Thyroid Clinical| Volume 159, ISSUE 1, P102-112, January 2016

Mapping endocrine surgery: Workforce analysis from the last six decades

Published:October 05, 2015DOI:


      We analyzed the demographics of high-volume surgeons (HVS) for endocrine operations.


      We characterized HVS by region, specialty, gender, teaching-affiliation, American Association of Endocrine Surgeons (AAES) membership, and decade they entered practice. Providers were general surgeons (GS) and otolaryngologists (ENT); fellowship trained (FT) or not FT (NFT).


      We identified 395 HVS in 47 states entering practice between 1958 and 2011. Sixty-eight percent were GS, 35% were FT, and 35% were AAES members. GS, FT surgeons, and endocrine surgery FT surgeons (ES) performed more operations per surgeon. More FT surgeons were in Northeast, West (W), and Midwest than Southeast (SE) and Southwest (SW; P < .0001). More teaching surgeons and AAES members were in the Northeast and Midwest than SE, W, and SW (P < .0001). FT-GS increased over decades (P < .0001) but not FT-ENT (P = .3). Representation of ES, AAES members, and females increased over decades (P < .0001).


      The workforce for endocrine operations displayed increased representation of GS, FT surgeons, and women, correlating with the profile of recent AAES fellowship graduates. More insight is needed to understand why most HVS were not AAES members. Regional disparities can guide the placement of endocrine surgeons into both academic and community practices, increasing trainee exposure and patient access to specialty care.
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        • Pasieka J.L.
        Kindred spirits of the endocrines: the training of the future endocrine surgeons.
        J Surg Oncol. 2005; 89: 202-205
        • Wang T.S.
        Endocrine Surgery.
        Am J Surg. 2011; 202: 369-371
        • Sosa J.A.
        • Bowman H.M.
        • Tielsch J.M.
        • Powe N.R.
        • Gordon T.A.
        • Udelsman R.
        The importance of surgeon experience for clinical and economic outcomes from thyroidectomy.
        Ann Surg. 1998; 228: 320-330
        • Chen H.
        • Wang T.S.
        • Yen T.W.
        • Doffek K.
        • Krzywda E.
        • Schaefer S.
        • et al.
        Operative failures after parathyroidectomy for hyperparathyroidism: the influence of surgical volume.
        Ann Surg. 2010; 252: 691-695
        • Mitchell J.
        • Milas M.
        • Barbosa G.
        • Sutton G.J.
        • Berber E.
        • Siperstein A.
        Avoidable reoperations for thyroid and parathyroid surgery: effect of hospital volume.
        Surgery. 2008; 144: 899-906
        • Cherenfant J.
        • Gage M.
        • Mangold K.
        • Du H.
        • Moo-Young T.
        • Winchester D.J.
        • et al.
        Trends in thyroid surgery in Illinois.
        Surgery. 2013; 154: 1016-1023
        • Park H.A.
        • Roman S.A.
        • Sosa J.A.
        Outcomes from 3144 adrenalectomies in the United States: which matters more, surgeon volume or specialty?.
        Arch Surg. 2009; 11: 1060-1067
        • Saunders B.G.
        • Wainess R.M.
        • Dimick J.B.
        • Doherty G.M.
        • Upchurch G.R.
        • Gauger P.G.
        Who performs endocrine operations in the United States?.
        Surgery. 2003; 134: 924-931
        • Sosa J.A.
        • Wang T.S.
        • Yeo H.L.
        • Mehta P.J.
        • Boudourakis L.
        • Udelsman R.
        • et al.
        The maturation of a specialty: workforce projections for endocrine surgery.
        Surgery. 2007; 142: 876-883
        • Rahib L.
        • Smith B.D.
        • Aizenberg R.
        • Rosenzweig A.B.
        • Fleshman J.M.
        • Matrisian L.M.
        Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States.
        Cancer Res. 2014; 74: 2913-2921
        • Press D.M.
        • Siperstein A.
        • Berber E.
        • Shin J.J.
        • Metzger R.
        • Monteiro R.
        • et al.
        The prevalence of undiagnosed and unrecognized primary hyperparathyroidism: a population-based analysis of the electronic medical record.
        Surgery. 2013; 154: 1232-1237
        • Prinz R.A.
        Endocrine surgical training - some ABC measures.
        Surgery. 1996; 120: 905-912
      1. US Census Bureau. Population estimates. Available from:

        • Adkisson C.D.
        • Howell G.M.
        • McCoy K.L.
        • Armstrong M.J.
        • Kelley M.L.
        • Stang M.T.
        • et al.
        Surgeon volume and adequacy of thyroidectomy for differentiated thyroid cancer.
        Surgery. 2014; 156: 1453-1459
        • Gourin C.G.
        • Tufano R.P.
        • Forastiere A.A.
        • Koch W.M.
        • Pawlik T.M.
        • Bristow R.E.
        Volume-based trends in thyroid surgery.
        Arch Otolaryngol Head Neck Surg. 2010; 136: 1191-1198
      2. Centers for Medicare and Medicaid Services. Medicare Provider Utilization and Payment Data: Physicians and Other Supplier. Available from:

      3. Centers for Medicare and Medicaid Services. CMS Statistics Reference Booklets. Available from:

      4. ASPE Issue Brief. Access to Physicians’ Services for Medicare Beneficiaries. Available from:

        • Kuo J.H.
        • Pasieka J.L.
        • Parrack K.M.
        • Chabot J.A.
        • Lee J.A.
        Endocrine surgery in present-day academia.
        Surgery. 2014; 156: 1461-1469
      5. ACS Health Policy Research Institute and the American Association of Medical Colleges. The Surgery Workforce in the United States: Profile and Recent Trends [updated 2010 Apr]. Available from:

        • Carty S.E.
        2014 American Association of Endocrine Surgeons presidential address: evolution.
        Surgery. 2014; 156: 1289-1296
        • Shin J.J.
        • Milas M.
        • Mitchell J.
        • Berber E.
        • Gutnick J.
        • Siperstein A.
        The endocrine surgery job market: a survey of fellows, department chairs, and surgery recruiters.
        J Surg Educ. 2013; 70: 377-383