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The First Fifty Things You Need to Know If You Are Having Surgery 1/24/2014 7:24:20 AM
The first thing you need to know: Question # 1. How Has the Practice of Surgery Changed in the Last Thirty Years? (or, Why Do I Need This Book?)
You need a few essential facts up front in order to appreciate just how radically the practice and training of general surgeons has changed in the last three decades. There are huge differences in the way surgical patients are diagnosed and treated today. But, mostly you must appreciate the knowledge and behavioral differences between today’s surgeons and that of practitioners when I began practice in the mide-1970s. Understanding these changes can literally make the difference between life and death:
there is a nation-wide shortage of general surgeons
since the 1980s the number of general surgeons per 100,000 people has declined 26%
by 2025, the US will be short 40,000 general surgeons
there are two types of surgeons doing general surgical operations (hernias, gallbladders, breast surgery, colon cancer, trauma, etc): fellowship trained with extra expertise in more narrow practice areas, and general surgeons with five years of traditional broadly oriented training
Yet, about 50% of rural and suburban jobs don’t require fellowship training and only 17% of graduates will enter academic surgical positions requiring fellowship training
Therefore, we are not training general surgeons to meet the market needs of the US; as a result you may be exposed to a young surgeon who is over-trained or under-trained – including with a lot or very little experience – with the operation you need
Stated differently, you may encounter a surgeon who is fellowship trained with fabulous skills in specific areas (colon/rectal, pediatric, trauma/acute care, etc), but who does little general surgery in other areas; or, you may encounter a general surgeon with a lot of broadly based operations, but with little experience in complex challenging (and often laparoscopic) operations
Over 50% of recent graduates from US surgical programs expressed a lack of confidence in their skills
Now, you can hopefully understand why you have to ask questions about your surgeon and his or her training and experience. Mine is not a criticism of the surgical educational system – although I am deeply involved in surgical education and its necessary transformation – this book is designed to help you deal with the surgical system as it exists. And, let me say up front, my suggestions will inflame the indignity of many experienced general surgeons who have a depth of experience and talent. But, they must be patient with my suggestions. They overall surgical system is broken and until it is fixed patients must themselves make adaptations for their own safety.
