American Surgical Association

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General Surgery Workloads and Practice Patterns in the United States, 2007-2009: A 10-Year Update from the American Board of Surgery
R J Valentine, MD1, Andrew Jones, MD*2, Thomas W Biester, MD*2, Thomas H Cogbill, MD3, Karen R Borman, MD4, Robert S Rhodes, MD2
1UT Southwestern Medical Center, Dallas, TX;2American Board of Surgery, Philadelphia, PA;3Gundersen Lutheran Medical Center, La Crosse, WI;4Abington Memorial Hospital, Philadelphia, PA

OBJECTIVES: To assess changes in general surgery workloads and practice patterns in the past decade.
METHODS: The surgical operative logs of 4968 individuals recertifying in surgery 2007-2009 were reviewed. Data from 3362 (68%) certified only in Surgery (GS) were compared with 1606 (32%) with additional ABMS certificates (GS+). Independent variables were compared using factorial ANOVA.
RESULTS: Surgeons performed a mean of 533 procedures annually. The distribution of operations was: abdomen 128, alimentary tract 83, breast 54, endoscopy 97, vascular 41, trauma 5, endocrine 9, head/neck 3, laparoscopic 93, and miscellaneous 20. Yet GS practice emphasis is heterogeneous with significant differences in operative case loads by gender, age, and practice setting. Compared to 1995-1997, GS performed more procedures, especially endoscopic (P<.001), endocrine (P<.001), and laparoscopic (P<.001). GS+ performed 15-33% of all core general surgery procedures. GS women performed far more breast operations and fewer abdomen, alimentary tract and laparoscopic procedures compared to GS men (p <0.001). Surgeons recertifying at 10 years performed more abdominal, alimentary tract and laparoscopic procedures compared to those recertifying at 20 or 30 years (P < .001). Rural surgeons performed far more endoscopic and gynecologic procedures and fewer abdominal, alimentary tract, and laparoscopic procedures than urban counterparts (P < .001). U.S. medical school graduates had similar workloads and distribution of operations to IMGs.
CONCLUSIONS: A substantial portion of core GS procedures currently are performed by GS+. Reduced core operative experience in GS+ residencies may negatively impact access to general surgical care.


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