Back to 2026 Abstracts
GLP-1 Demand Shock: Work Reallocation, Productivity Decline, and Training Implications Across General and Bariatric Surgery
*Ramsey M. Dallal1, *Aditya Das
1, *Alec C. Beekley
1, *Talar Tatarian
1, *Davinder K. Malhotra
2, *T. D. Harrison
1, Charles J. Yeo
11Surgery, Jefferson Health, Philadelphia, Pennsylvania; 2Business, Thomas Jefferson University, Philadelphia, Pennsylvania
Objectives: The rapid adoption of GLP-1 receptor agonists has reduced the demand for metabolic and bariatric surgery (MBS), disrupting established practice patterns. This study evaluates adaptive case realignment, productivity, and workforce implications for both MBS and general surgeons in a large, diverse healthcare system, to inform national surgical planning.
Methods: We analyzed 180,809 general surgical procedures (Q2 2021-Q2 2025) across 31 hospitals, including 30,119 cases performed by 22 MBS surgeons. Mixed-effects negative binomial and logistic regression modeled quarterly case volumes, work relative value units (wRVUs), and minimally invasive surgery (MIS) utilization, adjusted for procedure category, region, and surgeon type, with clustering by surgeon and hospital. Results are reported as quarterly incidence rate ratios (IRRs), reflecting the relative change in procedural demand with 95% confidence intervals (CIs).
Results: Unadjusted quarterly MBS volume decreased from 678 cases (Q2 2021) to 374 cases (Q2 2025). The regression-adjusted decline was 36.8% (IRR = 0.96 per quarter, p < 0.005). The number of bariatric (MBS) surgeons, procedure types, and case mix index remained stable. MBS surgeons offset declining MBS demand by shifting routine cases from general surgeons, whose adjusted volume decreased by 7.6% (IRR=0.99, p=0.04) despite general surgeon staffing increasing from 199 to 208. MBS surgeons achieved this by shifting to lower-wRVU cases (elective hernia: IRR=1.04 /quarter; p=0.002; soft tissue: IRR=1.02; cholecystectomy: IRR=1.02—all p<0.05). Replacing high-wRVU MBS procedures (23.2 wRVU/case) with the same number of lower-wRVU general surgeries (8.8 wRVU/case) drove a 22% wRVU decline per MBS surgeon over the study period (p=0.005). For abdominal cases, MBS surgeons had a 90% MIS rate, compared with 62% for general surgeons (OR=6.02, p<0.001); although general surgeons improved to 70% by 2025 (IRR=1.03/quarter, p<0.001).
Conclusions: The rapid and widespread adoption of GLP-1 receptor agonists was associated with a marked and sustained reduction in metabolic and bariatric surgery (MBS) volume (adjusted 36.8% decline) and a concomitant 22% decrease in wRVU output per MBS surgeon, as lower-wRVU general surgeries replaced high-wRVU bariatric cases. Still, this intra-specialty reallocation has produced productivity pressures that threaten the viability of specialist MBS programs, whose fixed costs are predicated on higher-margin procedures. Health systems should rebalance resources to maintain financial stability. Surgical residency and MIS fellowship training programs should align with evolving practice realities by redesigning curricula to combine proficiencies in both obesity treatment and advanced general surgery MIS, and by balancing graduate numbers with market demand to reduce workforce oversupply and underemployment.
Back to 2026 Abstracts
