Shortage of Doctors, Shortage of Data: A Review of the Global Surgery, Obstetrics, and Anesthesia Workforce Literature

• Published in: World journal of surgery Vol. 38; no. 2; pp. 269 - 280
• Main Authors: Hoyler, Marguerite, Finlayson, Samuel R. G., McClain, Craig D., Meara, John G., Hagander, Lars
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-02-2014; Springer Nature B.V
• Subjects: Abdominal Surgery; Africa; Anesthesiology - manpower; Cardiac Surgery; Clinical Medicine; Developing Countries - statistics & numerical data; General Surgery; Global Health; Global Surgery; Gross Domestic Product; Gynecology - manpower; Humans; Kirurgi; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Obstetrics - manpower; Physicians - supply & distribution; Poverty; Surgery; Surgical Provider; Surgical Workforce; Thoracic Surgery; Vascular Surgery; Workforce Data; Africa; Global Surgery; Gross Domestic Product; Surgical Provider; Surgical Workforce; Workforce Data
• ISSN: 0364-2313; 1432-2323; 1432-2323
• DOI: 10.1007/s00268-013-2324-y

Introduction
The global surgery workforce is in crisis in many low- and middle-income countries (LMICs). The shortage of surgery, obstetrics, and anesthesia providers is an important cause of the unmet need for surgical care in LMICs. The goal of this paper is to summarize the available literature about surgical physicians in LMICs and to describe ongoing initiatives to supplement the existing surgical workforce data.
Methods
We performed a systematic search and literature review of the English-language literature regarding the number of surgeons, obstetrician–gynecologists, and anesthesiologists practicing in LMICs.
Results
Literature describing the number of surgeons, obstetricians, and anesthesiologists practicing in LMICs represents a small minority of LMICs, and indicates consistently low levels of surgical physicians. Our literature search yielded comprehensive data for only six countries. No national data were found for 23 of the 57 countries considered by the World Health Organization (WHO) to be in health workforce ‘crisis.’ Across LMICs, general surgeon density ranged from 0.13 to 1.57 per 100,000 population, obstetrician density ranged from 0.042 to 12.5 per 100,000, and anesthesiologist density ranged from 0 to 4.9 per 100,000. Total anesthesiologist, obstetrician, and surgeon density was significantly correlated with gross domestic product (GDP) per capita (
r
2
 = 0.097,
p
 = 0.0002).
Conclusion
The global surgery workforce is in crisis, yet is poorly characterized by the current English-language literature. There is a critical need for systematically collected, national-level data regarding surgery providers in LMICs to guide improvements in surgery access and care. The Harvard Global Surgery Workforce Initiative and the WHO global surgical workforce database are working to address this need by surveying Ministries of Health and surgical professional organizations around the world.