Changing relationship of pediatric surgical workforce to patient demographics.

Background: Physician workforce studies indicate that more specialists contribute to higher average costs. The closely monitored pediatric surgery specialty may reflect what is occurring in other specialties.

Methods: This report reviews the number of complex operations performed on infants and children in 1970, with <225 trained US pediatric surgeons, and in 2010, when there were 1,130. The number of births remained consistent during this 40-year period.

Results: In 2010, approximately 10,710 complex index operations were performed on children in the United States by certified pediatric surgeons, resulting in 9.5 per surgeon annually. Data from the University of California, Los Angeles, and the Vanderbilt Children's Hospital confirm these observations.

Conclusions: The progressive disparity in the number of pediatric surgeons trained and the number of complex index operations performed annually may increase costs and calls into question the ability of individual pediatric surgeons to maintain optimal competence. Consideration might be given to performing index operations at centers of excellence.