Surgery News - June 2008 - (Page 7)

JUNE 2008 • SURGERY NEWS OPINION tion. Would we pay homage to the internist who treats hypertensive patients in the fourth decade of life to the exclusion of all other maladies? Spread the talent around. Let residents know about towns with populations under 50,000 that would welcome them. Show us some love. If general surgeons are needed and wanted, stop the pay cuts. Change your rhetoric. Lighten up on the talk about fellowship-trained surgeons doing certain procedures in certain locations. No one should have to apologize for being just a general surgeon. David J. Farrell, M.D., FACS Porterville, Calif. 7 LETTERS Get Real About Operative Experience As an elderly, retired, rural surgeon, I have followed the issue of restricted work hours for residents to reduce management errors seemingly related to sleep deprivation (“IOM Committee Looks Into Safety of Work Schedules,” February 2008, p. 1). The progressive flagellations toward more controlled management of work time I find interesting, but none of the debate addresses the real issues. The obvious solution is to limit the work week to three and a half to four 12hour shifts per week; do away with the weekend concept, with each day serving as a full service work day for the facility; and extend the general surgery residency to 10 years to ensure adequate clinical and operative experience. Certainly, reducing work hours reduces the clinical experience obtained by trainees in the past. But there are other bases for error or poor performance. First, factors such as lack of supervision, fatiguing activities engaged in during trainees’ own time, family distress or tragedy, social disturbance, recreational drug use, and responsibility for a critically ill patient may enter into the equation. These issues seem not to be considered in the published information that I’ve seen. Second, especially in the rural setting, an element of deprivation is unavoidable, and lack of experience in this arena when good oversight and guidance are available does not “train” the surgeon in managing, avoiding, or recognizing the potential for errors. Family and social influences are also factors that may lead to errors, and will never be resolved. Perhaps the breadth of investigation should be widened to also include the real world. Stuart A. Reynolds M.D., FACS Havre, Mont. In Support of General Surgery SURGERY NEWS is replete with articles warning of the crisis in general surgical manpower. The consensus is that we need more general surgeons, that they need to be better distributed geographically, and that they need to be available to take call in our increasingly crowded emergency departments. Yet forces conspire against this. Residents gain less experience in an 80-hour work week than they did in a 110-hour work week: 5 years of training equals only 700-800 cases—less than half the number of cases they did 2 decades ago. And fellowship training takes the general surgeon out of the workforce. We now have breast, hand, pancreatic/biliary, endocrine, colorectal, vascular, minimally invasive, bariatric, trauma, and acute care surgeons, as well as surgical intensivists. Each specialty has its own fellowship and professional societies. Each has its own self-serving proponents who will tell audiences at CME meetings that “this procedure should only be performed by fellowship-trained surgeons practicing at a designated center of excellence.” This subspecialization limits the places where general surgeons can live and work. Most require a city of more than 100,000 and a drawing area exceeding 250,000. That leaves a lot of territory uncovered by general surgeons. And many subspecialists apply for a narrower scope of clinical privileges in a thinly veiled attempt to escape emergency department on-call duty. Reimbursement reductions affect all physicians, but the hammer falls hardest on the general surgeon. I don’t know the answer, but I’ve got some ideas. Beef up the general surgical residencies. By partnering with private hospitals, all university-based programs should be able to supply their residents with experience approaching 2,000 cases in 5 years. Stop glorifying surgical subspecializa- LETTERS TO THE EDITOR SURGERY NEWS is your publication, and we’re eager to share your opinions. Please send correspondence, including your name and address, to surgerynews@facs.org or to: American College of Surgeons Communications Office 633 N. St. Clair St. Chicago, IL 60611-3211 Letters may be edited for space and clarity. New InfoV.A.C. 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Surgery News - June 2008 Contents Work Hours New Digs Banking Blood Improved Imaging

Surgery News - June 2008

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