Grover Atul, Gorman Karyn, Dall Timothy M, Jonas Richard, Lytle Bruce, Shemin Richard, Wood Douglas, Kron Irving
Director, Government Relations, Association of American Medical Colleges, 2450 N St NW, Washington, DC 20037, USA.
Circulation. 2009 Aug 11;120(6):488-94. doi: 10.1161/CIRCULATIONAHA.108.776278. Epub 2009 Jul 27.
Even as the burden of cardiovascular disease in the United States is increasing as the population grows and ages, the number of active cardiothoracic surgeons has fallen for the first time in 20 years. Meanwhile, the treatment of patients with coronary artery disease continues to evolve amid uncertain changes in technology. This study evaluates current and future requirements for cardiothoracic surgeons in light of decreasing rates of coronary artery bypass grafting procedures.
Projections of supply and demand for cardiothoracic surgeons are based on analysis of population, physician office, hospital, and physician data sets to estimate current patterns of healthcare use and delivery. Using a simulation model, we project the future supply of cardiothoracic surgeons under alternative assumptions about the number of new fellows trained each year. Future demand is modeled, taking into account patient demographics, under current and alternative use rates that include the elimination of open revascularization. By 2025, the demand for cardiothoracic surgeons could increase by 46% on the basis of population growth and aging if current healthcare use and service delivery patterns continue. Even with complete elimination of coronary artery bypass grafting, there is a projected shortfall of cardiothoracic surgeons because the active supply is projected to decrease 21% over the same time period as a result of retirement and declining entrants.
The United States is facing a shortage of cardiothoracic surgeons within the next 10 years, which could diminish quality of care if non-board-certified physicians expand their role in cardiothoracic surgery or if patients must delay appropriate care because of a shortage of well-trained surgeons.
随着美国人口的增长和老龄化，心血管疾病的负担日益加重，然而活跃的心胸外科医生数量却在20年来首次下降。与此同时，在技术发生不确定变化的情况下，冠心病患者的治疗仍在不断发展。本研究根据冠状动脉搭桥手术率的下降情况，评估了当前及未来对心胸外科医生的需求。
对心胸外科医生供需情况的预测基于对人口、医生办公室、医院和医生数据集的分析，以估计当前的医疗使用和服务模式。我们使用一个模拟模型，在关于每年新培训学员数量的不同假设下，预测未来心胸外科医生的供应情况。考虑到患者人口统计学特征，在当前及包括取消开放式血运重建在内的不同使用率情况下，对未来需求进行建模。如果当前的医疗使用和服务提供模式持续下去，到2025年，基于人口增长和老龄化，对心胸外科医生的需求可能会增加46%。即使完全取消冠状动脉搭桥手术，预计心胸外科医生仍会短缺，因为由于退休和新入职人数下降，同期活跃供应预计将减少21%。
美国在未来10年内将面临心胸外科医生短缺的问题，如果非委员会认证的医生在心胸外科手术中扩大其作用，或者患者因缺乏训练有素的外科医生而不得不推迟适当治疗，这可能会降低医疗质量。
