title: Evolving patterns of vascular surgery care in the United States: a report from the American Board of Surgery.
abstract: BACKGROUND
  The purpose of this study was to analyze the distribution of major vascular procedures among general and vascular surgeons and to compare the evolution of vascular surgical practice of general and vascular surgeons at specific points in their careers.
  
  
  METHODS
  Case logs of surgeons seeking recertification in surgery from 2007 to 2009 were reviewed. Data from 3,362 physicians certified only in surgery (GS) were compared with 363 additionally certified in vascular surgery (VS). Independent variables were compared using factorial ANOVA.
  
  
  RESULTS
  The mean numbers of major vascular procedures (±SD) were 10 ± 51 for GS and 192 ± 209 for VS (p < 0.001). Thirty-three percent of the total vascular procedures reported were performed by GS. Compared with VS, GS performed significantly fewer vascular procedures in all major procedure categories, and GS certifying at 10 years performed fewer vascular procedures (6.7 ± 47) than those recertifying at 20 years (11.5 ± 48) and 30 years (13.6 ± 59) (p < 0.01). In contrast, VS certifying at 10 years performed more vascular procedures (235 ± 237) compared with those recertifying at 20 years (157 ± 173) and 30 years (104 ± 115). The mean number of vascular procedures was not different for sex, geographic location, or practice type, after controlling for other variables in the study.
  
  
  CONCLUSIONS
  The majority of GS currently do not perform any major vascular procedures, and younger GS are performing fewer such procedures than their older counterparts. The opposite is true for VS. These opposing trends indicate that vascular procedures are shifting from GS to VS in modern surgical practice, and this may have important implications for patient access to vascular surgery care, considering the limited capacity for VS to assume the excess case load.
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. james.valentine@utsouthwestern.edu
authors.forename: R James
authors.initials: RJ
authors.lastname: Valentine
authors.forename: Robert S
authors.initials: RS
authors.lastname: Rhodes
authors.forename: Andrew
authors.initials: A
authors.lastname: Jones
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Biester
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001014:Aortic Aneurysm / Q000601:surgery; D002560:Cerebrovascular Circulation; D002568:Certification; D015986:Confounding Factors, Epidemiologic; D057510:Endovascular Procedures / Q000706:statistics & numerical data; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends*; D012424:Rural Population / Q000706:statistics & numerical data; D013044:Specialty Boards; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data / Q000639:trends; D013997:Time Factors; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data* / Q000639:trends*; D057772:Vascular System Injuries / Q000601:surgery