Monday, October 23, 2006

The Future of Surgery XII.....
With a hat-tip to Kevin here are my two cents worth on what he calls the "softening" of surgical residency. The article from Forbes:'Flex' Training Can Boost Number of Surgeons:
Medical students studying surgery often quit before completing their training. Now, a new study suggests that schools that offer part-time and other flexible training options could boost and maintain students' interest in surgery.

The Web-based survey also found that some residents, fellows and practicing surgeons also would be interested in flexible training options.

"Many of today's medical students have more diverse interests and, when they apply for postgraduate training, may prefer specialties in which a more flexible approach to training (i.e., part time, reduced hours or extended period of time off) is an option to allow them to integrate other professional and family interests," wrote a team from the University of Virginia Health System in Charlottesville.
But are these the surgeons you want to care for you or your family members?
Currently in the United States, surgical residencies last a minimum of five years. As many as 20 percent of surgical residents quit their programs before they finish. In most cases, lifestyle concerns are the reason, according to background information in article.
And in other cases they fail to measure up academically or find they are unsuited for surgery as a career. "Lifestyle concerns" strikes me as a catch-all term for those who are too lazy or don't have the personality to survive through a surgical residency. If my personal experience is a guide, the eighty percent who graduate don't miss the twenty-percent who didn't very much.
Of the 4,308 medical students and doctors who took part in the survey, 20 percent to 30 percent said they'd accept a residency that lasted longer than five years if they could train part time, but few said they'd accept an extension to more than seven years.

The survey also found that 36 percent of female and 24 percent of male medical students said a more flexible approach to training would make them more likely to choose a career in surgery.
What would they do when they weren't surgical residents? The reason that residency is at least five years is because it takes that long to acquire the operative experience to become proficient at a procedure. Performing one, two, or even ten appendectomies does not make one an expert. There is a great possibility that without constant exposure during the "formative years" of one's residency that skills will not be as developed as they should be. Now for the "money graf":
"In light of recent concerns about decreasing applications to general surgery training programs and a need to appeal to students with greater interest in controllable lifestyle careers, a more flexible approach to surgical training could boost interest and improve applicant caliber," the authors noted.
(Emphasis mine)
So in order to appeal to the minority who would really like to become surgeons except for the sacrifice and time commitment required, we will make it a part-time experience. As some commenters to Kevin's post point out, general surgery remains very competitive. As seen in the 2006 match, only one slot went unfilled nationwide. Here are some figures from the 2005 match:

So are does this paper offer a solution for a problem that does not exist? Maybe maybe not. With close to eighty percent of chief residents pursuing fellowship training of one form or another maybe extending the training would encourage more residents to stick with general surgery. I doubt it though, while the residency my be part-time one would be hard-pressed to find a part time private practice job right now. Maybe not so hard in the future. The patient population wants knowledgeable, well-rested, and attentive physicians. With the 80-hour workweek limits in training and the habits learned under that system spreading to the "real world", two out of three isn't bad.
The abstract to the Archives of Surgery paper is here.


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