A novel approach for the accurate prediction of thoracic surgery workforce requirements in Canada


      To develop a microsimulation model of thoracic surgery workforce supply and demand to forecast future labor requirements.


      The Canadian Community Health Survey and Canadian Census data were used to develop a microsimulation model. The demand component simulated the incidence of lung cancer; the supply component simulated the number of practicing thoracic surgeons. The full model predicted the rate of operable lung cancers per surgeon according to varying numbers of graduates per year.


      From 2011 to 2030, the Canadian national population will increase by 10 million. The lung cancer incidence rates will increase until 2030, then plateau and decline. The rate will vary by region (12.5% in Western Canada, 37.2% in Eastern Canada) and will be less pronounced in major cities (10.3%). Minor fluctuations in the yearly thoracic surgery graduation rates (range, 4-8) will dramatically affect the future number of practicing surgeons (range, 116-215). The rate of operable lung cancer varies from 35.0 to 64.9 cases per surgeon annually. Training 8 surgeons annually would maintain the current rate of operable lung cancer cases per surgeon per year (range, 32-36). However, this increased rate of training will outpace the lung cancer incidence after 2030.


      At the current rate of training, the incidence of operable lung cancer will increase until 2030 and then plateau and decline. The increase will outstrip the supply of thoracic surgeons, but the decline after 2030 will translate into an excess future supply. Minor increases in the rate of training in response to short-term needs could be problematic in the longer term. Unregulated workforce changes should, therefore, be approached with care.

      CTSNet classification

      Abbreviations and Acronyms:

      CCHS (Canadian Community Health Survey), CT (computed tomography), T-MED (Canadian Thoracic Manpower and Education)
      To read this article in full you will need to make a payment


        • Roos N.P.
        • Fransoo R.
        How many surgeons does a province need, and how do we determine appropriate numbers?.
        Healthc Manage Forum. 2001; 14: 11-21
        • Cesa F.
        • Larente S.
        Work force shortages: a question of supply and demand.
        Health Policy Res Bull. 2004; 8: 12-16
        • Esmail N.
        Canada's physician supply.
        Fraser For. 2011; 2: 12-18
        • Vanderby S.A.
        • Carter M.W.
        • Latham T.
        • Ouzounian M.
        • Hassan A.
        • Tang G.H.
        • et al.
        Modeling the cardiac surgery workforce in Canada.
        Ann Thorac Surg. 2010; 90: 467-473
        • Grondin S.C.
        • Schieman C.
        • Kelly E.
        • Darling G.
        • Maziak D.
        • Mackay M.P.
        • et al.
        A look at the thoracic surgery workforce in Canada: how demographics and scope of practice may impact future workforce needs.
        Can J Surg. 2013; 56: E75-E81
      1. Statistics Canada. 2001, 2005, 2008. Canadian Community Health Survey (public-use microdata file). Statistics Canada (producer). Using LANDRU (distributor). Available at: Accessed November 15, 2012.

        • Abraham J.E.
        • Stefan K.J.
        • Hunt J.D.
        Population Synthesis Using Combinatorial Optimization at Multiple Levels.
        Transportation Research Record. 2012;
      2. Statistics Canada. 2007. Age and sex highlight tables, 2006 census. Catalogue no. 97-551-XWE2006002. Available at: Accessed November 15, 2012.

      3. Statistics Canada. 2006. Census of Canada, 2006, Individuals File (public-use microdata file). Statistics Canada (producer). Using LANDRU (distributor). Available at: Accessed November 15, 2012.

      4. Statistics Canada. No date. Table 051-0012. Interprovincial migrants, by age group and sex, Canada, provinces and territories (table). CANSIM (database). Available at: Accessed November 15, 2012.

      5. Statistics Canada. No date. Table 051-0047. Components of population growth by census metropolitan area, sex and age group for the period from July 1 to June 30, based on the Standard Geographical Classification (SGC) 2006 (table). CANSIM (database). Available at: Accessed November 15, 2012.

      6. Statistics Canada. No date. Table 101-0030. In-, out- and net-migration estimates, by geographic regions of origin and destination (table). CANSIM (database). Available at: Accessed November 15, 2012.

      7. Statistics Canada. No date. Table 102-4503. Live births, by age of mother, Canada, provinces and territories (table). CANSIM (database). Available at: Accessed November 15, 2012.

      8. Statistics Canada. No date. Publication 82-625-X. Body composition of Canadian adults 2007 to 2009. Available at: Accessed November 15, 2012.

      9. Department of Demography, Université de Montréal (Canada). Canadian Human Mortality Database. Available at: Accessed November 15, 2012.

      10. Peto R, Lopez AD, Boreham J, Thun M. Detailed estimates of smoking-attributed deaths by age, sex and disease, 2nd ed. 2006. Available at: Accessed November 15, 2012.

      11. Statistics Canada. No date. Table 104-7006. Changes in smoking between 1994/1995 and 2010/2011, household population aged 12 and over who reported on smoking every 2 years, by age group and sex, Canada and provinces (table). CANSIM (database).

        • Tammemagi C.M.
        • Pinsky P.F.
        • Caporaso N.E.
        • Kvale P.A.
        • Hocking W.G.
        • Church T.R.
        • et al.
        Lung cancer risk prediction: prostate, lung, colorectal and ovarian cancer screening trial models and validation.
        J Natl Cancer Inst. 2011; 103: 1058-1068
        • Slatore C.G.
        • Gould M.K.
        • Au D.H.
        • Deffeback M.E.
        • White E.
        Lung cancer stage at diagnosis: individual associations in the prospective VITamins and lifestyle (VITAL) cohort.
        BMC Cancer. 2011; 11: 228
        • Abraham J.E.
        • Hunt J.D.
        Random utility location, production and exchange choice: additive logit model and spatial choice microsimulation.
        Transportation Research Record. 2007; 2003: 1-6
        • Berger L.
        • Mace J.M.
        • Ricco J.B.
        • Saporta G.
        Methodology for the evaluation of vascular surgery workforce in France.
        Public Health. 2013; 127: 65-71
        • Craig D.
        • Byrick R.
        • Carli F.
        A physician workforce planning model applied to Canadian anesthesiology: planning the future supply of anesthesiologists.
        Can J Anaesth. 2002; 49: 671-677
        • Fraher E.P.
        • Knapton A.
        • Sheldon G.F.
        • Meyer A.
        • Ricketts T.C.
        Projecting surgeon supply using a dynamic model.
        Ann Surg. 2013; 257: 867-872
        • Keaver L.
        • Webber L.
        • Dee A.
        • Shiely F.
        • Marsh T.
        • Balanda K.
        • et al.
        Application of the UK foresight obesity model in Ireland: the health and economic consequences of projected obesity trends in Ireland.
        PLoS One. 2013; 8: 1-8
        • Zaidat O.O.
        • Lazaro M.
        • McGinley E.
        • Edgell R.C.
        • Nguyen T.
        • Linfante I.
        • et al.
        Demand-supply of neurointerventionalists for endovascular ischemic stroke therapy.
        Neurology. 2012; 79: S35-S41
        • Aberle D.R.
        • Adams A.M.
        • Berg C.D.
        • Black W.C.
        • Clapp J.D.
        • Fagerstrom R.M.
        • et al.
        Reduced lung-cancer mortality with low-dose computed tomographic screening.
        N Engl J Med. 2011; 365: 395-401
        • Bach P.B.
        • Mirkin J.N.
        • Oliver T.K.
        • Azzoli C.G.
        • Berry D.A.
        • Brawley O.W.
        • et al.
        Benefits and harms of CT screening for lung cancer: a systematic review.
        JAMA. 2012; 307: 2418-2429
        • Burton K.R.
        • Wong I.K.
        A force to contend with: the gender gap closes in Canadian medical schools.
        Can Med Assoc J. 2004; 170: 1385-1386