The Maturation of a Specialty: Workforce Projections for Endocrine Surgery Julie Ann Sosa, MA, MD, FACS Associate Professor of Surgery Sections of Oncologic and Endocrine Surgery Yale University School of Medicine New Haven, CT
Rising incidence of endocrine disease
6.6% of US population
Thyroid cancer: 1.5% of all new cancers
240% increase over 30 yrs
Fastest growing cancer in women
1.5% Americans ≥65 yrs (3.9 million)
Adrenal incidentalomas: 5-12% of CTs, autopsies
Many endocrine diseases are treated surgically.
Minimally invasive surgery under local anesthesia in the outpatient setting.
Laparoscopy has improved outcomes.
Volume : Outcome Association
High-volume surgeons have better outcomes.
Shorter length of hospital stay
Lower hospital costs
Better outcomes for:
(Sosa et al, 2007, 2008 using HCUP)
Volume: Cost Association
Volume: Length of Stay Association
Volume: Complication Rate Association
Disparities in Outcomes
Inequity in access to high-volume surgeons
Elderly and super-elderly
Lower socioeconomic status
Southern U.S., rural areas
Government insurance (Medicare, Medicaid)
- Sosa et al 2007, 2008 using HCUP
Access to High-Volume Surgeons, By Race
Access to High-Volume Surgeons, By Geographic Region
Despite more specialty-trained endocrine surgeons, the increasing incidence of endocrine disorders raises the question:
Will there continue to be compromised
access to high-volume endocrine surgeons?
To project endocrine surgeon supply and demand over the next several decades in the U.S.
Methods - Supply
Survey of endocrine surgery fellows
Clinical experience during residency, fellowship, practice
General surgery residency – ACGME
Endocrine surgery experience
Surgeon volume of endocrine procedures in the U.S.
Comparison of Endocrine Surgery Experience
Volume distribution of surgeons performing endocrine procedures, 2004 * 75 18 6 1 24 25 25 26 *Using HCUP dataset
Methods - Demand
U.S. Census Bureau population projections
HCUP-NIS / SEER (Surveillance, Epidemiology, and End Results)
Procedures abstracted using ICD-9 procedure,diagnosis codes
Incidence rates for benign and malignant disease
Annual retirement rate of 2.3%
Projected number of specialty-trained endocrine surgeons
U.S. Census bureau population projections
Changes in disease incidence
Projected numbers of high-volume endocrine surgeons in the U.S., 2004-2030
Age-adjusted estimates of endocrine procedures in the U.S., 2000-2030
Projections of total endocrine procedures performed in the U.S., 2004-2030
Incidence of endocrine disease will continue to increase.
Specialty-trained endocrine surgeons will increase in number, but
The majority of endocrine procedures will continue to be performed by lower-volume surgeons.
Implications: Graduate Medical Education
Standardization of training across endocrine surgery fellowships
Patient, provider education
NY State cardiac reporting system: publicly available data on mortality following CABG by hospital, surgeon