title: The general surgery workforce shortage is worse when assessed at county level.
abstract: BACKGROUND
  Multiple studies have documented a significant decrease in the general surgery workforce in the United States, both rural and urban, for the past 3 decades. This 11-year study evaluates the Texas general surgery workforce at both the state and local level in 2002 and 2012.
  
  
  METHODS
  Data were obtained from the Texas Medical Board, the United States Census Bureau/Texas State Library and Archives Commission, and the Texas Department of State Health Services for 2002 and 2012. A benchmark target of 7 general surgeons per 100,000 population was used.
  
  
  RESULTS
  During the study period, the Texas population increased 21%, and actively practicing physicians increased 44%. All surgical specialists increased by 26%. General surgeons increased 4%; however, the number of general surgeons per 100,000 population decreased 14% (from 6.7 to 5.8/10(5)). Using the total Texas population for 2012, an additional 329 general surgeons are needed by benchmark standards. However, when analyzed by individual county population, 449 additional general surgeons are needed in the individual counties. These effects were greater in the nonmetropolitan areas of Texas where per capita general surgeons decreased by 21%.
  
  
  CONCLUSIONS
  The absolute increase in Texas general surgeons over the past decade has not kept pace with an increase in the Texas population. The general surgery workforce deficit based on the Texas state population underestimates the local workforce shortage, particularly in the nonmetropolitan areas of Texas.
authors.affiliation: Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; University Hospital, San Antonio, TX, USA. Electronic address: stewartr@uthscsa.edu.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Stewart
authors.forename: Lillian F
authors.initials: LF
authors.lastname: Liao
authors.forename: Molly
authors.initials: M
authors.lastname: West
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Sirinek
mesh_terms: D013502:General Surgery; D006280:Health Workforce / Q000706:statistics & numerical data*; D006801:Humans; D010820:Physicians / Q000600:supply & distribution*; D012424:Rural Population; D013781:Texas
keywords: General surgery; Physician recruitment and retention; Rural; Surgery; Texas; Workforce