Richard T. Bosshardt I’m a Surgeon, and I’ve Never Been More Alarmed About My Profession Today’s surgical residency graduates are increasingly unprepared for professional practice.
https://www.city-journal.org/article/surgery-safe-american-college-of-surgeons
I have been a surgeon for 38 years. Three of those I spent as a general surgeon in the Navy, the remainder as a plastic surgeon in private practice. I have never been more alarmed about the state of my profession than I am today.
My concerns began surfacing about 25 years ago. I was collaborating with a newly trained general surgeon on a bilateral breast reconstruction, a procedure that utilizes tissue flaps from the patient’s abdomen. This is a significant and lengthy operation, and I appreciated the young surgeon’s offer to close the abdominal donor site. To my horror, however, he began taking excessively wide needle “bites” of the abdominal wall using a heavy-gauge suture, visibly distorting the abdominal wall as he pulled these sutures tight. After watching in disbelief for a few minutes, I thanked him and said that I could manage without help. The young surgeon subsequently gained a reputation for handling tissues roughly and for being difficult to work with. It came as no surprise when he left our hospital after less than a year.
Every colleague whom I have spoken with has noticed the same thing: an alarming number of surgical residency graduates are unprepared for professional practice. The problem has only gotten worse. I recently worked with another young surgeon on a breast cancer patient, for example, and was shocked to discover that he had never performed an axillary node dissection—a common operation to remove lymph nodes from a cancer patient’s armpit. How could a surgeon have completed five years of training without learning how to do this?
One of my colleagues heads a surgical residency at an elite medical institution and has served as his certifying board’s examiner for nearly 20 years, overseeing the certification of young surgeons. He has noted two changes during this period. First, many candidates for certification complete their surgeries slowly—taking, for example, seven hours to complete an operation that should take at most four. The problem is so widespread that some insurers have put a cap on anesthesia reimbursement for cases that take too long, even though it is the surgeon, not the anesthesiologist, who determines the duration of the procedure.
Second, and relatedly, my colleague noted a rise in patients’ post-operative complications. This makes sense, since operating time is one of the determinants of surgical-complication rates. Additionally, he lamented that too many training programs fail to give residents adequate surgical experience. This has several potential causes: there may be too many residency positions for the available cases; some programs allow residents to list procedures that they merely observe as part of their surgical experience; and work hours for doctors in training have been reduced, giving them less time to learn.
Another reason why the quality of surgeons and of surgery has declined: DEI in our medical and educational institutions. I have spoken to program directors in residency programs who say that they are afraid to correct, hold back, or drop underperforming minority trainees for fear of being reprimanded, accused of bias, or even losing their jobs.
The American College of Surgeons continues to push DEI initiatives, ignoring or censoring anyone who disagrees. For example, ACS has implemented remedial training for graduate surgeons through “mentorship” programs. One challenge: finding enough experienced surgeons of the correct ethnic, racial, or gender identity to serve as mentors.
A surgeon who successfully completed a full residency was once expected to practice independently without supervision. Increasingly, this is no longer the case. I worry for the future of my profession—and even for myself, on the day that I enter the world of surgery as a patient.
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