Wednesday, January 21, 2009

The Dying of General Surgery

Chief surgical resident Aaron Kendrick, who wanted to be a surgeon since middle school, has spent almost six years in a grueling general surgery training program at Erlanger hospital.
But this summer he’s switching gears to begin a three-year residency in anesthesiology, a field with better pay and a more relaxed schedule that will allow Dr. Kendrick to spend time with his wife and new baby, due in December.


“Mainly for me it’s the predictability of schedule,” he said. “General anesthesiologists work shift work, and when your shift is done, you go home.”

The number of general surgery residents here who practice as general surgeons is falling, said Dr. Phillip Burns, chairman of the department of surgery at the University of Tennessee College of Medicine’s campus in Chattanooga.

“Whereas 15 years ago 75 percent of our (general surgery residency) graduates here would be going into general surgery practice, it’s now down to about 25 percent,” Dr. Burns said.

...

“We have a shortage of surgeons, and physicians in general, that is coming on like a freight train in this country,” Dr. Burns said. “If we don’t do something to increase the numbers of surgeons that are graduating and available to go into spots, we’re going to have huge problems. In 10 years we’re going to have catastrophic problems.”


...

It’s a field in which pay is declining, with falling reimbursements from private insurers and government programs such as Medicare. Doctors also point to increasing medical liability insurance costs as a deterrent to entering the field.

For many young doctors entering practice with sometimes $150,000 in debt, general surgery may not make sense as a career choice, said Dr. Charles Portera, a surgical oncologist, a subspecialty that still incorporates general surgery.

“It’s kind of a sad state of affairs,” he said. “You’ve got to work harder to make the same amount of money that you did a few years ago. ... Why should these young kids go into it when there’s easier ways to make a living out there and still have a family and quality free time?”

[Full Article]


As a guy who's been interested in surgery since early childhood, it was quite the smack in the face to find that I have yet to encounter even one person involved in the medical field who would recommend going into general surgery. And I've spoken to plenty. The training is long, you work like a dog, and the compensation is small (and shrinking - thanks Medicare!) compared to the time put in and opportunity costs - and especially compared to the careers of other specialties.

General Surgery is a dying field in America through the shrinking compensations of government programs, endless hassles of hospital administrative red tape, which make for an unpleasant working environment and which exist only secondary to the perverse litigiousness of American society. This artificially intense liability of a surgeon simply working his trade also manages to add insult to injury by requiring ever larger chunks of one's salary be handed directly to malpractice insurance. As surgeons need to take on larger and larger loads just to stay afloat it saps them of leisure time, basic family interaction and those periodic iconic personal events that make up a person's private life.

Why would anyone want to be a general surgeon?

Heck, in twenty years where are you even going to find a general surgeon when your kid has emergent appendicitis at 3am? Is America ever going to wake up?

18 comments:

Anonymous said...

There is currently an even greater shortage of anesthesiologists, although the malpractice insurance isn't any lower.

Nice Jewish Guy said...

It's a big problem. And unless something is done to make it more attractive for someone to go into General Surgery, it's not going to get any better. What will happen-- and what is already happening-- is that the field will become comprised almost exclusively of foreign medical graduates. Not to say that FMGs are any less skilled or knowledgable, but they are still making more in the US in their fields here than their countries of origin.

Orthoprax said...

Manya,

"There is currently an even greater shortage of anesthesiologists, although the malpractice insurance isn't any lower."

Yeah, but that shortage is due more to an increased national demand, not a reducing supply. Anesthesiology is currently one of the more competitive residencies to get into and the compensation plus lifestyle is widely appealing (it's on the ROAD). I suspect that shortage will be self-correcting within a few years.


NJG,

Seems to me that this country is going enthusiastically headlong into the idea that it's good for society to give away the labor of doctors to the lowest bidder. The idea that because the work is so important it ought to be free for everyone is perverse. Doctors are willing to work hard for their patients but they're not going to put up with being slaves to the system or a cog in an administrator's care plan.

Lots of important fields are suffering in America because the incentives for practice are so backwards.

Ben Avuyah said...

I was actually scheduled to go into general surgery at one point, until I heard one attending complaining that on the rare occasions he had time off he really didn't know what to do with it.... all of his relationships outside the hospital had just, sort of, dwindled away.

Surgical subspecialties are still pretty nice ;-)

But I share your concern... health care is going in so many wrong directions at once it's hard to know how to pull out of this nose dive.

Orthoprax said...

Ben,

Ah, for nothing too serious I hope, but I know what he means. Not that my schedule is so terrible yet it's already much more difficult to be as socially active as I was compared to my college years. I just don't have the time to hang out with all the people I once did. The schedule of a GS is that much more overbearing and that much more socially debilitating.

Some surgical specialties are nice, which is why I'm considering maybe doing vascular right now. But we'll see. In any case I'll need to run the gauntlet of at least a tough 5 year surgical residency - where (as I hear) the hours are worse than at any other time of a surgeon's career. But I'm willing to do that if the outcome is something worthwhile - not the (literally) endless night of a GS' lifestyle.

What kind of medicine do you practice? Any advice? ;-)

Ben Avuyah said...

I'll be happy to give you my two cents...I'll email you !

Orthoprax said...

Yes, please do!

Anonymous said...

OP,

Somehow I see you as an ID guy. What you've said about surgery is true. It'd be a shame for you to hit rock bottom 8 months into your intern year at 5 in the morning after a 40 hour shift. The next day you'll be switching to ER or anesthesia and glad you don't have to waste another 4 months of your life in hell surrounded by bitter and petty minigods. You have one life to live. Let others make the mistake.

I found PM&R late in my fourth year, ignored ignorant comments by others, and have been tremendously happy doing interventional spine. Don't forget that derm, rads and anesthesia were scoffed upon only 20 years ago!

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Niha said...

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Anonymous said...

Very thoughtful article. I love to be a surgeon however I hate to be one in this country mainly because of these hungry, pethetic and inhumane lawyers. These bastards dont want to change anything because they are the ones making rules at the top too.

secure tabs said...

you know that I met Aaron Kendrick when he was a child, and i am so glad to hear about him since it's been many years that I did not know anything about him. I'm also glad that he is working so hard at Erlanger Hospital

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Yes, i think that the general surgery includes many other surgeries. For instance, It also is called minimally invasive surgery, bandaid surgery, or keyhole surgery. The Orthopaedic Surgeons only operate a length of usually 0.5–1.5 cm as opposed to the larger incisions needed in laparotomy. Usually, the trauma surgery is one of general surgeries. It is an important component of the invasive treatment of physical injuries, typically in an emergency setting. The trauma surgeon takes on the responsibility for the initial resuscitation and stabilization of the patient, as well as persistent evaluation and management.

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anonymous said...

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