    Council on Long Range Planning and Development: Report on the future of general surgery. JAMA 1989;262:3178–3183.Google Scholar
  6. 6.
    Jonasson O, Kwakwa F, Sheldon GF. Calculating the workforce in General Surgery. JAMA 1995;274:731–734.PubMedCrossRefGoogle Scholar
  7. 7.
    Kwakwa F. Unpublished data on certified general surgeons as of March 1993 extracted from the database of the American Board of Medical Specialties (ABMS), 1994.Google Scholar
  8. 8.
    Kwakwa F, Jonasson O. The general surgery workforce. Am J Surg 1997;173:59–62.PubMedCrossRefGoogle Scholar
  9. 9.
    Surgery in the United States: A Summary Report of the Study on Surgical Services for the United States (SOSSUS). Baltimore: American College of Surgeons and the American Surgical Association, 1975.Google Scholar
  10. 10.
    Donaldson WF. GMENAC, the numbers game. ACS Bull 1981; March:12–18.Google Scholar
  11. 11.
    Harris JE. How many doctors are enough. Health Aff (Millwood) 1986 Winter;5(4):73–83.CrossRefGoogle Scholar
  12. 12.
    Hart LG, Wagner E, Pirzada S, Nelson AF, Rosenblatt RA. Physician staffing ratios in staff-model HMOs: A cautionary tale. Health Aff (Millwood) 1997;16:55CrossRefGoogle Scholar
  13. 13.
    Weiner JP. The demand for physician services in a changing health care system: A synthesis. Med Care Rev 1994;50: 412–449.Google Scholar
  14. 14.
    Feil EC, Welch HG, Fisher ES. Why estimates of physician supply and requirements disagree. JAMA 1993;269:2659–2663.PubMedCrossRefGoogle Scholar
  15. 15.
    Iglehart JK. From physician shortage to patient shortage: The uncertain future of medical practice. Health Aff (Millwood) 1986 Fall;5(3):142–151.CrossRefGoogle Scholar
  16. 16.
    Graduate Medical Education National Advisory Committee: Summary Report to the Secretary, Department of Health and Human Services, vol 1. Publ. No. (HRA) 81–651. Hyattsville, MD: Health Resources Administration, 1980.Google Scholar
  17. 17.
    Perry HB, Detmer DE, Buchanan-Davidson DJ. Policy proposal for correcting the imbalance in general surgical manpower. Surgery 1984;95:243–248.PubMedGoogle Scholar
  18. 18.
    Kindig DA, Libby D. How will graduate medical education reform affect specialties and geographic areas? JAMA 1994; 272:37–42.PubMedCrossRefGoogle Scholar
  19. 19.
    Kwakwa F, Jonasson O. The longitudinal study of surgical residents, 1993–1994. J Am Coll Surg 1996;183:425–433.PubMedGoogle Scholar
  20. 20.
    Jonasson O, Kwakwa F. Retirement age and the work force in general surgery. Ann Surg 1996;224:574–582.PubMedCrossRefGoogle Scholar
  21. 21.
    Witte CL. Is vagotomy and gastrectomy still justified for gastroduodenal ulcer? J Clin Gastroenterol 1995;20:2–3.PubMedCrossRefGoogle Scholar
  22. 22.
    Labenz J, Borsch G. Highly significant change of the clinical course of relapsing and complicated peptic ulcer disease after cure of Helicobacter pylori infection. Am J Gastroenterol 1994;89:1785–1788.PubMedGoogle Scholar
  23. 23.
    Axon A. Helicobacter gastroduodenitis: a serious infectious disease. Br Med J 1997;314:1430–1431.CrossRefGoogle Scholar
  24. 24.
    Escarce JJ, Chen W, Schwartz JS. Falling cholecystectomy thresholds since the introduction of laparoscopic cholecystectomy. JAMA 1995;273:1581–1585.PubMedCrossRefGoogle Scholar
  25. 25.
    Milheiro A, Castro Sousa F, Oliveira L, João Matos M. Pulmonary function after laparoscopic cholecystectomy in the elderly. Br J Surg 1996;83:1059–1061.PubMedCrossRefGoogle Scholar
  26. 26.
    Johnson A. Laparoscopic surgery. Lancet 1997;349:631–635.PubMedCrossRefGoogle Scholar
  27. 27.
    Winawer SJ, Fletcher RH, Miller L, Godlee F, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 1997;112:594–642.PubMedCrossRefGoogle Scholar
  28. 28.
    Giardiello FM, Brensinger JD, Petersen GM, et al. The use and interpretation of commercial APC gene testing for familial adenomatous polyposis. N Engl J Med 1997; 336: 823–827.PubMedCrossRefGoogle Scholar
  29. 29.
    Health Care Financing Administration, Bureau of Data Management and Strategy. 1995 Medicare Part B Procedure Summary File. Washington, DC: US Department of Health and Human Services, June 30,1996.Google Scholar
  30. 30.
    Henderson IC. Risk factors for breast cancer development. Cancer 1993;71(suppl):2127–2140.PubMedCrossRefGoogle Scholar
  31. 31.
    Bassett L, Winchester DP, Caplan RB, et al. Stereotactic core-needle biopsy of the breast: a report of the joint task force of the American College of Radiology, American College of Surgeons, and College of American Pathologists. CA Cancer J Clin 1997;47:171–190.PubMedCrossRefGoogle Scholar
  32. 32.
    Staren ED, Sabel MS, Gianakakis LM, et al. Cryosurgery of breast cancer. Arch Surg 1997;132:28–33.PubMedCrossRefGoogle Scholar
  33. 33.
    Yusuf SW, Baker DM, Chuter TAM, Whitaker SC, Wenham PW, Hopkinson BR. Transfemoral endoluminal repair of abdominal aortic aneurysm with bifurcated graft. Lancet 1994;344:650–651.PubMedCrossRefGoogle Scholar
  34. 34.
    Parodi JC. Endo vascular repair of aortic aneurysms, arteriovenous fistulas, and false aneurysms. World J Surg 1996; 20:655–663.PubMedCrossRefGoogle Scholar
  35. 35.
    Perry MO. What’s new in vascular surgery. J Am Coll Surg 1997;184:223–232.PubMedGoogle Scholar
  36. 36.
    Ginzberg E, Ostow M. Managed care: a look back and a look ahead. N Engl J Med 1997;336:1018–1020.PubMedCrossRefGoogle Scholar
  37. 37.
    Bureau of Health Professions, U.S. Department of Health and Human Services. National Conference, Estimating Medical Specialty Supply and Requirements in a Changing Health Care Environment: The Technical Challenge. Washington, DC: DHHS, March 27–28, 1995.Google Scholar
  38. 38.
    National Health Policy Reform: The Rural Perspective. Kansas City, MO: National Rural Health Association, 1992.Google Scholar
  39. 39.
    Health Care in Rural America. Office of Technology Assessment (OTA), Publ. No. OTA-H-434. Washington, DC: Government Printing Office, 1990.Google Scholar
  40. 40.
    Staff Report, Special Committee on Aging, United States Senate. The Rural Health Care Challenge. Washington, DC: Government Printing Office, 1988:100–145.Google Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Olga Jonasson
  • Francis Kwakwa

There are no affiliations available

Personalised recommendations