Where have all the surgeons gone? Chances are your hospital is feeling the effects of today’s shortage of general surgeons – and if not, it will soon. Recent Health Resources and Services Administration studies have reported uneven geographic distribution of general surgeons, with the most severe shortages at rural hospitals. American Association of Medical Colleges research also anticipates the surgeon shortage will worsen over the coming decade as many in the surgical workforce reach retirement age. Additionally, Americans are living longer and the population of adults requiring more surgical care is growing, exacerbating the shortage.
In particular, general surgeons with a broad acute care skillset are becoming increasingly rare. Hospitals of all sizes require surgeons capable of performing common procedures such as appendectomies or trauma surgery after severe injuries, but the traditional lifestyle of a general surgeon is demanding. Often they work full-time during the day at their own private practice yet must also remain on call at all hours of the night to treat hospital patients. Surgeons who help to cover the ER feel the schedule strain most acutely. For quality of work and life, it’s not ideal to be on call 24/7, wake up early for elective surgery, have the day’s patient schedule disrupted for yet another emergency case and then potentially be responsible for treating patients at night. Given the choice, many surgeons will opt for more lucrative specialty practices or opt out of surgery in general to achieve better control over their schedules.
While personnel shortages place strain on all facets of hospital care, a general surgeon deficit in the ER has an immediate impact on patient outcomes. Waiting for an on-call surgeon to arrive can cause delays in procedures where timing often matters. Patients may “walk” from the ER to seek care in another hospital. When a hospital cannot provide timely emergency and acute care, its case mix, financial health and reputation – and much more important, the health of its community—suffer. Quality measures decline and rural hospitals that lack reliable access to surgeons may even be forced to shut down due to inadequate staffing, leaving the community with a gap in care.
A solution for the future Over the past several years, workers of all sorts have become more focused on quality of life than ever before. Awareness of burnout and its mental health effects has increased, and the pandemic prompted an even greater shift in priorities and a desire for work-life balance. How can today’s hospital reconcile the demand for general surgeons with the turn away from the unpredictable lifestyle? Enter the surgicalist.
