Commentary - The Orthopaedic Workforce

Since the 1970s, the number of clinically active specialists in the United States per 100,000 population has more than doubled. For example, the number of orthopaedic surgeons increased from 3.6 in 1970 to 7.1 currently (Fig. 1). The increase in the supply of physicians has been associated with an increase in per capita costs and in utilization of specialist care. As a result of this escalation in health-care spending, the federal government has called for a dramatic change in the way in which they support graduate medical education. In this new scenario, institutions would be rewarded for reducing the number of residency trainees3. Fig. 1 Map showing the ratios of orthopaedic surgeons per 10,000 United States residents by hospital referral region in the United States in 1996 (Dartmouth Atlas Working Group, Hanover, New Hampshire, 1998). However, it is necessary to determine how many physicians are needed. In order to do this prudently, the organizations that are responsible for the education and training of future orthopaedists commissioned a study by the RAND Corporation4. The results of this study, which appear in this issue of The Journal, indicate a current excess of 3546 orthopaedic surgeons, which will increase to 4122 by the year 2010. The RAND researchers4 obtained these estimates of excess capacity by applying what they characterize as a demand-based method to estimate workforce requirements. According to their definition, demand is the same as the average utilization rate for the nation. They estimated this rate for services provided by orthopaedic surgeons by using several databases that, taken together, cover the major sectors in which orthopaedic care is provided: physicians' offices, ambulatory care centers, and hospitals. The number of full-time-equivalent orthopaedists required to provide services for the nation was then calculated on the basis of the rate …