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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 51  |  Issue : 2  |  Page : 69-75

Analysis of surgical manpower for the past 20 years in Taiwan


1 Department of Surgery, Division of Pediatric Surgery, Tri-Service General Hospital, Taipei, Taiwan
2 Department of Surgery, Division of General Surgery, Tri-Service General Hospital, Taipei, Taiwan
3 Departments of Neurosurgery, Tri-Service General Hospital, Taipei, Taiwan
4 Departments of Urology, Tri-Service General Hospital, Taipei, Taiwan

Date of Submission12-Jan-2018
Date of Decision06-Feb-2018
Date of Acceptance11-Feb-2018
Date of Web Publication24-Apr-2018

Correspondence Address:
Dr. Guan-Yeu Diau
Department of Surgery, Division of Pediatric Surgery, Tri-Service General Hospital, Taipei
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/fjs.fjs_4_18

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  Abstract 

Background: The Taiwan Surgical Association (TSA) has been in operation for more than 50 years since its establishment. We checked the data of the members recently to have a full understandings and mastery of the human resources of TSA.
Materials and Methods: All the data were collected from the basic data pool of the member maintained by the TSA. The annual membership, new memberships, deaths and withdrawals, age distribution, gender, surgical subspecialty, geographic distribution, and new major surgical specialist-issued licenses were checked.
Results: The results were total membership increased lineally and doubled from 3020 to 6154; new members increased 124–197 per year, death and withdrawal were 4–53 annually; highest age range was 51–60, mean age 52.99 and median age 53; ratio of male and female increased from 0.8% to 4.4%; great majority of surgical specialist was gastroenterological surgery 29%, orthopedics 14%, urology 13%, thoracic and cardiovascular surgery 13%, and plastic surgery 11%; members were higher in metropolitan, Taipei 21.7%, New Taipei City 8.2%, Taichung 14%, and Kaohsiung 14.8%; and number of surgical-related subspecialty increased recently.
Conclusions: There are still a lot of areas for the TSA members to explore. The data suggest that the government officials could provide more beneficial acts to the development of surgical society in Taiwan. For example, they might be able to guide a reasonable work shift hour limit, maximal care surgical patients' number, adequate nurse practitioners, setup legal surgical assistants in the operation room, well-training sufficient surgical residents program, and balance the number for the surgical subspecialty.

Keywords: Manpower, surgeon, Taiwan surgical association


How to cite this article:
Diau GY, Chan DC, Ma HI, Yu DS. Analysis of surgical manpower for the past 20 years in Taiwan. Formos J Surg 2018;51:69-75

How to cite this URL:
Diau GY, Chan DC, Ma HI, Yu DS. Analysis of surgical manpower for the past 20 years in Taiwan. Formos J Surg [serial online] 2018 [cited 2018 May 25];51:69-75. Available from: http://www.e-fjs.org/text.asp?2018/51/2/69/231141


  Introduction Top


The Taiwan Surgical Association (TSA) has been in operation for more than 50 years since its establishment. We checked the data of the members recently to have a full understandings and mastery of the human resources of TSA. The data were collected from the pool of the member maintained by the TSA.


  Materials and Methods Top


All the data were collected from the basic data pool of the member maintained by the TSA. To have broad spectrum of inputs, some of the references were collected from the internet instead of the classical academic medical literatures.

The annual membership, new memberships, deaths and withdrawals, age distribution, gender, surgical subspecialty, geographic distribution, and new major surgical specialist-issued licenses were checked.


  Results Top


From the annual membership data of the TSA, the total membership increased linearly and doubled from 3020 to 6154 in the recent 20 years [Figure 1].
Figure 1: Annual membership in Taiwan Surgical Association from 1997 to 2017

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The new members increased around 124–197 each year. However, only 63 members were newly added by the influence of the graduation general medical training program (PGY) in 2016 [Figure 2].
Figure 2: New memberships in Taiwan Surgical Association from 1997 to 2016

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The death and withdrawal of the TSA were between 4 and 53 annually. The death of the members might be underestimated because it was not an obligation to inform the TSA by the families [Figure 3].
Figure 3: Deaths and withdrawals of the Taiwan Surgical Association from 2000 to 2017

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Since every member received at least 4-year training after graduation from medical school, the entry age of TSA was usually above 30 years. The data revealed the age between 51 and 60 years at the top of the spectrum, which accounts for 28.44%. The second was the 41–50 range, which accounts for 23.55%. The mean age of the members is 52.99 years and the median age is 53 years [Figure 4].
Figure 4: Age distribution of the members in Taiwan Surgical Association in 2017

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According to the Taiwan Medical Association, the nationwide age of physician in Taiwan was around 30–39 years, followed by the age of 40–49 years. Compared to the age of all practicing doctors, the surgeon's age of TSA was higher.[1]

As for the number of women in TSA, the number of female memberships steadily increased annually from 25 to 261 in the recent 20 years. The number of male members also increased linearly from 3045 to 5893. The ratio of male and female members increased from 0.8% to 4.4% [Figure 5].
Figure 5: Male and female members in Taiwan Surgical Association from 1977 to 2016

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The great majority of surgical specialist in TSA was the gastroenterological surgery, which stood for 29%. The second is orthopedics 14%, then urology 13%, thoracic and cardiovascular surgery 13%, plastic surgery 11%, and neurosurgery 10% separately. Pediatric surgery is the smallest group and accounts for only 2% of all TSA members [Figure 7].
Figure 7: Surgical subspecialty in Taiwan Surgical Association in 2017

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Members of TSA were added together according to the location of the serviced hospitals. It revealed that the number was higher in metropolitan areas. The Taipei and New Taipei City added up to around 30%. Taichung and Kaohsiung were about 14%. It showed a relatively low number of surgeons available, especially in the east parts of Taiwan and offshore islands [Figure 8].
Figure 8: Geographic distribution of members in Taiwan Surgical Association in 2016

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According to the data from the Ministry of Health and Welfare, the number of surgical-related subspecialty was from 18% to 31%. The number of general surgery dramatically decreased on account of the PGY training in 2016. Other than the general surgery, the related subspecialty increased prominently in 2015. The most obvious increase occurred in orthopedics (65%) and urology (36%). Plastic surgery also issued more licenses than the past [Figure 6]. These results seemed to have a strong correlation with the booster by the medical society due to lack of workforce in five major categories (physicians, surgeons, obstetricians and gynecologists, pediatricians, and emergency doctors) in Taiwan.[2]
Figure 6: New major surgical specialist licenses issued by Ministry of Health and Welfare from 2000 to 2016

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  Discussion Top


From the data reported by Taiwan Medical Association, the physicians in Taiwan were 46,600, with the surgeons accounting for 13.38%.[1] Over the past few years, the medical society was alert to the reduction of workforce in five major categories (physicians, surgeons, obstetricians and gynecologists, pediatricians, and emergency doctors) in Taiwan. From the workforce trend in 2013, 2014, and 2015, there was a significant increase in the number of surgical-related subspecialties. This phenomenon seemed to have a very positive feedback to the efforts by the medical society.[2]

The traditional basic image that surgeons have given to us in the past is that work is hard and it takes some physical effort, and in this respect, women feel like there is no such job for men. With the surgical technique improvements rapidly, women have the characteristics of carefulness, good temper, and patience, especially some delicate surgery can play these characteristics well in the surgical fields recently. Even so, the female members of the Taiwan Medical Association and the European and American countries are relatively small; the current female membership in the total number of members is 4.24%. The current number of surgeons in the United States was around 16,000, while American female surgeons account for 19.2%,[3] the British female physician, who accounts for all physicians in the 11%.[4] Can see that this will be female members to have a lot of room for growth.

Generally speaking, in private or consortium hospitals, the number of surgical specialists will be regulated as the market demands, given the demand for market mechanisms. Many public hospitals or teaching hospitals usually take into account the balanced development and teaching needs of various departments. Therefore, in addition to the clinical needs, some surgical specialties will be tutored although the performance of the operation is not obvious, but in order to take into account the right of the few patients to seek medical treatment, to be protected, and the diversity of diseases for teaching purposes. According to foreign statistics in surgeons, obstetricians, and anesthesiologists, the most dense areas of the three physicians are in northern Europe's Norway, Finland, German, Ukraine, and so on. The moderate dense areas include the United States, Russia, England, Italy, and Chile. The least areas are in Central African countries such as Chad, Niger, and Madagascar. The results of this study show that the density of Taiwanese physicians is in the middle of the posterior segment.[5] According to the US Labor Office 2016, surgeons are in higher density in states including Massachusetts, New York, California, Texas, New Jersey, North Carolina, and so on, while surgeons are less in Midwestern North Dakota, Montana, Wyoming, Oklahoma, Kansas, Alaska, and Arizona in the US.[6]

There were 6154 memberships of the TSA in 2017. However, there is no proper scientifically forecasting model available at present time. As a result, it is very difficult to determine these workforces were enough and sufficient for Taiwan or not. The number of operations increased as time went by. The data from the United Kingdom revealed that there were around 17,000 doctors worked in the surgical fields, including 7200 surgical visiting staffs in 2014. There were 4,700,000 cases who required hospitalization for surgery in 2013, which included 1,300,000 general surgical cases, 1,200,000 trauma and orthopedic surgical cases, and 730,000 urologic surgery. It is increased by 27% when compared to that of 2003.[4]

With the evolution of the time, the new generation of physicians ask for the quality of life of individuals, the requirements become more and more important. As in the past, overtime work, even the statute, has been revised so that the physician group is no longer in the plight of overwork. Some of the older surgeons I have come into contact with are very hard and rigorous when they are trained by a surgeon. In the past, there have been many demands that in the current standard of trained young physicians may be harsh at present time. Even now in the hospital, these predecessors seem to be the same as the super business is 24 h 365 days without a break. As long as there are patients in the hospital, even if the state and the case of holidays, will certainly come to the hospital to visit the patients routinely. This kind of devoted hardworking role model is no longer to follow nowadays. In general, some physicians, for example, only if the hospital has a patient, and is to be discharged to the duty, will come to the hospital patients.

It is not easy to reach a consensus on the way in which workforce needs can be met. The reform model of the domestic nursing division by fixed schedule, maximum working hours limit, the upper limit care patients, and so on, really let the painstaking surgeons envy unceasingly. However, the training of surgical residents' contact the amount of surgery are not so much and solid compare with the past. To refer to the situation in the United States, the 2015, a more severe year of surgery, is orthopedic, urology, and general surgery. According to a study by the the Tiyatien resources and services administration, in the case of the US surgeon's needs, the US surgeon's estimates will be in short supply, 20,340 person in 2025. The only adequate surgical specialist is colorectal surgeons. The regional impact was also one of the important factors. For example, in the northeastern United States, where the highest density of surgeons, general surgery, colorectal surgery, and cardiovascular surgery are available, there is no shortage of predictions, but other secondary specialties, there will be less than the 1700 residual prediction.[7]

Generally speaking, the pressure of on surgeons is more than that of other physicians. In the past, clinical work has been critical, and today's requirements for surgeons are not just clinical. Often in order to meet the requirements of the hospital administration or assessment, there is a lot of work to be done outside the industry, both at home and abroad, both have the same trend and cause heavy workload. According to foreign statistics, the pressure of on surgeons, in all physician groups, belongs to the highest class. The first is the physician in charge of the intensive care unit, followed by the emergency room physician on duty, and the relatively light pressure burden, including ophthalmologists, pathologists, psychiatrists, and dermatologists. According to foreign statistics, the greatest source of stress that causes surgeons to be exhausted is mainly the etheric red tape work, and others include longer working hours, less pay not proportional to the degree of hard work to care of too many critically ill patients, and difficulty to get along with colleagues. If the vacation is more than 2 weeks in a year, the pressure will be less. It also has a soothing effect with at least two times a week of regular exercise. The use of alcohol and drugs to reduce pressure is not of much help.[8]

The workforce for the maintenance of the surgical system seemed more and more fragile and difficulty recently reflected by our surgical society in Taiwan. The introduction of national health insurance did decrease the deaths from amenable causes 5.83% per year between 1996 and 1999 in Taiwan.[9] However, this also contributed to the old age population increase dramatically in Taiwan. The surgical and anesthesia risks will increase in the elderly groups. The postoperative care certainly need more medical resources to throw in. The reform for the surgical society certainly will influence the national health insurance. The policy from the government officials will be phenomenal and critical in Taiwan.

All the surgical resident trainings will be accomplished in the teaching hospital and medical center. The shortage of residents in the middle size and local hospital become quite common in Taiwan. The nurse practitioners become a very helpful resource in the daily practice since 11 years ago. This really helps the surgeons a lot. However, the qualified surgical nurse practitioners are not allowed to serve as the assistant in the operating room. The legal surgical assistants in the operating room could possibly and hope to be the next significant reform step in Taiwan.

Some of the surgical subspecialty became much more difficult to sustain due to lack of the successors. Medical students were not inclined to choose surgery as a career due to lack of the personal interest, career-oriented lifestyle, workload, and stress recently.[10] On the other hand, gender issue was always an important factor to determine the final medical specialty for the medical student in the past. Luckily, the gender of the medical students was not a very important issue in Taiwan now.[11],[12] The medical students are extremely smart in Taiwan. The work stress for surgeons could not easily reduce. However, a good occupation environment such as proper work hour limit, reduced unwanted legal problems, and certain promise of salaries could always be guided and provided by the government. The financial status of the national health insurance is not so tight at present time in Taiwan. It would be a very good opportunity for the government to introduce and provide more reinforcement to the surgical society now.


  Conclusions Top


The current status in the workforce of TSA has been discussed. There are still a lot of areas for the members to explore. The data suggest that the government officials might be able to provide more acts that are beneficial to the development of surgical society in Taiwan. For example, they can guide a reasonable work shift hour limit, maximal care surgical patients' number, provide adequate nurse practitioners, setup legal surgical assistants in the operating room, well-training sufficient surgical residents program, and balance the number for the surgical subspecialty.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Taiwan Medical Association Annual Report; 2016. Available from: http://www.tma.tw/stats/files/2016_stats.pdf. [Last accessed on 2018 Jan 12].  Back to cited text no. 1
    
2.
Health and Welfare Statistics Department, Taiwan. Available from: https://dep.mohw.gov.tw/DOS/lp-1728-113.html. [Last accessed on 2018 Jan 12].  Back to cited text no. 2
    
3.
Women in Business, Statistics on the Number of Women Surgeons in the United States. Available from: https://www.thebalance.com/number-of-women-surgeons-in-the-us-3972900. [Last accessed on 2018 Jan 12].  Back to cited text no. 3
    
4.
Royal Eton of Surgeons, Surgery and the NHS in Numbers. Available from: https://www.rcseng.ac.uk/news-and-events/media-centre/media-background-briefings-and-statistics/surgery-and-the-nhs-in-numbers/. [Last accessed on 2018 Jan 12].  Back to cited text no. 4
    
5.
Holmer H, Lantz A, Kunjumen T, Finlayson S, Hoyler M, Siyam A, et al. Global distribution of surgeons, anaesthesiologists, and obstetricians. Lancet Glob Health 2015;3 Suppl 2:S9-11.  Back to cited text no. 5
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6.
United States Department of Labor, Bureau of Labor Statistics. Available from: https://www.bls.gov/oes/current/oes291067.htm. [Last accessed on 2018 Jan 12].  Back to cited text no. 6
    
7.
The Health Resources and Services Administration, Bureau of Health Workforce, National and Regional Projections of Supply and Demand for Surgical Specialty Practitioners: 2013-2025. Available from: https://www.bhw.hrsa.gov/health-workforce-analysis/research/projections. [Last accessed on 2018 Jan 12].  Back to cited text no. 7
    
8.
Medscape General Surgeon Lifestyle Report; 2015. Available from: https://www.medscape.com/features/slideshow/lifestyle/2015/general-surgery. [Last accessed on 2018 Jan 12].  Back to cited text no. 8
    
9.
Lee YC, Huang YT, Tsai YW, Huang SM, Kuo KN, McKee M, et al. The impact of universal national health insurance on population health: The experience of Taiwan. BMC Health Serv Res 2010;10:225.  Back to cited text no. 9
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10.
Chen YC, Shih CL, Wu CH, Chiu CH. Exploring factors that have caused a decrease in surgical manpower in Taiwan. Surg Innov 2014;21:520-7.  Back to cited text no. 10
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11.
Chen WC, Chu DC, Chen RC, Chang SY. Gender difference in the manpower and specialty selection among medical students and physicians: A ten year tend study from 1998 to 2007. J Med Educ 2010;14:251-61.  Back to cited text no. 11
    
12.
Chung YC, Lin CY, Huang CN, Yang JH. Perceptions on gender awareness and considerations in career choices of medical students in a medical school in Taiwan. Kaohsiung J Med Sci 2013;29:629-35.  Back to cited text no. 12
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