Department of Surgery, University of California, Davis, Sacramento.
Department of Trauma, Mercy San Juan Medical Center, Carmichael, California.
JAMA Surg. 2015 Feb;150(2):144-51. doi: 10.1001/jamasurg.2014.2242.
The scope of general surgery practice has evolved tremendously in the last 20 years. However, clinical experience in general surgery residency training has undergone relatively little change.
To evaluate the current scope of academic general surgery and its implications on surgical residency.
DESIGN, SETTING, AND PARTICIPANTS: The University HealthSystem Consortium and Association of American Medical Colleges established the Faculty Practice Solution Center (FPSC) to characterize physician productivity. The FPSC is a benchmarking tool for academic medical centers created from revenue data collected from more than 90,000 physicians who practice at 95 institutions across the United States.
The FPSC database was queried to evaluate the annual mean procedure frequency per surgeon (PFS) in each calendar year from 2006 through 2011. The associated work relative value units (wRVUs) were also examined to measure physician effort and skill.
During the 6-year period, 146 distinct Current Procedural Terminology codes were among the top 100 procedures, and 16 of these procedures ranked in the top 10 procedures in at least 1 year. The top 10 procedures accounted for more than half (range, 52.5%-57.2%) of the total 100 PFS evaluated for each year. Laparoscopic Roux-en-Y gastric bypass was consistently among the top 10 procedures in each year (PFS, 18.2-24.6). The other most frequently performed procedures included laparoscopic cholecystectomy (PFS, 30.3-43.5), upper gastrointestinal tract endoscopy (PFS, 26.5-34.3), mastectomy (PFS, 16.5-35.0), inguinal hernia repair (PFS, 15.5-22.1), and abdominal wall hernia repair (PFS, 21.6-26.1). In all years, laparoscopic Roux-en-Y gastric bypass generated the highest number of wRVUs (wRVUs, 491.0-618.2), and laparoscopic cholecystectomy was regularly the next highest (wRVUs, 335.8-498.7).
A significant proportion of academic general surgery is composed of bariatric surgery, yet surgical training does not sufficiently emphasize the necessary exposure to technical expertise and clinical management of the patient undergoing bariatric surgery. As the scope of general surgery practice continues to evolve, general surgery residency training will need to better integrate the exposure to bariatric surgery.
重要性：在过去的 20 年中，普通外科实践的范围发生了巨大的变化。然而，普通外科住院医师培训中的临床经验相对变化不大。
目的：评估当前的学术普通外科范围及其对外科住院医师培训的影响。
设计、环境和参与者：大学健康系统联盟和美国医学协会设立了教员实践解决方案中心（FPSC），以描述医生的生产力。FPSC 是一个基准工具，用于学术医疗中心，它是根据来自美国 90 多个机构的 90000 多名医生的收入数据创建的。
主要结果和措施：从 2006 年到 2011 年，FPSC 数据库被查询以评估每位外科医生每年的平均手术频率（PFS）。相关的工作相对价值单位（wRVU）也被检查以衡量医生的努力和技能。
结果：在 6 年期间，146 个独特的当前程序术语代码被列为前 100 个程序，其中 16 个程序至少在 1 年中位列前 10 个程序。前 10 个程序占每年评估的前 100 个 PFS 的一半以上（范围为 52.5%-57.2%）。腹腔镜 Roux-en-Y 胃旁路术一直是每年前 10 名手术之一（PFS，18.2-24.6）。其他经常进行的手术包括腹腔镜胆囊切除术（PFS，30.3-43.5）、上消化道内镜检查（PFS，26.5-34.3）、乳房切除术（PFS，16.5-35.0）、腹股沟疝修补术（PFS，15.5-22.1）和腹壁疝修补术（PFS，21.6-26.1）。在所有年份中，腹腔镜 Roux-en-Y 胃旁路术产生的 wRVU 数量最多（wRVU，491.0-618.2），腹腔镜胆囊切除术通常是第二高（wRVU，335.8-498.7）。
结论和相关性：学术普通外科的很大一部分由减重手术组成，但外科培训并没有充分强调对接受减重手术的患者进行技术专业知识和临床管理的必要接触。随着普通外科实践范围的继续演变，普通外科住院医师培训将需要更好地整合减重手术的接触。
