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Surgeon Shortage Possible - excite.com

Discussion in 'Medical Students - MD' started by ducam, Mar 15, 2002.

  1. ducam

    ducam Pearl Diver
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    03/15/2002 4:06 AM EST

    By LINDSEY TANNER

    Doctors say general surgeons could wind up on the critical list if today's medical students continue to choose a comfortable lifestyle over grueling, unpredictable work hours.

    The number of applicants to residency programs in general surgery has dropped 30 percent in the past nine years, according to studies in the March issue of the journal Archives of Surgery.

    The trend began in the 1980s, but last year was the first since then that the number of general surgery positions offered to U.S. medical school graduates exceeded the number of students interested, the studies say.

    Medical students are more likely to be married and female than they were a generation ago. And unlike large numbers of their predecessors, many actually want a life outside medicine, according to the studies.


    More students are entering specialties that require shorter training periods, such as radiology, anesthesiology and emergency medicine.

    General surgery typically involves abdominal operations, such as appendix removal, and trauma cases.

    The effect of the drop-off in general surgeons could be tremendous in the coming years, some doctors say.

    It could even result in deaths and health complications as patients who need emergency surgery such as appendix removal may have to wait hours while a surgeon is located, said Dr. Anthony Meyer, chief of surgery at the University of North Carolina in Chapel Hill and author of one of the reports.

    When the shortage hits, "it can't be fixed right away. You can't just say we need more surgeons and turn up the spigot," Meyer said. "When it hits, it will hit for a while."

    Joy Henningsen, 26, who is graduating from University of Alabama at Birmingham medical school this year, said in an Archives article: "Long hours, being on call, and family considerations are often enough to make some students think twice about general surgery. Regardless of whether surgeons actually have a decreased quality of life relative to other physicians, many medical students perceive that to be the case."

    UAB-Birmingham's Dr. Kirby Bland, who graduated from medical school in 1968, said his generation "was very work-oriented and very focused on your work more than perhaps on your family."

    The effect is also starting to reach some subspecialties, including cardiac surgery, which could have shortages of interested medical students in the next few years, Meyer said.

    The American College of Surgeons is trying to make surgery more attractive to students by encouraging medical schools to liven up the curriculum, said Dr. Thomas Russell, executive director.

    Northwestern University's medical school, like many others, is trying to reduce residents' grueling work hours, said Dr. Richard H. Bell Jr., the 57-year-old chief of surgery at Northwestern Memorial Hospital in Chicago.

    Bell said the school is also arranging for students to go into the operating room to see the technical artistry that so attracted him to surgery.

    Becoming a general surgeon takes five years of residency training, two years more than fields such as radiology and dermatology. That is in addition to four years each of medical school and undergraduate education.

    A generation ago, general surgeons could set up practice after those five years and perform all kinds of operations. In theory, they still can, but with the growing number of subspecialties such as heart surgery and pediatric surgery, many general surgeons cannot compete until they seek four or five additional years of training in one of those fields, Bell said.

    With the average U.S. medical school graduate $100,000 in debt, facing several years of earning $50,000 a year as a resident isn't very appealing, Bell said.

    The extra training means most will not start their careers until their mid-30s or later, which deters many women who want to have children, Bell said. Today, almost half of U.S. medical school graduates are women, compared with less than a third in 1974.

    American Medical Association figures show the number of general surgeons grew steadily in the 1970s and '80s but slipped from 38,376 in 1990 to 36,650 in 2000. Last year, 68 residency positions in general surgery were untaken. They eventually were filled, many with foreign medical school graduates, a trend that is expected to continue, Bland said.

    Bland predicted even more general surgery positions will go unfilled this year. That will be determined on Match Day next Thursday, when medical students nationwide are matched with residency programs.

    ---
     
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  3. ghostcow

    ghostcow Member
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    geez, this is the third thread on this article.
     
  4. HPSP

    HPSP Member
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    Medical School applications are down 35% over the same timeframe. I think the problem is not lack of interest but more likely one of the results of the aforementioned. Just my opinion.
     
  5. Jim Picotte

    Jim Picotte Senior Member
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    I don't think the applicants being down to med school has anything to do with it as all the medical school slots get filled anyway. You're just going to see more and more surgery positions filled by IMG's.

    At least where I'm at, my general surgery rotation in medical school was very malignant which I think had to do with the residents being on call every other day (when one resident is on vacation) or every 3 days. While I really liked general surgery, the personality of the surgeons (I shouldn't generalize, but they weren't very good where I trained) and the hours made me drop surgery off my list of possible career choices and I really liked it.

    I may be selfish but I'm not willing to work 100 hours a week during my residency. While I love medicine, I also love my family, friends and do have a lot of other interests. I think the main reason is the hours and lifestyle which is why we're seeing such an increase in interest for radiology, anesthesiology and other very rewarding specialties that don't have as many malignant personalities and hours allow for more free time away from medicine.
     
  6. saffron

    saffron Senior Member
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    yeah, i agree...i'm surprised that there is not more of an outcry from physicians and the medical community about the outrageous number of hours doctors have to work, years and years of training, while taking on massive debt for little or almosr no compensation.

    my friend went into i-banking and had a starting salary of 90K straight out of college. this is not including perks like signing bonuses, paid trips, "business" dinners... :rolleyes:

    physicians save lives, go into debt, and waste away their 20's working like mad and are struggling to pay back loans and make ends meet. is it any surprise, then, that more students are opting out of fields like surgery? :mad:

    you may love medicine, but my god, you have to live don't you? if you're working that hard, you deserve compensation for it- if they doubled the salary of surgery residents (say at least 70 K- which is what a person with that much schooling DESERVES), then perhaps there would be more lifestyle incentives to go into it. not that money is everything, but a perk like that may make being a slave for 5 more years more bearable/appealing.

    sorry for the rant, but i think its ridiculuous the way that one of the most hard-working, educated professionals get so little when there are tons of stupid business majors (we all know ppl who partied all through college), etc. that are making killings without any extra education.

    after all this, i'm still going to med school. am i crazy? <img border="0" title="" alt="[Eek!]" src="eek.gif" />
     
  7. Medic171

    Medic171 Senior Member
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    While I agree that docs hours should be decreased, I have no problem with the compensation. For me, anything over 90K a year is more than enough.

    Also, I do not think it is fair to call business majors "stupid". That is a poor generalization. They usually have a minimum of an MBA with extra corporate or specialized training, they are no idiots. In addition, there are many business people who work as much or more than some docs. Do you think ceo's, executives, or even jr. executives put in 40 hours a week and go home? Many of them work 15 hours a day 6 days a week. Comparing professions is the wrong way to look at it. Instead, worry about the medical profession alone by adjusting the work hours that we are comfortable with for the compensation we feel is right, not by comparing other professions. Just because we save lives does'nt mean we are more knoble than other professions. Just because our education takes longer than most other does not mean that we deserve more. A person studying quantum physics may go 4 yrs undergrad, 4 to 5 yrs grad, and spend several more years in research, and most of those folks do not make more than 60K or 70K, yet some might regard them as more educated than doctors.
     
  8. SocialistMD

    SocialistMD Resident Objectivist
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    Something I find kind of funny is how there are people who say "this is too much work" and then there are people who are actually looking forward to that kind of schedule. All of my classmates who want to go into surgery wonder what the big complaint with resident work hours is. We all think it will be fun. Then again, the mantra of the surgeon is that the only thing wrong with Q2 call is that you miss out on half of the cases. :)
     
  9. jargon124

    jargon124 Senior Member
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    This mistake sort of makes me question the article. (Rads=5 years, Derm=4 years)

    "Becoming a general surgeon takes five years of residency training, two years more than fields such as radiology and dermatology. That is in addition to four years each of medical school and undergraduate education."
     
  10. jargon124

    jargon124 Senior Member
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by SocialistMD:
    <strong>Then again, the mantra of the surgeon is that the only thing wrong with Q2 call is that you miss out on half of the cases. :) </strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">That's great! LMAO... :D
     
  11. neutropeniaboy

    neutropeniaboy Blasted ENT Attending
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Medic171:
    <strong>While I agree that docs hours should be decreased, I have no problem with the compensation. For me, anything over 90K a year is more than enough.
    </strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Come on, man. Don't sell yourself short. You go to school for 30 years of your life, accumulate debt between $100,000-$200,000 (Medical school +/- undergrad), work over 80 hours per week, have to deal with the hassel of doing everything you possibly can to ensure that you get paid 1/3 of what you deserve, sacrifice your social life, and end up with much less respect than what your colleagues had 20 years ago...Geesh....$500,000/yr minimum!
     
  12. neutropeniaboy

    neutropeniaboy Blasted ENT Attending
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by jargon124:
    <strong>This mistake sort of makes me question the article. (Rads=5 years, Derm=4 years)

    "Becoming a general surgeon takes five years of residency training, two years more than fields such as radiology and dermatology. That is in addition to four years each of medical school and undergraduate education."</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">I don't think it's really the technical errors that make the article marginal. The gist of the article hits the nail on the head. The concerns of the graduates are fairly represented in the article. At the very least, the article overestimates some training periods and salaries, and this isn't such a problematic inaccuracy.
     
  13. Street Philosopher

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    I-banking is extremely tough as well. They probably work as much hours (if not more!) during the first few years of their job. My friend did Economics during school and is looking for a job. He said he didn't want to do i-banking because he "wanted to have a life." From what my buddy said, it seems that i-banking requires 80-100 hrs a week for at least the first few years. It's very stressful, and that 90,000 a year isn't paying them to sit on their ass; they have to work like hell for it.

    That being said, I still think the current situation with residents, salary, and hours is still ridiculous. BUT, I have yet to experience it so it'd be too early for me to know for sure.
     
  14. saffron

    saffron Senior Member
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Medic171:
    <strong>While I agree that docs hours should be decreased, I have no problem with the compensation. For me, anything over 90K a year is more than enough.

    Also, I do not think it is fair to call business majors "stupid". That is a poor generalization. They usually have a minimum of an MBA with extra corporate or specialized training, they are no idiots. In addition, there are many business people who work as much or more than some docs. Do you think ceo's, executives, or even jr. executives put in 40 hours a week and go home? Many of them work 15 hours a day 6 days a week. Comparing professions is the wrong way to look at it. Instead, worry about the medical profession alone by adjusting the work hours that we are comfortable with for the compensation we feel is right, not by comparing other professions. Just because we save lives does'nt mean we are more knoble than other professions. Just because our education takes longer than most other does not mean that we deserve more. A person studying quantum physics may go 4 yrs undergrad, 4 to 5 yrs grad, and spend several more years in research, and most of those folks do not make more than 60K or 70K, yet some might regard them as more educated than doctors.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">yeah i agree it was a hasty generalization- i have some very smart b-school friends. but i guess my point was, they don't have to study nearly as hard in undergrad as most premeds i know...so the hard work and long hours actually begin 4 years earlier for future doctors.

    i realize i-bankers and other business people put in 15 hour days, but at least they get paid well (and right out of college) for it. med students work just as hard and get debt.

    yes, many people go back to get MBAs- but usually the company pays for you to go get the additional training.

    i dont think doctors are more "knoble" (did you mean noble? :) ) than anyone else. im sure ppl studying quantum physics are just as smart. ok? but working in a lab is not the same as working 12 hour shifts and being on call every other night.

    i still think that doctors work too many years and too many hours, and sometimes i am concerned with the sacrifices that i am going to have to make- not as much of a social life as i would like, not enough time for family and friends, delaying having a family of my own, etc. it can seem daunting when i think that after all this i might be making 35K when im 30 years old with over 100K in debt with the interest accumulating every second.

    just my opinion. :D
     
  15. tussy

    tussy Senior Member
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    Surgery is a vocation, not a career. You do it because you love it, and because you have chosen to devote your life to it. If you want a 40 hour work week, don't become a surgeon because the two are not compatable.
     
  16. fourthyr

    fourthyr Member
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    469 unfilled spots general surgery this year, 2002. Comparing the ratio of unfilled spots to programs, general surgery is number one.
     
  17. Whisker Barrel Cortex

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    The number of unfilled surgery spots includes preliminary spots. Last year there were 512 unfilled surgery spots with only 68 of those being categorical surgery spots. The vast majority of these were likely filled in the scramble. There is no surgeon shortage and will not be unless the demand rises. The supply will stay the same.
     
  18. nitro girl

    nitro girl Junior Member
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    i had initially wanted to go into ortho when i started this whole med school thing, it seems like a really interesting job, lots of mechanical pulling and drilling and rewarding right away. I also have a plate from a racing accident, and a lot of other contact with ortho guys...unfortunately i am female and in all honesty i am not sure i could commit to a specialty that would take so much of my time and energy if i want to ever have kids. Seriously. Even with a very decent and understanding husband(not yet, some day) I don't think kids understand that you put your job before them.

    thats my two cents. So at this point Im thinking ER, Anethesiology too...what can I say
     
  19. MacGyver

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    Next thing you know, program directors at hospitals will be screaming that we need MORE residency positions to make up for the shortfall.

    And guess whos going to take those positios? You got it, IMG/FMGs will be called in.

    Program directors will use this article as a ploy to get more cheap labor and free money (medicare funds residencies) from the government.
     
  20. leila8888

    leila8888 Junior Member

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    The best advice I have gotten from my program director in surgery and also from several surgical residents was: If there is ANYTHING else you want to go into besides surgery...DO IT! Unfortunately, for some of us, that is not an option, since surgery is IT. You could almost call it a curse!! :p
     
  21. MacGyver

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by tussy:
    <strong>Surgery is a vocation, not a career. You do it because you love it, and because you have chosen to devote your life to it. If you want a 40 hour work week, don't become a surgeon because the two are not compatable.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">I assume you are referring to hours during residency. There is really only 1 or 2 that actually get 40 hours a week, the rest are much higher. Besides, there is a HUGE difference between 40 hrs/week and 120 hrs/week. Why do we have to go to the extreme? Why not 85 hours/wk?

    A lot of surgeons seem to have the "its a surgery thing, you wouldnt understand" attitude. That same kind of arrogance/cockiness is exactly what has PLAGUED medical care for the last century. Its time for a new attitude check. NO specialty is above reproach, I dont care how technical and demanding it supposedly is.

    I say cut the government's role in residency funding and let the system privatize. Yes, the hospitals will stop getting free labor, but if they REALLY need that govt money just to break even, then its an untenable situation that is destined to fail regardless of govt intervention. Long term, it means that govt has to spend more and more $ per resident to keep the system afloat because of inefficient hospital operation. Besides, who needs to run an efficient hospital money-wise, when they can continue to expect government money handouts with no strings attached?
     
  22. leorl

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by MacGyver:
    <strong>Next thing you know, program directors at hospitals will be screaming that we need MORE residency positions to make up for the shortfall.

    And guess whos going to take those positios? You got it, IMG/FMGs will be called in.

    Program directors will use this article as a ploy to get more cheap labor and free money (medicare funds residencies) from the government.</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">I think implying that IMGs/FMGs are somehow less qualified and less competent to work, and that they'd be willing to settle for inferior jobs and likening them to migrant/illegal farmers with the same terminology as applied to them is very insulting.

    While IMGs/FMGs are not given priority, to think that medical care would be compromised by having them in the work force is not only wrong, but shows intolerance and prejudice on your part. While you didn't implicitly state it, this is what I gather from the tone of that statement, and is just letting you know before the misjudgment propagates.
     
  23. assyrian

    assyrian Junior Member
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    hi leorl thanks for saying something good about imgs. it happens very rarely on these discussion boards.
     
  24. D-

    D-

    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif"> </font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">if today's medical students continue to choose a comfortable lifestyle over grueling, unpredictable work hours.

    Geez, this is not a surprise.
     
  25. leorl

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    np assyrian, I'm just saying it from the perspective of a possible future IMG/FMG. I never quite got that argument. If there is a demand for say...surgeons, since that's the post...and the demand is not filled by US surgeons...what is wrong with taking IMGs/FMGs? It's not like the IMGs/FMGs are being chosen over the US-trained ones, and they're all just as qualified (unless trained in a very underdeveloped area)...but to get to residency, IMGs/FMGs have had to perform well on the USLME's and the CSA, so there is some standardization. MacGuyver mentions the pride/arrogance of surgeons plaguing the medical community. Well ironically, his tone against IMGs/FMGs also depicts an arrogant attitude, and THAT plagues the medical community.

    As far as the labor thing, I don't even think you'll find many people, IMG or not, willing to put up with 120 hours/week. Or even 85+ hours/week. That's just really insane and not humanly possible to sustain for very long. Filling surgical residencies with IMGs I don't think would be a very good answer, as I wouldn't forsee a huge number of IMGs wanting to put up with those conditions just to get into the US. NOT to mention, quite a few IMGs are US citizens who've done undergrad in the US and know what all this entails.
     
  26. assyrian

    assyrian Junior Member
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    hi leorl, you will be surprised to know that there will be many imgs who will be ready to go into a resdiency which requires 120 hours. some of them want to be in the usa so badly that i have seen a few ,who are fully trained surgeons in their country, but come here and change their specialty to something totally unrelated. i personally dont think that is good. but just imagine if some imgs are ready to change the specialty in which they have been working for many years, then they will also be ready to put in as much work as they are asked to do. also from your post i got the impression that you may consider going to med school outside the usa. my advice to you is that if you are interested in a competetive specialty or are ambitious and want to go to a reputed university for residency, then dont go to a foreign med school. i am not an american citizen and so i dont think that i deserve an equal right to residency opportunities as an american graduate. but when i was interviewing , i saw so many americans who had gone to foreign medical schools and were being treated like crap just because they went to a foreign med school. i think it is very unfair to do that to an american citizen.
     
  27. leorl

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    thanks assyrian, it'd definitely something I've spent hours and hours weighing out, but it's something I feel I've gotta do :) . The schools I've chosen are relative "safe" in regards to gaining entrance back in the US and on-par education. It's definitely something I keep debating...but also know I'll regret it if I don't.
     
  28. MacGyver

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    leorl,

    I wasnt trying to attack IMGs. I am attacking the program directors. They are always actively seeking to expand residency slots in ALL specialties just so they can get free government money.

    Medicare funds each residency slot at $100,000 per year. You do the math. Its a profit for hospitals to have as many resident slots as possible. Thats why we have seen a massive increase in the number of residency slots. Has access to medical care improved as a result of this increase? Absolutely not, in fact it has gotten worse.

    I dont fault the IMGs for taking advantage of it, but I DO fault the program directors and the government personnel in charge of funding.
     
  29. leorl

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    I'm not too knowledgeable in this area, but if they try to expand the number of residency slots...should that not decrease the workload, thus decreasing the number of residency hours?
     
  30. fourthyr

    fourthyr Member
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    dunno leorl.... who's gonna pay for the extra residents? and how do the fixed # of caseloads get spread amongst more surgery trainees?
     
  31. leorl

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    I was assuming that if more residents were used to get more money, this would be where the extra $$ to pay for residents would be. However, I know this is naive thinking. Is there a book or anything out there that we can read about this? It's intriguing.
     
  32. fourthyr

    fourthyr Member
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    all this is very interesting to me too, leorl...

    I don't know if there's a book....

    if you find one, definitely let us all know!
     

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