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Dana Christian Lynge, MD; Eric H. Larson, PhD; Matthew J. Thompson, MBChB, MPH; Roger A. Rosenblatt, MD, MPH; L. Gary Hart, PhD

Arch Surg. 2008;143(4):345-350.

Hypothesis  The overall supply of general surgeons per 100 000 population has declined in the past 2 decades, and small and isolated rural areas of the United States continue to have relatively fewer general surgeons per 100 000 population than urban areas.

Design  Retrospective longitudinal analysis.

Setting  Clinically active general surgeons in the United States.

Participants  The American Medical Association's Physician Masterfiles from 1981, 1991, 2001, and 2005 were used to identify all clinically active general surgeons in the United States.

Main Outcome Measures  Number of general surgeons per 100 000 population and the age, sex, and locale of these surgeons.

Results  General surgeon to population ratios declined steadily across the study period, from 7.68 per 100 000 in 1981 to 5.69 per 100 000 in 2005. The overall urban ratio dropped from 8.04 to 5.85 (–27.24%) across the study period, and the overall rural ratio dropped from 6.36 to 5.02 (–21.07%). The average age of rural surgeons increased compared with their urban counterparts, and women were disproportionately concentrated in urban areas.

Conclusions  The overall number of general surgeons per 100 000 population has declined by 25.91% during the past 25 years. The decline has been most marked in urban areas. However, more remote rural areas continue to have significantly fewer general surgeons per 100 000 population. These findings have implications for training, recruiting, and retaining general surgeons.

Author Affiliations: Departments of Surgery (Dr Christian Lynge) and Family Medicine (Drs Larson, Thompson, Rosenblatt, and Hart) and Washington-Wyoming-Alaska-Montana-Idaho Rural Health Research Center (Dr Hart), University of Washington, Seattle. Dr Larson is now with MEDEX Northwest, University of Washington. Dr Thompson is now with the Department of Primary Health Care, University of Oxford, Oxford, England.

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