Surgical Manpower

TLDR

The United States has roughly twice the surgeon density and operative volume of England and Wales, yet the precision of surgical indications is insufficient to judge whether the higher US rates reflect overuse or UK underuse. The study aims to refine estimates of national surgical manpower needs by integrating data on required operative care with overall medical workforce requirements. Fee‑for‑service payment, solo practice models, and a more aggressive therapeutic culture drive the United States’ higher operation rates, whereas increased consultation, stricter regulation, and facility restrictions suppress England and Wales’ operative volumes.

Abstract

Abstract There are twice as many surgeons in proportion to population in the United States as in England and Wales, and they perform twice as many operations. Fee-for-service, solo practice and a more aggressive therapeutic approach appear to contribute to the greater number of operations in the United States. More frequent use of consultation, closely regulated and standardized surgical practices and restrictions in facilities and numbers of surgeons appear to contribute to the lower rates of operations in England and Wales. Indications for surgery are not sufficiently precise to allow determination of whether American surgeons operate too often or the British too infrequently. Determination of surgical manpower needs requires better information on how much operative treatment the public health requires and must also take into account the total medical manpower needs of the country.