title: Mapping endocrine surgery: Workforce analysis from the last six decades.
abstract: BACKGROUND
  We analyzed the demographics of high-volume surgeons (HVS) for endocrine operations.
  
  
  METHODS
  We characterized HVS by region, specialty, gender, teaching-affiliation, American Association of Endocrine Surgeons (AAES) membership, and decade they entered practice. Providers were general surgeons (GS) and otolaryngologists (ENT); fellowship trained (FT) or not FT (NFT).
  
  
  RESULTS
  We identified 395 HVS in 47 states entering practice between 1958 and 2011. Sixty-eight percent were GS, 35% were FT, and 35% were AAES members. GS, FT surgeons, and endocrine surgery FT surgeons (ES) performed more operations per surgeon. More FT surgeons were in Northeast, West (W), and Midwest than Southeast (SE) and Southwest (SW; P < .0001). More teaching surgeons and AAES members were in the Northeast and Midwest than SE, W, and SW (P < .0001). FT-GS increased over decades (P < .0001) but not FT-ENT (P = .3). Representation of ES, AAES members, and females increased over decades (P < .0001).
  
  
  CONCLUSIONS
  The workforce for endocrine operations displayed increased representation of GS, FT surgeons, and women, correlating with the profile of recent AAES fellowship graduates. More insight is needed to understand why most HVS were not AAES members. Regional disparities can guide the placement of endocrine surgeons into both academic and community practices, increasing trainee exposure and patient access to specialty care.
authors.affiliation: Department of Endocrine Surgery, Endocrinology and Metabolism Institute, The Cleveland Clinic, Cleveland, OH. Electronic address: vikramdk83@gmail.com.
authors.forename: Vikram D
authors.initials: VD
authors.lastname: Krishnamurthy
authors.affiliation: Department of Endocrine Surgery, Endocrinology and Metabolism Institute, The Cleveland Clinic, Cleveland, OH.
authors.forename: Judy
authors.initials: J
authors.lastname: Jin
authors.affiliation: Department of Endocrine Surgery, Endocrinology and Metabolism Institute, The Cleveland Clinic, Cleveland, OH.
authors.forename: Allan
authors.initials: A
authors.lastname: Siperstein
authors.affiliation: Department of Endocrine Surgery, Endocrinology and Metabolism Institute, The Cleveland Clinic, Cleveland, OH.
authors.forename: Joyce J
authors.initials: JJ
authors.lastname: Shin
mesh_terms: D013507:Endocrine Surgical Procedures / Q000706:statistics & numerical data*; D005257:Fellowships and Scholarships / Q000706:statistics & numerical data; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data*; D006280:Health Workforce / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010036:Otolaryngology / Q000706:statistics & numerical data*; D013043:Specialties, Surgical / Q000706:statistics & numerical data*; D066231:Surgeons / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology