BACKGROUND: Hepato-pancreatico-biliary (HPB) fellowship training has risen in popularity in recent years and hence large numbers of graduating fellows enter the workforce each year. Studies have proposed that the increase in HPB-trained surgeons will outgrow demand in the USA. This study shows that the need for HPB-trained surgeons refers not to the meeting of demand in terms of case volume, but to improving patient access to care. METHODS: The National Inpatient Sample (NIS) database for the years 2005-2011 was queried for CPT codes relating to pancreatic, liver and biliary surgical cases. These numbered 6627 in 2005 and increased to 8515 in 2011. Cases were then mapped to corresponding states. The number of procedures in an individual state was divided by the total number of procedures to give a ratio for each state. A similar ratio was calculated for the population of each state to the national population. These ratios were combined to give a ratio by state of observed to expected HPB surgical cases. RESULTS: Of the 46 states that participate in the NIS, only 18 achieved ratios of observed to expected cases of >1. In the remaining 28 states, the number of procedures was lower than that expected according to each state's population. CONCLUSIONS: The majority of the USA is underserved in terms of HPB surgery. Given the growing number of HPB-trained physicians entering the job market, this sector should focus on bringing understanding and management of complex disease to areas of the country that are currently in need.
BACKGROUND: Hepato-pancreatico-biliary (HPB) fellowship training has risen in popularity in recent years and hence large numbers of graduating fellows enter the workforce each year. Studies have proposed that the increase in HPB-trained surgeons will outgrow demand in the USA. This study shows that the need for HPB-trained surgeons refers not to the meeting of demand in terms of case volume, but to improving patient access to care. METHODS: The National Inpatient Sample (NIS) database for the years 2005-2011 was queried for CPT codes relating to pancreatic, liver and biliary surgical cases. These numbered 6627 in 2005 and increased to 8515 in 2011. Cases were then mapped to corresponding states. The number of procedures in an individual state was divided by the total number of procedures to give a ratio for each state. A similar ratio was calculated for the population of each state to the national population. These ratios were combined to give a ratio by state of observed to expected HPB surgical cases. RESULTS: Of the 46 states that participate in the NIS, only 18 achieved ratios of observed to expected cases of >1. In the remaining 28 states, the number of procedures was lower than that expected according to each state's population. CONCLUSIONS: The majority of the USA is underserved in terms of HPB surgery. Given the growing number of HPB-trained physicians entering the job market, this sector should focus on bringing understanding and management of complex disease to areas of the country that are currently in need.
Authors: David C Chang; Yiyi Zhang; Debraj Mukherjee; Christopher L Wolfgang; Richard D Schulick; John L Cameron; Nita Ahuja Journal: J Am Coll Surg Date: 2009-12 Impact factor: 6.113
Authors: Julie Dunderdale; John C McAuliffe; Sandre F McNeal; Stacy M J Bryant; Brett D Yancey; Grace Flowers; John D Christein Journal: J Am Coll Surg Date: 2013-04 Impact factor: 6.113
Authors: Taylor S Riall; Karl A Eschbach; Courtney M Townsend; William H Nealon; Jean L Freeman; James S Goodwin Journal: J Gastrointest Surg Date: 2007-08-13 Impact factor: 3.452
Authors: Marquita R Decker; Nathan W Bronson; Caprice C Greenberg; James P Dolan; Kenneth C Kent; John G Hunter Journal: J Am Coll Surg Date: 2013-12 Impact factor: 6.113
Authors: Kota Sahara; Anghela Z Paredes; Diamantis I Tsilimigras; J Madison Hyer; Katiuscha Merath; Lu Wu; Rittal Mehta; Eliza W Beal; Susan White; Itaru Endo; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2019-02-04 Impact factor: 3.452
Authors: Erin H Baker; Jacob E Dowden; Allyson R Cochran; David A Iannitti; Eric T Kimchi; Kevin F Staveley-O'Carroll; D Rohan Jeyarajah Journal: HPB (Oxford) Date: 2016-02-18 Impact factor: 3.647
Authors: Qinyu Chen; Fabio Bagante; Katiuscha Merath; Jay Idrees; Eliza W Beal; Jordan Cloyd; Mary Dillhoff; Carl Schmidt; Adrian Diaz; Susan White; Timothy M Pawlik Journal: World J Surg Date: 2018-09 Impact factor: 3.352
Authors: Kelvin Allenson; Kea Turner; Brian D Gonzalez; Erin Gurd; Sarah Zhu; Nicole Misner; Alicia Chin; Melissa Adams; Laura Cooper; Diana Nguyen; Samer Naffouje; Diana L Castillo; Maria Kocab; Brian James; Jason Denbo; Jose M Pimiento; Mokenge Malafa; Benjamin D Powers; Jason B Fleming; Daniel A Anaya; Pamela J Hodul Journal: BMC Nutr Date: 2021-12-09