title: Estimating the need for hepato-pancreatico-biliary surgeons in the USA.
abstract: BACKGROUND
  Hepato-pancreatico-biliary (HPB) fellowship training has risen in popularity in recent years and hence large numbers of graduating fellows enter the workforce each year. Studies have proposed that the increase in HPB-trained surgeons will outgrow demand in the USA. This study shows that the need for HPB-trained surgeons refers not to the meeting of demand in terms of case volume, but to improving patient access to care.
  
  
  METHODS
  The National Inpatient Sample (NIS) database for the years 2005-2011 was queried for CPT codes relating to pancreatic, liver and biliary surgical cases. These numbered 6627 in 2005 and increased to 8515 in 2011. Cases were then mapped to corresponding states. The number of procedures in an individual state was divided by the total number of procedures to give a ratio for each state. A similar ratio was calculated for the population of each state to the national population. These ratios were combined to give a ratio by state of observed to expected HPB surgical cases.
  
  
  RESULTS
  Of the 46 states that participate in the NIS, only 18 achieved ratios of observed to expected cases of >1. In the remaining 28 states, the number of procedures was lower than that expected according to each state's population.
  
  
  CONCLUSIONS
  The majority of the USA is underserved in terms of HPB surgery. Given the growing number of HPB-trained physicians entering the job market, this sector should focus on bringing understanding and management of complex disease to areas of the country that are currently in need.
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Noaman
authors.initials: N
authors.lastname: Ali
authors.forename: Colin
authors.initials: C
authors.lastname: O'Rourke
authors.forename: Kevin
authors.initials: K
authors.lastname: El-Hayek
authors.forename: Sricharan
authors.initials: S
authors.lastname: Chalikonda
authors.forename: D Rohan
authors.initials: DR
authors.lastname: Jeyarajah
authors.forename: R Matthew
authors.initials: RM
authors.lastname: Walsh
mesh_terms: D002391:Catchment Area, Health; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000639:trends*; D005544:Forecasting; D005762:Gastroenterology / Q000639:trends*; D006301:Health Services Needs and Demand / Q000639:trends*; D061847:Hospitals, High-Volume / Q000639:trends; D006801:Humans; D020380:Needs Assessment / Q000639:trends*; D013038:Specialization / Q000639:trends*; D066231:Surgeons / Q000600:supply & distribution* / Q000639:trends*; D013997:Time Factors; D014481:United States; D000078329:Workforce