title: Colorectal procedures: what proportion is performed by American board of colon and rectal surgery-certified surgeons?
abstract: OBJECTIVE
  The surgical workforce within the United States is moving rapidly toward increasing subspecialization. We hypothesized that over time an increasing proportion of colorectal procedures is performed by subspecialty-trained colorectal surgeons.
  
  
  METHODS
  We used data from the Surveillance, Epidemiology, and End Results-Medicare program to examine the treatment of patients who underwent a colorectal surgical procedure between 1992 and 2002. We established whether the surgeon responsible for the patient's initial care was a board-certified colorectal surgeon based on a linkage with 2 overlapping data sources: 1) historical data from the American Board of Colon and Rectal Surgery and 2) the American Medical Association Physician Masterfile.
  
  
  RESULTS
  We examined a total of 104,636 procedures; overall, 30.6% of anorectal procedures, 22.0% of proctectomies, 14.0% of ostomy-related procedures, and 11.5% of colectomies were performed by board-certified colorectal surgeons. Procedures in regions with lower population density or during urgent/emergent hospitalizations were more likely to be performed by a noncolorectal surgeon. Operations for cancer and those performed on an elective basis were more likely to be performed by a board-certified colorectal surgeon. Over time, the proportion of each of these types of cases performed by a colorectal surgeon increased. This increase was fastest for anorectal procedures.
  
  
  CONCLUSIONS
  During the 11-year period of our study, there was a significant increase in the proportion of colorectal surgical procedures performed by board-certified colorectal surgeons.
authors.affiliation: Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA. etzioni.david@gmail.com
authors.forename: David A
authors.initials: DA
authors.lastname: Etzioni
authors.forename: Rebecca R
authors.initials: RR
authors.lastname: Cannom
authors.forename: Robert D
authors.initials: RD
authors.lastname: Madoff
authors.forename: Glenn T
authors.initials: GT
authors.lastname: Ault
authors.forename: Robert W
authors.initials: RW
authors.lastname: Beart
mesh_terms: D000368:Aged; D002321:Career Choice; D002568:Certification; D002983:Clinical Competence; D003108:Colonic Diseases / Q000453:epidemiology / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000601:surgery; D003107:Colorectal Surgery / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012002:Rectal Diseases / Q000453:epidemiology / Q000601:surgery*; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D000078329:Workforce