Surgical Education in the United States: Portents for Change
This is an excellent article clearly identifying the problems that face surgeons and surgical education and the potential for severe physician/surgeon shortages in the next decade or so.
> A recent survey of 70 medical schools in 35 states reported shortages in surgeons that approximate 20%. A survey by the Massachusetts Medical Society suggests a physician shortage in general surgery of 32%, with orthopaedics, neurosurgery, and urology having even greater shortages.
> Everyone wants the best care, but no one wants to pay in time, effort, or money.
It’s the classic problem in today’s society where people believe health care to be a right. They firmly believe that if they have health insurance, of any type even Medicaid, they are entitled to the best of care and that it should be covered by their “insurance.”
What people don’t understand is physician reimbursement for procedures, office visits, consultations, etc. bears little resemblance to physician fees. Physician fees are essentially only relevant in a few “cash only” type of practices. Third party payors aren’t interested and don’t care what the physician’s fee is. All they want to know is…
_”Does the physican participate in our health plan?”_
If yes, then they will reimburse based upon their fee schedule and disallow the rest.
If no, then they will reimburse at a rate that is less than their reimbursement for a participating provider and let the physician try to collect whatever is left of their fee.
I could go on for days on this but…
> The general surgeon, the hallowed product of surgical training in this country, is a vanishing breed. More than 70% of surgeons completing general surgical residency opt for subspecialty training immediately after residency,[19-21] and an even greater majority self-differentiate by the time of first recertification.
> Surgeons, on occasion, have taken extreme responses to pressures of legislation and registration. Look to the current federal and state debate on malpractice and the limits on malpractice awards. Consider the decision by some to opt out of the Medicare system providing boutique practices or indeed enrolling patients in personal managed programs of health care delivery. All these pressures show little sign of ameliorating. The constituencies of payor and surgeon, both seen as losing, is an area of great dissatisfaction. A better solution than just opting out is needed.
But what is it?
> The experiences of other countries are that professionalism has been lost and the surgical technician becomes another member of the nonprofessional health care delivery workforce.
This would be a bad situation.