title: Maryland's surgical workforce-2007: an in-depth analysis and implications for the future.
abstract: BACKGROUND
  Critical decisions about the future supply of surgeons must be based on an accurate assessment of current surgical manpower. This study examined the demographics and clinical activities of seven surgical subspecialty groups on the frontlines of health care in Maryland. These data are compared with those customarily quoted in the literature, and the implications of these findings are discussed.
  
  
  METHODS
  Clinical activity of surgeons versus administrative, teaching, research, and other obligations was determined after interviews with medical directors in all of Maryland's 52 acute care hospitals. Additional information was obtained from residency program directors, chairmen, and others, if necessary. Data were stratified by specialty, location of practice, and age of surgeon.
  
  
  RESULTS
  Data were analyzed for general, orthopaedic, ENT, vascular, and noncardiac thoracic surgeons, neurosurgeons, and urologists. Surgeons in rural western, eastern, and southern regions spent 86.3% of their time in care of patients compared with 70.3% for surgeons in urban, suburban, or teaching settings. Across the state, the number of surgeons providing care to patients per 100,000 residents was below reported requirements in general surgery, vascular, and noncardiac surgery. Overall, 40.3% of surgeons were 55 years or older in 2007.
  
  
  CONCLUSIONS
  Critical shortages of qualified surgeons currently exist in many regions of Maryland, especially in rural regions. Administrative, teaching, and research activities significantly reduce the amount of time surgeons are able to devote to patient care, particularly in academic and suburban settings. Fewer surgeons are available to care for patients in Maryland, and they are significantly older than assumed in manpower databases. Access to surgical care in Maryland will be jeopardized if these issues are not considered in future health care workforce discussions.
authors.affiliation: The Sandra and Malcolm Berman Comprehensive Breast Care Center, Greater Baltimore Medical Center, Baltimore, MD 21204, USA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Maizel