I posted a previous note about how general surgery is becoming a less attractive specialty for new medical school graduates (see: General Surgeons as the Primary Care Docs of the Operating Room). The article quoted drew a parallel between general surgeons and primary care physicians. The reason that general surgery is becoming less attractive is that these specialists often shoulder a heavy burden of the call schedule in hospitals and also end up referring many of the interesting cases to the surgical subspecialists. In that note, I addressed the on-call issue in the following way:
For me, the on-call issue is a distraction that can be solved relatively easily. The hospitals can hire their own surgicalists about which I have previously blogged (see: The Emergence of the Surgicalist) and taking a fair amount of call will be a condition of their employment by the health system. In terms of referral patterns and with a shortage of general surgeons, I envision that the PCPs will refer to the surgical subspecialists. But what happens if there is a shortage of PCPs?
Now
comes a new article in the Washington Post that discusses how the shortage of general surgeons is having a
negative effect on healthcare delivery in rural areas (see: Shortage of General Surgeons Endangers Rural Americans). Below is an excerpt from the article with boldface emphasis mine:
Many young physicians are opting for non-surgical specialties, such as radiology or cardiology, in which they can earn as much money as a surgeon with less grueling and unpredictable hours. Many young surgeons, in turn, choose to concentrate in fields such as transplant surgery or plastic surgery, in which they can make more money and don't have to face (usually alone) the wide range of problems a generalist faces. "The shortage of general surgeons is at crisis dimensions," said George F. Sheldon, director of the American College of Surgery's Health Policy Institute. If the trend continues, he said, "the quality of health care will suffer, as the services of a surgeon are unique." In 1980, 945 newly trained general surgeons were certified in the United States. In 2008, the number was essentially the same -- 972 -- even though the population has increased by 79 million. In 1994, there were 7.1 general surgeons per 100,000 people. Today there are five per 100,000.
It occurs to me that a new breed of surgicalist could be developed to provide general surgery services in rural areas of the country. Multiple rural hospitals could join together and hire a salaried surgicalist(s) (i.e., a regional surgicalist) who would be an employee of the hospital network. In order to address the on-call burden, it would probably be necessary to hire two or more of them for any individual network. In addition, it would also be useful to establish telemedicine links across the participating hospitals so that a referring PCP or internist could rapidly obtain a teleconsultation with the regional surgicalist to determine whether surgery was necessary for a particular patient and where the surgery would be performed.
Despite the fact that a hospital surgicalist (or regional surgicalist) is becoming more of a generalist, these specialists will still retain the key advantage over primary care physicians (PCP) of performing procedures and therefore enjoying a salary advantage (see: Two Definitions for the Physician Proceduralist). This may make the idea of developing a position of regional surgicalist more feasible.
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