Worldwide there are an estimated specialist surgeons
Worldwide, there are an estimated 1 112 727 specialist surgeons (IQR 1 059 158–1 177 912), 550 134 anaesthesiologists (529 008–572 916) and 483 357 obstetricians (456 093–517 638; ). Low-income and lower-middle-income countries, representing 48% of the global population, have 20% of this workforce, or 19% of all surgeons, 15% of anaesthesiologists, and 29% of obstetricians. Africa and southeast Asia are particularly underserved. In terms of density, low-income countries have 0·7 providers per 100 000 opioid receptor (IQR 0·5–1·9), compared with 5·5 (1·8–28·2) in lower-middle income countries, 22·6 (11·6–56·7) in upper-middle-income countries, and 56·9 (32·0–85·3) in high-income countries. There are also significant differences by WHO region (; ).
The results of this study represent the first truly global compilation of national surgical specialist workforce data and constitute a first step towards routinely collecting surgical workforce data through the WHO Global Surgical Workforce Database. The workforce of fully trained surgeons, anaesthesiologists, and obstetricians is critically inadequate in many parts of the world, and grossly inequitably distributed.
The results of this study must be interpreted carefully. Our database, consisting of official or published country-level data, will need to be validated and expanded. Through emphasising aggregate numbers and by using imputations based on general health-system indicators, we have sought to minimise the role of missing or potentially erroneous data points. More importantly, our data do not fully describe the health workforce that does surgery and anaesthesia, since physicians and other health-care providers who were not licensed as surgeons were excluded from the current study to facilitate international comparisons. Adjunct data regarding the considerable number of associate clinicians who do surgery would add a valuable level of granularity and nuance to the current description of the global surgical workforce. Our results do, however, confirm the global misdistribution of surgical specialists, and indicate that most of the world\'s surgical patients are either served by non-physicians or non-specialists, or ecological niche are not served at all. This also affects the many low-resource countries where surgical task-shifting is used. Defined as the redistribution of responsibilities from highly qualified professionals to those with fewer qualifications, task shifting has been used as a way to increase access to surgical care and reduce surgical costs. However, without trained surgeons, anaesthesiologists, and obstetricians to act as supervisors and educators, such systematised and formally structured task-shifting programmes are challenged.
One of the most significant barriers to surgical care worldwide is the shortage of surgeons, anaesthesiologists, and obstetricians, which in resource-poor settings is exacerbated by emigration. We contacted 75 high-income countries with a request for data on the number of specialist surgeons, anaesthesiologists, and obstetricians and their country of initial medical qualification. Data were retrieved from national administrative sources (see for details). Specialists were defined according to the licensing authority of the respective country. Countries in workforce crisis were defined according to the WHO definition of having less than 228 physicians, nurses, and midwives per 100 000 population.