Ricketts Thomas C, Adamson William T, Fraher Erin P, Knapton Andy, Geiger James D, Abdullah Fizan, Klein Michael D
*Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC †University of North Carolina, Chapel Hill School of Medicine ‡Departments of Family Medicine and Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC §SMAP, Limited, Winchester, England ¶University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI ||Ann and Robert Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL **Children's Hospital of Michigan, Detroit, MI.
Ann Surg. 2017 Mar;265(3):609-615. doi: 10.1097/SLA.0000000000001810.
To describe the future supply and demand for pediatric surgeons using a physician supply model to determine what the future supply of pediatric surgeons will be over the next decade and a half and to compare that projected supply with potential indicators of demand and the growth of other subspecialties.
Anticipating the supply of physicians and surgeons in the future has met with varying levels of success. However, there remains a need to anticipate supply given the rapid growth of specialty and subspecialty fellowships. This analysis is intended to support decision making on the size of future fellowships in pediatric surgery.
The model used in the study is an adaptation of the FutureDocs physician supply and need tool developed to anticipate future supply and need for all physician specialties. Data from national inventories of physicians by specialty, age, sex, activity, and location are combined with data from residency and fellowship programs and accrediting bodies in an agent-based or microsimulation projection model that considers movement into and among specialties. Exits from practice and the geographic distribution of physician and the patient population are also included in the model. Three scenarios for the annual entry into pediatric surgery fellowships (28, 34, and 56) are modeled and their effects on supply through 2030 are presented.
The FutureDocs model predicts a very rapid growth of the supply of surgeons who treat pediatric patients-including general pediatric surgeon and focused subspecialties. The supply of all pediatric surgeons will grow relatively rapidly through 2030 under current conditions. That growth is much faster than the rate of growth of the pediatric population. The volume of complex surgical cases will likely match this population growth rate meaning there will be many more surgeons trained for those procedures. The current entry rate into pediatric surgery fellowships (34 per year) will result in a slowing of growth after 2025, a rate of 56 will generate a continued growth through 2030 with a likely plateau after 2035.
The rate of entry into pediatric surgery will continue to exceed population growth through 2030 under two likely scenarios. The very rapid anticipated growth in focused pediatric subspecialties will likely prove challenging to surgeons wishing to maintain their skills with complex cases as a larger and more diverse group of surgeons will also seek to care for many of the conditions and patients which the general pediatric surgeons and general surgeons now see. This means controlling the numbers of pediatric surgery fellowships in a way that recognizes problems with distribution, the volume of cases available to maintain proficiency, and the dynamics of retirement and shifts into other specialty practice.
使用医生供应模型描述儿科外科医生未来的供需情况，以确定未来十五年儿科外科医生的供应情况，并将预测的供应与需求的潜在指标以及其他亚专业的增长情况进行比较。
预测未来医生和外科医生的供应取得了不同程度的成功。然而，鉴于专科和亚专科住院医师培训的快速增长，仍有必要预测供应情况。本分析旨在支持关于未来儿科外科住院医师培训规模的决策。
本研究使用的模型是对“未来医生”医生供应与需求工具的改编，该工具用于预测所有医生专科的未来供应与需求。按专科、年龄、性别、活动和地点分类的全国医生库存数据，与来自住院医师和专科医师培训项目以及认证机构的数据相结合，纳入基于主体或微观模拟的预测模型，该模型考虑了各专科之间的流动情况。医生退出执业以及医生和患者群体的地理分布也包含在模型中。对每年进入儿科外科专科医师培训的三种情况（28人、34人和56人）进行建模，并展示其对到2030年供应情况的影响。
“未来医生”模型预测，治疗儿科患者的外科医生供应将迅速增长，包括普通儿科外科医生和专注的亚专科医生。在当前情况下，到2030年所有儿科外科医生的供应将相对快速增长。这种增长速度远快于儿科人口的增长速度。复杂外科病例的数量可能与该人口增长率相匹配，这意味着将有更多接受过这些手术培训的外科医生。目前进入儿科外科专科医师培训的比率（每年34人）将导致2025年后增长放缓，每年56人的比率将使供应到2030年持续增长，并可能在2035年后趋于平稳。
在两种可能的情况下，到203年进入儿科外科的比率将继续超过人口增长速度。预计专注的儿科亚专科将迅速增长，这可能给希望保持处理复杂病例技能的外科医生带来挑战，因为更多不同类型的外科医生也将寻求诊治许多目前普通儿科外科医生和普通外科医生所处理的病症和患者。这意味着要以一种认识到分布问题、维持熟练程度所需病例数量以及退休和转向其他专科执业动态的方式来控制儿科外科专科医师培训的人数。
