Online Program

Shortage of surgeons, obstetricians and anesthesiologist in low and middle income countries

Wednesday, November 6, 2013 : 10:30 a.m. - 10:45 a.m.

Marguerite Hoyler, Harvard Program in Global Surgery and Social Change, Boston, MA
Samuel Finlayson, MD MPH, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Center for Surgery and Public Health, Boston, MA
John Meara, MD, DMD, MBA, Department of Plastic Surgery, Boston Childrens Hospital, Boston, MA
Lars Hagander, MD, Department of Pediatric Surgery and International Pediatrics, Lund University Faculty of Medecine, Lund, Sweden
Purpose: A lack of surgical providers is a major barrier to essential surgical care worldwide. It is is particularly concerning due to the rising burden of non-communicable diseases, many of which require surgical treatment, and the ongoing crisis in maternal mortality. The goal of this research was to gather data about the number of surgeons, obstetricians and anesthesiologists world-wide, and to assess the correlation between national surgical physician density and maternal mortality. Materials and Methods: We performed a systematic review of the English-language literature about surgeons, obstetrician and anesthesiologists in LMICs. We also consulted WHO, OECD, and surgical society websites. Results: Across LMICs, general surgeon density ranged from 0.13 to 1.57 per 100,000 people; obstetrician density ranged from 0.042 to 12.5; and anesthesiologist density ranged from 0 to 4.9. Maternal mortality decreased 14% for every unit increase in surgical physician per 1,000, controlling for both health expenditure as percent of GDP and rates of skilled birth attendance (p=0.018). Only five LMICs were described in terms of surgeons, obstetricians, and anesthesiologists. Conclusion and policy implications: Surgical physician density can be 100 times lower in LMICs than in HICs. Surgery workforce data may be essential health systems indicators, but are often unavailable for LMICs. The Global Surgery Workforce Initiative is currently surveying Ministries of Health and professional organizations to determine the number of surgical providers in LMICs. GWSI data will describe the global surgical workforce and inform surgical systems strengthening efforts on international and national levels.

Learning Areas:

Other professions or practice related to public health
Provision of health care to the public
Public health or related public policy
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe the global surgical workforce shortage and demonstrate the potential utility of surgical physician density as a health systems indicator.

Keyword(s): Maternal Care, Workforce

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Harvard Medical Student and full-time Research Associate the at the Program in Global Surgery and Social Change.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.