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?

Tuesday, January 20, 2009

Little Details

Right in the third sentence of his inaugural address Pres. Obama says:

"Forty-four Americans have now taken the presidential oath."

Eh, not so much. Grover Cleveland swore himself in twice in nonconsecutive terms as number 22 and 24 Presidents of the United States.

Oh well.

In any case Obama made a decent speech, but I still think the best presidential speech I ever heard was this one:

Still brings tears to my eyes...

Monday, January 19, 2009

How I'm feelin'...

Greatly Relieved - that a cease fire has finally been established in Gaza. Though...

Endlessly Frustrated - that a true peace seems further away than ever.

Growingly Anxious - about big career decisions that I'll need to make this year as I realize med school is nearing its final few stretches and most of my information comes in second hand form.

Downright Concerned - about the fate of medical practice in America where managed care, government regulations and CYA practice secondary to litigiousness is progressively grinding enthusiasm out of the field.

Abashedly Hopeful - as I see the strength of American democracy in the upcoming inauguration of Obama, through whom I also feel a...

Frank Solidarity - with the Black people of America who are seeing what was unthinkable just a few decades earlier.

Awed Delight - for Sully Sullenberger who with aplomb saved 150+ lives with an amazing landing in the Hudson.

Defeatedly Blase - about studying all this week for the coming exam that caps off my latest hospital rotation. Though I've also got..

High Hopes - for my irregular week off after that exam when maybe I'll go skiing and have a superbowl party or something.

There you go. The latest review of what's on OP's mind lately.

Thursday, January 01, 2009

Conubium aka Kiddushin

"According to [early] Roman law, a child is the legal heir of his father and is in his father's custody (potestas) only if his father and mother were joined in a legal marriage (justum matrimonium). The capacity to contract a legal marriage was called conubium (or ius conubii), and was possessed almost exclusively by Roman citizens. Marriage between a person with conubium and a person without conubium was valid, but it was not a justum matrimonium; and without a justum matrimonium, the status of the child follows that of the mother." - Shaye J. D. Cohen, "The Beginnings of Jewishness," page 294.

Compare with:

According to Jewish law, a child follows the tribal status of his father if both his father and mother possessed the capacity to join in a legal marriage. This capacity is called kiddushin and is possessed exclusively by Jews. Relations between a person capable of kiddushin and a person incapable of kiddushin, say a Jew and a Gentile, results in the status of the child following that of the mother.

An echo of Roman law in Halachic matrilineal descent?