At both places I work with surgical residents, they have so much autonomy that the staff often meet the pt in preop or the OR.
This still goes on in certain areas of academia, but it's going away. Surgical attendings recognize that residents should be allowed
appropriate autonomy and
appropriate supervision. Like anyone, residents don't like it. I do agree with you that some of these Wild-wild-west type places have the
blind leading the blind (i.e. senior surgical residents with crappy technique and judgment
responsible for teaching said crappy technique and judgment to junior residents).
Anecdotal stories of bad residents tend to be concentrated in these institutions, but I still don't think it's fair to accuse
surgery residents in general of being dangerous cowboys with bad judgment. Remember how the surgical attendings that you now respect got to where they are today.
Either way, I stand by the view that surgical housestaff have more autonomy and are in a position to make errors that are more significant than any other trainee. I just think you all are so used to that situation that you don't see how different it is than the way non-surgical housestaff function. So, when housestaff are involved, I'd rather my patients were on an IM service. They are more likely to do what I ask and less likely to get bored and either intervene or discharge my patient.
I highlighted the most important part of your paragraph. If they're
your patients, and you want to be the one making their medical decisions, then you should admit them to
your service.
The current #s per the ASGE are 140 colons and 130 EGDs. Higher #s for ercp and eus. These are numbers for fellows though and we start from having done almost no procedures before fellowship. I train surgical residents in endoscopy and I think they are generally faster at picking it up unless they get their start with someone who does the "you push, I'll drive" technique. I did 2000+ procedures in fellowship and i think that's typical. I felt colos got easier around #80 and way easier around #200. ERCP and EUS both clicked for me a little late (in the 300s somewhere).
There are not too many surgeons trying to do ERCPs and EUS. You teach surgery residents, so you know there's a disparity of talent and interest in endoscopy.
During my general surgery residency, I did over 50 bronchs, 100-150 EGDs, 30 PEGs, and 200+ colonoscopies. Not all residents go into CRS, but many do go into rural environments, and I feel that with those numbers they are well prepared to perform endoscopy. I will admit that after doing another 250+ colonoscopies as a fellow, I feel more comfortable.
As for the turf war stuff, I'm not sure what literature you mean......but I have no problem with anyone scoping who is good enough.
That's what I was waiting to hear. The truth is that volume and scope of practice usually dictate quality, regardless of specialty. As long as surgeons (and even ::gasp:: FP docs) meet the quality measures we've mentioned, I think it's appropriate for them to do endoscopy, especially if they are in an underserved area where there aren't a bunch of gastroenterologists available.
I was referring to the literature that shows that subspecialty training in colorectal surgery leads to better patient outcomes. Patients undergoing elective or emergency surgery on the colon or rectum, whether for benign or malignant disease, do better with a CR surgeon (morbidy, mortality, DFS)...this is more significant with the rectum than the colon. Some of this literature is inherently flawed, but it accentuates my point that volume and scope of practice dictate quality.
However, despite my beliefs that I do a better colectomy or LAR/APR than a run-of-the-mill general surgeon, I would never be so bold as to say that general surgeons shouldn't operate on the colon. It's just not practical, as plenty of general surgeons are more-than-qualified to do these surgeries, and colorectal surgeons couldn't possibly cover the volume of colectomies that occur in the US. Now, substitute "colonoscopy" for "colectomy," and you can see how I think this situation applies to you.
Anyway, I don't think we disagree as much as you think we do, and I'm also prone to histrionics when my specialty is attacked, so I call for a truce. We've hijacked this thread enough, and I'm sure the snowflakes want to go back to complaining about unfair evaluations.