Vascular surgeons in France: an endangered species?

In France, in the next 10 years, a large number of vascular surgeons will retire, and the risk of them not being replaced has raised the question of our capability to predict future activity in this discipline. Otherwise, the French population is expanding and aging. It will increase by 2.7% in 2020, and the number of individuals aged >65 years is expected to increase by 3.3 million, which represents a 33% rise between 2005 and 2020. As the number of vascular surgery procedures is closely associated with aging population, we can expect a significant increase in vascular surgery workload. We present a model to predict changes in vascular surgery activity according to population aging, including other parameters that could affect workload evolution.

To meet vascular surgeons' needs in the coming years, we initially performed an overview of the demographics of practitioners and estimated the retirements. The second part of our work consisted in studying three groups of arterial surgical and endovascular procedures used in the treatment of infrarenal abdominal aortic aneurysm, peripheral arterial occlusive disease (PAOD), and carotid artery occlusive disease. Data were selected and extracted from the national Medical Information System Program database. Our predictive model is based on the OMPHALE method developed by the National Institute for Statistics and Economic Studies, and we applied it from the year 2000 to 2030. To integrate other parameters affecting workload, we established, from year 2000 data, a prediction based on aging population for the year 2008. Based on this model, we defined a weighted index for each group by comparing expected and observed workloads. This index has been applied to validate our weighted predictive model for year 2009.

Among the 611 vascular surgeons in activity in 2011, nearly two-thirds will retire in the next 15 years. Compared with the number of surgeons in formation, there will be a lack of four surgeons per year in the same period. Our predictive model reported an increase by 61% for the three groups for the period 2000 to 2030. Between 2009 and 2030, nearly 22,700 additional acts are expected, representing a 38% increase. According to the model, between 2000 and 2008 only, vascular procedures increased in total by 52.2%, with an increase of 89% in the PAOD group. Between 2000 and 2009, the global increase was 58.0%, with 3.9% for abdominal aortic aneurysm, 101.7% for PAOD, and +13.2% for carotid artery occlusive disease. Our weighted model based on aging population and corrected by a weighted factor predicted this increase. If the activity for each surgeon remained constant, 183 additional surgeons would be needed according to our refined model.

In addition to the replacement of numerous retired surgeons, aging population and other factors could result in a significant increase in the demand for vascular surgical services.