Objectives: To estimate the workforce needed by 2030 in seven surgical specialties to serve a population of 364 million people and to quantify the cost associated with training additional surgeons. Materials and Methods: A review of the certificates granted in otolaryngology, orthopedic surgery, thoracic surgery, obstetrics and gynecology, neurosurgery, urology, and general surgery was conducted. Using a population-based algorithm we extended the results of Richard Cooper’s pioneering work to these fields of surgery. The assumptions were: unchanged physician to population ratio, 30 years in practice from completion of residency to retirement, no revision of the Balanced Budget Act of 1997 and therefore no additional residency positions offered. Per resident expenses were estimated at $80,000 including salaries, benefits, and other direct medical education costs.
Results: We will have to train more than 100,000 surgeons by 2030 in order to maintain access for our citizens (see TOTAL, column 6) .

SPECIALTY	YEARS	CERTIFIC-	TOTAL	SHORTAGE	TOTAL	NUMBER	MAN	PER	TOTAL
AND	TO	ATIONS	TRAINED		TO BE	PER	YEARS	CLASS	COST
POPULATION	TRAIN	PER	2011 TO		TRAINED	CLASS	PER	COST	2011 TO
RATIO		YEAR	2030		2011 TO		CLASS	AT $80,000	2030
					2030			MILLIONS	MILLIONS
OB-GYN -27.2	4	1,200	24,000	13,636	37,636	1,882	7,527	$602	$12,044
ENT- 3.2	5	300	6,000	2,516	8,516	426	2,129	$170	$3,406
ORTHO - 6.5	5	650	13,000	4,355	17,355	868	4,339	$347	$6,942
GENERAL - 7.5	5	1,000	20,000	2,525	22,525	1,126	5,631	$451	$9,010
UROLOGY - 3.31	5	260	5,200	3,884	9,084	454	2,271	$182	$3,634
NEURO - 1.06	6	125	2,500	228	2,728	136	818	$65	$1,309
THORACIC - 1.42	2	100	2,000	1,994	3,994	200	399	$32	$639
TOTAL		3,635	72,700	29,138	101,838	5,092	23,115	$1,849	$36,984

Conclusions:
1.
There will not be enough surgeons in the seven specialties studied..
2.
We will have to train more than 100,000 surgeons by 2030 in order to maintain access for our citizens at an annual cost of almost $2,000,000,000.
3.
That will cost almost $37,000,000,000 - an extra cost of more than $10,000,000,000.
4.
To do this, the Balanced Budget Act of 1997 must be revised to permit more residents to be trained in the United States.