Surgical Workforce

Increasing evidence indicates a current and growing shortage of surgeons. This is a critical component of the crisis in healthcare because only surgeons are uniquely trained and qualified to provide certain necessary, lifesaving procedures.

Surgery is an essential element in the care of a community or region. In areas with an insufficient surgical workforce, patients in need of care must travel to a place with surgical capabilities, leading to delays in care and potentially suboptimal outcomes. A 2021 report released by the American Association of Medical Colleges projects shortages of 15,800-30,200 in all surgical specialties by 2034. The high cost of medical education contributes to this ongoing physician shortage. Physicians often accumulate immense student debt during their education, and then must undertake several years of residency training with low pay, during which time their student loans accrue significant interest. This financial burden poses a barrier for students wishing to pursue certain specialties, practice in underserved areas, or even enter the health care profession at all. ACS supports legislative efforts to reduce the burden of student loan debt on physicians. 

Non-compete agreements, also known as restrictive covenants, are provisions in employment contracts that can prohibit individuals from joining a competing firm or starting a new venture in the same field after leaving their employer. Non-competes are common in employment contracts, including those in the healthcare sector. Unfortunately, many employed surgeons are subject to contractual terms which include a restrictive covenant enforceable upon their voluntary separation or involuntary dismissal from employment, with or without cause. Studies have found that non-competes are often used even when they are illegal or unenforceable with a chilling effect on employee movement. The ACS maintains that surgeons should be free to practice where they choose. Prohibiting non-competes under federal law would provide surgeons with an option to work for a competitor, start a private practice, or even practice in an underserved area, rather than be forced to move hundreds of miles or forgo a professional opportunity.

As part of a multi-pronged effort to address workforce shortages, ACS successfully secured language in the FY 2019 appropriations bill that directed the Department of Health and Human Services (HHS), via Health Resources Services Administration (HRSA), to study access to general surgeons by underserved populations. In addition to the study, HRSA was directed to provide a report detailing potential surgical shortages, especially related to geographic location (i.e., rural, urban, and suburban). This congressionally mandated report released in 2020 found a maldistribution of the surgical workforce, with widespread and critical shortages of general surgeons particularly in rural areas. ACS believes that the current data highlights an urgent need to establish a surgical shortage designation. Having a surgical shortage designation will allow for better resource allocation and incentives to practice in areas where we know there are not enough general surgeons.

HRSA General Surgeon Projection Report

The Affordable Care Act (ACA) created a Medicare incentive payment program for major surgical procedures provided in health professional shortage areas (HPSAs) to increase and improve access to high-quality surgical care in rural and underserved areas. This initiative, called the HPSA Surgical Incentive Payment Program (HSIP), provided a payment incentive to surgeons who performed major operations—defined as those with a 10-day or 90-day global period under the Medicare Physician Fee Schedule—in a geographic HPSA. HPSAs are geographic areas that lack sufficient numbers of physicians to meet the healthcare needs of an area or population. HPSAs are designated by the Health Resources and Services Administration (HRSA). The HSIP program expired in 2015.

The American College of Surgeons urges Congress to reauthorize the HPSA Surgical Incentive Payment Program for a period of five years. A five-year reauthorization of the HSIP will provide general surgeons, who are a key element of rural, frontline care, with the additional support they need to recover after the crisis and continue serving rural communities.

The ACS maintains that broad reforms to the way in which Graduate Medical Education (GME) is funded and administered are long overdue and necessary to ensure that that we are able to produce a physician workforce capable of meeting the needs of our nation’s population. The ACS believes solutions must be flexible, nimble, patient-centric and, most importantly, evidenced-based. Specifically, the ACS strongly believes that obtaining accurate and actionable workforce data is a critical prerequisite to any GME reform efforts. In addition, we propose that a single stream of funds for both indirect medical education (IME) and direct graduate medical education (DGME), managed by a regional governance body accountable for receipt of those funds, could remedy much of the complexity inherent in the current system. Finally, in order to preserve the innovation and excellence for which our country’s medical system is known, GME should continue to be supported as a public good.

ACS response to Senate Finance Committee Request for Information on GME Reform (6/24/24)