title: General surgeon workforce in Tennessee in the era of the Affordable Care Act.
abstract: BACKGROUND
  The Affordable Care Act of (ACA) 2010 may result in an increase in demand for surgery and may exacerbate any existing surgeon shortage. The purpose of this study was to examine factors associated with general surgeon workforce within counties in Tennessee in light of the ACA.
  
  
  METHODS
  The Area Resource File for 2011 was utilized for this study. Counties with less than 3 active surgeons/100,000 persons were classified as shortage counties (SC). Counties with more than 6 active surgeons/100,000 persons were considered over-supply counties (OC). Demographic factors for each county were determined. Univariate and multivariable analysis was used to determine factors associated with SC.
  
  
  RESULTS
  There are 95 counties in the state and 45.3% were SC and 33.7% were OC. Sixty-nine (72.6%) of the counties had at least one hospital and 57 (60%) were in non-metro counties. Multivariable logistic regression analysis revealed that increasing percent uninsured in a county was positively associated with a SC. No other factors were associated with SC. To meet the cutoff of three surgeons per 100,000 in SC 23 general surgeons would be required. There was an excess of 219 general surgeons in OCs.
  
  
  CONCLUSIONS
  There appears to be an adequate supply of general surgeons but a maldistribution exists, particularly if demand increases with the implementation of the ACA. If redistribution of surgeons does not occur through natural changes in supply and demand, careful policy changes may be considered to encourage redistribution of surgeon resources to meet demand in counties that are currently underserved.
authors.affiliation: The Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Jerkins
authors.forename: Ben L
authors.initials: BL
authors.lastname: Zarzaur
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Fabian
mesh_terms: D013502:General Surgery; D006295:Health Resources / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data; D008507:Medically Underserved Area; D008962:Models, Theoretical; D015999:Multivariate Analysis; D058991:Patient Protection and Affordable Care Act; D010820:Physicians / Q000600:supply & distribution*; D013714:Tennessee; D000078329:Workforce
keywords: Affordable Care Act; Health care reform; Surgeon workforce