Check out this article y'all. Pretty interesting. Here's the link.........
NY Times Article
-----------------------------------
Anyone in the O.R.?
By STEVEN G. FRIEDMAN
ANHASSET, N.Y.
With the recent award of $140 million in a medical malpractice case, and strikes by surgeons in several states, the issue of malpractice insurance and its drain on the profession is impossible to ignore. Insurance premiums need to be lowered, laws must be enacted to produce reasonable awards and stifle frivolous lawsuits, and jurors and patients must learn that a poor outcome is not synonymous with malpractice.
Yet this problem is just one factor conspiring to bring the profession of surgery to its knees. According to the National Resident Matching Program, a private, nonprofit corporation, the number of American medical students applying to general surgery residency programs declined by 30 percent from 1992 to 2002. If this trend continues, less than 5 percent of medical school graduates will choose a career in surgery by 2005, and only 75 percent of general surgery residency positions will be filled by graduates of medical schools in the United States.
There are several reasons for these dire statistics. For one, women may be attending medical school in record numbers, but they are avoiding surgery. Studies have demonstrated that female residents tend to be more concerned than their male counterparts about raising children, maternity leave, personal relationships, career advancement and the availability of role models. Surgical training programs are more inflexible than those in other specialties when it comes to work schedules and personal concerns.
Money is also an issue. According to the American Association of Medical Colleges, the debt incurred by most medical graduates has quadrupled to more than $100,000 since 1985. Because residents get menial salaries, longer residencies like general surgery mean greater difficulty repaying student loans. In addition, reimbursement for most surgical procedures has steadily decreased since 1992. The prospect of declining reimbursements has caused residents to drop out of training programs in record numbers. In some programs the attrition rate is as high as 25 percent; and practicing surgeons are retiring earlier than ever or undertaking new careers.
But the problems go beyond numbers. Quality of care is also under siege. The American Medical Association's Council on Medical Education recently approved limiting the number of hours that residents can work to 80 hours per week. While this restricted schedule may still seem excessive to those outside the profession, the limit will profoundly harm resident training. Surgical residents had typically worked 120 hours a week, guided by the philosophy that the more often one does a procedure, the better one performs it, and that continuity in patient care leads to better outcomes. Will patients now be better off with shift workers who have never seen the complete progress of an illness than they were with tired doctors who cared for them throughout the night?
A better solution would be to shorten the length of surgical residencies, particularly with respect to subspecialties. Five years of general surgery training is unnecessary for residents wishing to become pediatric, cardiac or vascular surgeons. Three years of general surgery followed by two or three years of subspecialty training would make more sense. Surgeons also need to spend more time with medical students and need to become better mentors.
Finally, the relentless cutbacks in Medicare reimbursements to doctors must cease. The trend of doctors refusing to treat Medicare patients is just beginning its ascent, resulting in daily denial of access to health care because the federal government will not pay a fair price for it.
Unless corrective measures are undertaken now, access to a surgeon will no longer be a question of picking a name from a directory or asking a friend or family doctor. Rather, it will be a question of whether there is anyone to see at all.
Steven G. Friedman is director of the residency program for vascular surgery at North Shore-Long Island Jewish Health System.
NY Times Article
-----------------------------------
Anyone in the O.R.?
By STEVEN G. FRIEDMAN
ANHASSET, N.Y.
With the recent award of $140 million in a medical malpractice case, and strikes by surgeons in several states, the issue of malpractice insurance and its drain on the profession is impossible to ignore. Insurance premiums need to be lowered, laws must be enacted to produce reasonable awards and stifle frivolous lawsuits, and jurors and patients must learn that a poor outcome is not synonymous with malpractice.
Yet this problem is just one factor conspiring to bring the profession of surgery to its knees. According to the National Resident Matching Program, a private, nonprofit corporation, the number of American medical students applying to general surgery residency programs declined by 30 percent from 1992 to 2002. If this trend continues, less than 5 percent of medical school graduates will choose a career in surgery by 2005, and only 75 percent of general surgery residency positions will be filled by graduates of medical schools in the United States.
There are several reasons for these dire statistics. For one, women may be attending medical school in record numbers, but they are avoiding surgery. Studies have demonstrated that female residents tend to be more concerned than their male counterparts about raising children, maternity leave, personal relationships, career advancement and the availability of role models. Surgical training programs are more inflexible than those in other specialties when it comes to work schedules and personal concerns.
Money is also an issue. According to the American Association of Medical Colleges, the debt incurred by most medical graduates has quadrupled to more than $100,000 since 1985. Because residents get menial salaries, longer residencies like general surgery mean greater difficulty repaying student loans. In addition, reimbursement for most surgical procedures has steadily decreased since 1992. The prospect of declining reimbursements has caused residents to drop out of training programs in record numbers. In some programs the attrition rate is as high as 25 percent; and practicing surgeons are retiring earlier than ever or undertaking new careers.
But the problems go beyond numbers. Quality of care is also under siege. The American Medical Association's Council on Medical Education recently approved limiting the number of hours that residents can work to 80 hours per week. While this restricted schedule may still seem excessive to those outside the profession, the limit will profoundly harm resident training. Surgical residents had typically worked 120 hours a week, guided by the philosophy that the more often one does a procedure, the better one performs it, and that continuity in patient care leads to better outcomes. Will patients now be better off with shift workers who have never seen the complete progress of an illness than they were with tired doctors who cared for them throughout the night?
A better solution would be to shorten the length of surgical residencies, particularly with respect to subspecialties. Five years of general surgery training is unnecessary for residents wishing to become pediatric, cardiac or vascular surgeons. Three years of general surgery followed by two or three years of subspecialty training would make more sense. Surgeons also need to spend more time with medical students and need to become better mentors.
Finally, the relentless cutbacks in Medicare reimbursements to doctors must cease. The trend of doctors refusing to treat Medicare patients is just beginning its ascent, resulting in daily denial of access to health care because the federal government will not pay a fair price for it.
Unless corrective measures are undertaken now, access to a surgeon will no longer be a question of picking a name from a directory or asking a friend or family doctor. Rather, it will be a question of whether there is anyone to see at all.
Steven G. Friedman is director of the residency program for vascular surgery at North Shore-Long Island Jewish Health System.
