The American College of Surgeons and GME. David B. Hoyt, MD FACS Executive Director American College of Surgeons Chicago, IL

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1 The American College of Surgeons and GME David B. Hoyt, MD FACS Executive Director American College of Surgeons Chicago, IL

2 Forces at work Quality and Professionalism Cost and Payment Workforce and training what are the challenges and solutions

3 Professionalism = Accountability

4 Surgeons 160,000 Overall Supply of Surgeons Projected to Decline 149,207 Projected Surgeon Supply, , , , ,000 80, ,197 91,883 60,000 40,000 20,000 Headcount FTE 18% Reduction in Headcount and 16% Reduction in FTE, Year Source: Fraher E, Knapton ASource: Fraer E, Knapton A, Sheldon GF, Meyer AA, Ricketts TC. Projecting Surgeon Supply Using a Dynamic Model. Annals of Surgery. (in press)

5 Declines in Surgical Workforce More Rapid than HRSA s Previous Projections Relative Change in Physician FTE from Surgical Specialty Change in FTE HRSA Physician Supply Model 1 Sheps/ACS Model Surgery -2, Colorectal Surgery Pediatric Surgery Thoracic Surgery Vascular Surgery Sub-Total Surgery -2, Neurosurgery Ob/Gyn. -3, Orthopedic -1, Ophthalmology -2, Otolaryngology Plastics Urology -1, All Surgery -13, Source: Fraher E, Knapton A, Sheldon GF, Meyer AA, Ricketts TC. Projecting Surgeon Supply Using a Dynamic Model. Annals of Surgery. (in press)

6 Headcount Proposed Changes to GME Will Not Solve Supply Issues 160, , , ,000 Effect of Proposed Changes to GME on Surgeon Supply 157,048 No change in GME 1% growth for 3 years (COGME 16 rebased to 2012) 5% decrease for 3 years then stable (per Deficit Reduction Commission) 15% increase between 2013 & 2017 (Nelson, Shumer, Reid) 140, , , , , , , , , Year Source: Fraher E, Knapton ASource: Fraer E, Knapton A, Sheldon GF, Meyer AA, Ricketts TC. Projecting Surgeon Supply Using a Dynamic Model. Annals of Surgery. (in press) Source: Fraher E, Knapton A, Sheldon GF, Meyer AA, Ricketts TC. Projecting Surgeon Supply Using a Dynamic Model. Annals of Surgery. (in press)

7 Need to Address Maldistribution In 2009: 959 counties did not have a surgeon. 9.7 million people lived in these counties. (959) Updated from Belsky D, Ricketts T, Poley S, Gaul K, Fraher E, Sheldon G. Surgical Deserts in the US: Places Without Surgeons. Chapel Hill, North Carolina. American College of Surgeons Health Policy Research Institute, July

8 General Surgical Residency Issues Undergraduate Preparation: 3 rd and fourth year under-utilized Impact of 80 hour work week 1 year lost, resident education and patient safety worse or unchanged > 75% Residents' Response to Duty-Hour Regulations A Follow-up National Survey Brian C. Drolet, M.D., Derrick A. Christopher, M.D., M.B.A., and Staci A. Fischer, M.D.N Engl J Med 2012; 366:e35 June 14, 2012

9 General Surgical Residency Issues Reduced breadth and complexity of operative experience Near elimination of peptic ulcer disease and related gastric surgery Elimination of biliary tree and portal vein surgery Endovascular revolution has markedly reduced open vascular procedures Reduction in trauma operative experience Laparoscopic v. open surgery Open surgery has markedly decreased but has not been replaced by comparable laparoscopic surgery

10 General Surgical Residency Issues Reduced opportunity for autonomy and independent decision making at senior levels Perception: need for further training Decline in oral certifying examination performance and confidence FAIL RATE (%) ABS EXAMINATION FAIL RATES BY YEAR QE CE YEAR

11 ASA Recommendations on GS Workforce Shortfalls Increase size of accredited surgery residencies Select resident candidates (in part) based on commitment to General Surgery Increase flexibility and breadth in general surgery training Enhance links with community-based hospitals Seek loan forgiveness for general surgeons Polk HC Jr, Bland KI, Ellison EC, Grosfeld J. Trunkey DD, Stain SC, Townsend CM. A Proposal for Enhancing the General Surgical Workforce and Access to Surgical Care. Annals of Surgery. 255(4): April 2012.

12 ACS Strategic Programs ACS Transition to Practice Develop 4 th Year Surgical Transition Training PGY-1 Certification of Practice Competency to Allow Earlier Independence of Practice ACS Transition to Practice Fellowship Sixth Year with independence Need ACGME, RRC s Support

13 Payment Issues Transition gaps will require: More Work in 4 th Year More Work for Extra Year More Direct Teaching Overall expenses will increase All payer proposals a possibility Senior Resident Billing Post PGY-4??? GME Dollars: Spent For Teaching and Direct to Program Directors

14 The Public Trust