Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Ann Surg. 2011 Sep;254(3):520-5; discussion 525-6. doi: 10.1097/SLA.0b013e31822cd175.
To assess changes in general surgery workloads and practice patterns in the past decade.
Nearly 80% of graduating general surgery residents pursue additional training in a surgical subspecialty. This has resulted in a shortage of general surgeons, especially in rural areas. The purpose of this study is to characterize the workloads and practice patterns of general surgeons versus certified surgical subspecialists and to compare these data with those from a previous decade.
The surgical operative logs of 4968 individuals recertifying in surgery 2007 to 2009 were reviewed. Data from 3362 (68%) certified only in Surgery (GS) were compared with 1606 (32%) with additional American Board of Medical Specialties certificates (GS+). Data from GS surgeons were also compared with data from GS surgeons recertifying 1995 to 1997. Independent variables were compared using factorial ANOVA.
GS surgeons performed a mean of 533 ± 365 procedures annually. Women GS performed far more breast operations and fewer abdomen, alimentary tract and laparoscopic procedures compared to men GS (P < 0.001). GS surgeons recertifying at 10 years performed more abdominal, alimentary tract and laparoscopic procedures compared to those recertifying at 20 or 30 years (P < 0.001). Rural GS surgeons performed far more endoscopic procedures and fewer abdominal, alimentary tract, and laparoscopic procedures than urban counterparts (P < 0.001). The United States medical school graduates had similar workloads and distribution of operations to international medical graduates. Compared to 1995 to 1997, GS surgeons from 2007 to 2009 performed more procedures, especially endoscopic and laparoscopic. GS+ surgeons performed 15% to 33% of all general surgery procedures.
GS practice patterns are heterogeneous; gender, age, and practice setting significantly affect operative caseloads. A substantial portion of general surgery procedures currently are performed by GS+ surgeons, whereas GS surgeons continue to perform considerable numbers of specialty operations. Reduced general surgery operative experience in GS+ residencies may negatively impact access to general surgical care. Similarly, narrowing GS residency operative experience may impair specialty operation access.
评估过去十年普通外科工作量和实践模式的变化。
近 80%的普通外科住院医师在外科亚专业接受额外培训。这导致普通外科医生短缺，尤其是在农村地区。本研究的目的是描述普通外科医生与认证外科亚专科医生的工作量和实践模式，并将这些数据与十年前的数据进行比较。
对 2007 年至 2009 年重新认证的 4968 名个体的手术操作日志进行了回顾。将仅在外科（GS）认证的 3362 名（68%）个体的数据与另外 1606 名（32%）获得美国医学专业委员会证书的个体（GS+）进行了比较。GS 外科医生的数据还与 1995 年至 1997 年重新认证的 GS 外科医生的数据进行了比较。使用析因方差分析比较了自变量。
GS 外科医生每年平均进行 533±365 例手术。与 GS 男性相比，GS 女性进行了更多的乳房手术，而腹部、消化道和腹腔镜手术则更少（P<0.001）。10 年重新认证的 GS 外科医生比 20 年或 30 年重新认证的外科医生进行了更多的腹部、消化道和腹腔镜手术（P<0.001）。与城市同行相比，农村 GS 外科医生进行了更多的内镜手术，而腹部、消化道和腹腔镜手术则更少（P<0.001）。美国医学院毕业生的工作量和手术分布与国际医学毕业生相似。与 1995 年至 1997 年相比，2007 年至 2009 年的 GS 外科医生进行了更多的手术，尤其是内镜和腹腔镜手术。GS+外科医生完成了 15%至 33%的普通外科手术。
GS 的实践模式存在异质性；性别、年龄和实践环境显著影响手术工作量。目前，大部分普通外科手术由 GS+外科医生完成，而 GS 外科医生仍进行大量的专科手术。GS+住院医师普通外科手术经验减少可能会对普通外科护理的获得产生负面影响。同样，GS 住院医师手术经验的缩小也可能会影响专科手术的获得。
