tag:blogger.com,1999:blog-4988839706387198339.post5663101028277205911..comments2024-03-17T12:51:46.412-07:00Comments on Cutting Through The Crap: Missing Doc You MeantSid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-4988839706387198339.post-2938414172590382422011-02-13T15:52:02.324-08:002011-02-13T15:52:02.324-08:00Good questions and comments, PT, for which I have ...Good questions and comments, PT, for which I have no answers. One thing I've said before -- even to a couple of former colleagues now in the hierarchy of surgical credentialing and the college -- is that there could be a formal post-training mentoring program, thru the ACS. I did something like it as the clinic from which I retired hired the three surgeons it took to replace the work I'd been doing: I worked with them in the OR, and showed them a few things here and there. Mutually beneficial.<br /><br />I can't argue that the disappearance of the true general surgeon, as it once was, is a bad thing: as you said, having skilled sub-specialists is probably a good thing for patients, other than the fractionation and the sense that post op care, even while the patient is in the hospital, will be done less and less by the operating surgeon.<br /><br />I would argue that the decreasing sense of "ownership" and of commitment will lead to declining quality of care in some ways, but maybe it's only the old-guy nostalgia. The next generation of surgeons won't feel bad about it and their patients won't have experienced anything else. Tradeoffs: one kind of efficiency for another.<br /><br />And, yes, whereas there are still general surgeons in big cities -- mostly older people, like me -- I think the future holds that only small towns with small hospitals will have them in a few years.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-4988839706387198339.post-68801637823768063512011-02-13T12:50:09.246-08:002011-02-13T12:50:09.246-08:00Interesting and controversial topic.
Based on the...Interesting and controversial topic.<br /><br />Based on the data you provided, it seems that, unless we're missing confounders, the 80 hour work week is having a negative effect on outcomes. I hope further studies prove this to be false.<br /><br />There is something to be said for a resident performing a procedure after a 30 hour call (with guidance from an attending, of course). When the resident becomes an attending, s/he will have experience making decisions and operating safely in a sleep deprived state, much like the situations you've probably found yourself in at the wee hours of the night countless times throughout your career. It's an unavoidable part of the job so residents should be prepared for it.<br /><br />So where does the discipline of General Surgery go from here? The sacrifice:reward ratio is out of balance. Residents are choosing fellowships to control their lifestyles and bolster their confidence/experience. The breadth of the specialty is being infringed upon by specialists (which is arguably not a bad thing for patients). The specialists are sometimes excluded from the call pool, leaving GS to cover the brunt of it. <br /><br />A few interesting "solutions" I've heard were:<br />- Rural Surgery Fellowships<br />- Acute Care Surgery Fellowships<br />- Surgical Critical Care Fellowships<br /><br />All 3 options seem to allow a surgeon to BE a true GENERAL surgeon. Of course, shouldn't ALL trainess be equipped to be a true General Surgeon without a fellowship at the end of residency training?<br /><br />Of course, none of this addresses the prophesy by Griffin/Schwartz.<br /><br />So, where/how would one become a true "family surgeon" today? Where does the "internist who can operate" fit in in todays medical landscape? Is one wanting to be a true general surgeon relegated to podunk, usa?<br /><br />Regards,<br />PTAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-4988839706387198339.post-12493771126476130752011-02-11T02:59:40.934-08:002011-02-11T02:59:40.934-08:00So how many lap cholys did YOU do before you start...So how many lap cholys did YOU do before you started chargin real money???<br />Don't answer, thats rhetorical, like asking me how many days in the last 30 years I haven't rubbed one out...<br />and "The Southern Medical Journal's" a joke, even in the South, like those "Ernest" movies.<br />I mean, we watch em and laugh, but nobody cites them to try and make a point.<br />and Cudos for slammin todays rediculously lax residency standards, I mean during my first year of Anesthesia, I was on call FOUR DAYS A MONTH!!!!!!!!!<br />Sometimes 5, and if it was a Friday or Saturday you didn't even really get your required Post-Call day off.<br />I mean you were off, but it was the weekend, so you would have been off anyway.<br />Ironic though, that your typical Anesthesia resident sits through more Lap Cholys than a budding cutter...<br />and how much do you get paid for assisting??<br />Ooops, low blow..<br /><br />FrankAnonymousnoreply@blogger.com