No Doctors in the House of Surgery

NEW YORK – Is there a doctor in the house? Apparently not, if you’re in an operating room.

Dramatically fewer medical students are going on to general surgical residencies, according to a recent report in the Archives of Surgery. That means the United States is facing a potential shortage of surgeons to mend our broken bodies in the near future.

"The worst-case scenario is that we would have severe access problems for patients if they needed an operation," said Dr. Thomas Russell, executive director of the American College of Surgeons. "If they needed an operation like a hip replacement, or had been involved in an accident, there might not be trauma surgeons for hundreds of miles around."

Almost as disturbing is the idea hospitals could be forced to hand over the scalpel to mediocre students, according to report author Dr. Kirby I. Bland, professor of the department of surgery at the medical school at the University of Alabama in Birmingham.

"It is becoming increasingly difficult for general-surgery programs to attract the best-qualified medical students, and there is cause for concern about the future of this specialty," he wrote.

Compounding the dearth of new general surgeons is the fact that the average retirement age in the field has dropped from the mid-60s to just under 60, Russell said.

Bland found that, over the last nine years, the number of students applying to such programs plummeted by 30 percent, meaning many general-surgery slots are going unfilled. That could eventually affect surgical subdisciplines like cardiac surgery or neurosurgery, which require additional years of specialized training in addition to the basic five years for general surgeons. Instead, more students are going into fields like radiology, anesthesia and emergency medicine.

The study found the new generation of doctors-to-be put more emphasis on priorities like having a family and more personal time, goals that can be hard to meet with the notoriously strenuous career of a surgeon. It can take more than 10 years to complete some surgical residencies.

"Surgery is a very demanding profession, not only as far as the technical aspects, but it’s also demanding emotionally and psychologically," Russell said. "Young people want more balance in their lives, and I think it’s healthy that surgeons want to do other things in their lives than be in the operating room."

Surgical residents can often spend as much as 110 hours a week in the hospital, generally more than other residents. And surgical residents commonly end up owing $100,000 or $200,000 for their schooling, while they toil away in their infamously low-paying residencies.

Doctors are making less and insurance companies are reimbursing less for surgical procedures.

That wasn’t enough to deter Paul Gause, a 25-year-old medical student at UCLA who chose a surgical residency this summer.

"Instead of trying to tell people what to do or give them medications to make them better, you’re affecting a change for someone that’s very direct," he said. "You’re helping people in a very direct way, and as a surgeon you can do very wonderful things for people."

Bland agreed it can take a special kind of person to become a general surgeon.

"None of us who practice general surgery would ever go back," he said in a telephone interview. "It’s something that gets in your blood."

But to keep attracting the best and brightest and keep surgical staffs well-manned, medical schools and residency programs will have to make changes, according to Dr. Joseph LoCicero III, chairman of the Finch University of Health Sciences at the Chicago Medical School. Besides paying closer attention to residents’ lifestyle needs, that could include taking the controversial step of requiring less surgical training in some cases, he said.

"If you’re going to do heart surgery for the rest of your life, why do you need to be able to do a hernia?" he asked.