Background: We wanted to determine whether current levels of fellowship training in hepato-pancreato-biliary (HPB) surgery will be sufficient to meet demand for HPB procedures in 2020. Study Design: The Nationwide Inpatient Sample database for 1988 through 2003 was used to construct projections for the number of HPB procedures that will be performed in the US each year through 2020. Available workforce literature was also used to generate estimates of current and future supply of HPB subspecialists. These demand and supply estimates were then used to construct sensitivity analyses of the mean number of HPB procedures per subspecialist in 2020, depending on the degree of regionalization that exists and the number of fellowship-trained subspecialists needed to train each year to meet projected demand for HPB procedures in 2020. Results: An estimated 16,800 HPB procedures will be performed in 2020, representing a 25% increase during the next 15 years. We estimate that 28 fellowship-trained HPB subspecialists will enter the workforce each year. If half of all HPB procedures are performed by HPB subspecialists in 2020, then the average subspecialist will perform only 14 such procedures that year. If high-volume HPB surgery is defined as 40 procedures per year, and 50% of HPB procedures are performed by high-volume surgeons in 2020, then only 15 fellows need to be trained in HPB surgery each year to meet demand in 2020. Conclusions: Current levels of fellowship training will result in an excess of HPB subspecialists in 2020.
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