Evolving Workload Disparities Between High- and Low-Volume Bariatric Surgeons: Implications for Surgical Quality and Training Policy-Insights from Taiwan's Nationwide Data (2016-2024).

Background: With the increasing prevalence of bariatric surgery, surgeon case volume has emerged as a key quality indicator. However, imbalances in workload between high-, medium-, and low-volume surgeons may affect clinical outcomes.

Methods: We conducted a nationwide analysis of Taiwan's bariatric surgery data from 2016 to 2024. Surgeons were categorized into three groups by annual case volume: high-volume (≥ 50 cases/year), medium-volume (10-49 cases/year), and low-volume (< 10 cases/year). Trends in procedure counts, hospital types, and surgical diversity were examined.

Results: During the study period, annual procedures increased from 2,486 to 4,728. The number of high-volume hospitals (≥ 100 cases/year) doubled from 7 to 14, accounting for 88.5% of all cases by 2024. Although the number of bariatric surgeons increased from 107 to 153 in 2024, only 23 (15.0%) were high-volume; yet they performed 94.42% of all procedures. Medium-volume surgeons (n = 8) represented 5.2% of the workforce, with an average annual caseload of 29.38 cases, contributing 4.97% of procedures. Low-volume surgeons (n = 122, 79.7% of the workforce) averaged 0.24 cases per year and contributed less than 1% of the total volume. Most newly trained surgeons remained in the medium- or low-volume categories, constrained by referral patterns, institutional barriers, and limited operative access.

Conclusions: This imbalance threatens workforce sustainability, skill retention, and equitable care. The findings highlight the need for policy and training reforms to better align bariatric surgery capacity with quality and access objectives.