Friday, August 13, 2010

A Snapshot of Surgery in France

In the last few days I have been working with the leadership of the American College of Surgeons as they develop policies for the surgical workforce and for surgery in the United States. This seemed like a good time to try to compare the surgical workforce in th etwo countries. The latest summary I could find for France is based on a Parliamentary report from last year on the Future of Surgery (l'Avenir de la Chirurgie). Data for the US surgeon supply comes from the American College of Surgeons Health Policy Research Institute.

On 1 January 2007, there were 24,719 surgeons in France plus 575 surgeons working in overseas departments. This included 16,121 private practitioners (some of whom may also work in public institutions) and 8,597 employed in public institutions. The dominant age of French surgeons is between 50 and 54, representing 21.3% of the total. Just under half, 44.9%, of French surgeons are under fifty years and 34% older than 50. (The US had a total of 135,854 surgeons in 2009, 36.6% were older than 55)

Women make up 23.3% of the French surgery workforce (US 21.3%) with the greatest proportion in obstetrics (37.6%) then pediatric surgery (36.4%) and ophthalmology (43%). The US also has the highest proportion in OBG, 47.1%, then general surgery 14.8%)

The regions with the highest proportion to population are Ile-de-France (Paris), Provence-Alpes-Cote d'Azur, and Rhone-Alpes. In the US the highest concentration of surgeons is in the northeast.

Physicians and surgeons in France may choose to practice completely in the private sector or they may split their time between private and public practice.
- 61.6% in private practice (individual firms, groups, health centers, etc.). This includes 6,532 exclusively in private practice and 6,773 who accept both public and private payers.
- 31.1% are in public hospitals with 4,485 acting as full-time surgeons and 1,057 practicing part time. Teaching hospitals include 2,208 employed surgeons. There are 2,624 FTE surgeons on some form of other contract—for specialized populations, research, management or to temporarily fill staff openings or locum tenens.

By early 2019, the current number of hospital surgeons is expected to decline nearly 30% primarily due to expected retirements. The US surgeon supply is expected to fall by 5-10% by 2025 because there is no growth in training programs and retirements will accelerate.

During 2004-7, the vacancy rate for surgeons in all posts has been stable at 18%, and this steady state is accomplished by the hiring of contracting surgeons.
- 6.4% of all surgeons are practicing in private hospitals; 932 of those are salaried and 347 are exclusively in private practice with 51 in PSPH (Private hospitals caring for public sector patients); 896 were private practitioners in mixed public-private practice.
- 0.9% of the total in another type of setting.

The highest proportion of all surgeons in France are in ophthalmology (22.3%), followed by obstetrics and gynecology (20.9%), general surgery (16.8%), and otorhinolaryngology (11.9%). In the US the largest number are in OBG followed by general surgery then orthopedics.

The distribution by specialty will likely evolve due to career choices among young surgeons and needs of the population. Since 2000 in France, there has been a significant growth in numbers of plastic surgeons while general surgery continues to lose numbers. The same applies in the United States but the greatest growth has been in orthopedics.

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