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1.
Sherif Emil Geoffrey Blair Jacob C. Langer Grant Miller Ann Aspirot Guy Brisseau B.J. Hancock 《Journal of pediatric surgery》2014
Background
There is significant lack of information regarding the Canadian pediatric surgery workforce.Methods
An IRB-approved survey aimed at assessing workforce issues was administered to pediatric surgeons and pediatric surgery chiefs in Canada in 2012.Results
The survey was completed by 98% of practicing surgeons and 13 of the 18 division chiefs. Only 6% of surgeons are older than 60 years, and only a fifth anticipate retirement over the next decade. The workforce is stable, with 82% of surgeons unlikely to change current positions. Surgical volume showed essentially no growth during the 5-year period 2006–2010. The majority of surgeons felt they were performing the right number or too few cases and anticipated minimal or no future growth in their individual practices or that of their group. Based on anticipated vacancies, the best estimate is a need for 20 new pediatric surgeons over the next decade. This need is significantly surpassed by the current output from the Canadian training programs.Conclusions
The Canadian pediatric surgery workforce is currently saturated. The mismatch between the number of graduating trainees and the available positions over the next decade has significant repercussions for current surgery and pediatric surgery residents wishing to practice in Canada. 相似文献2.
Background
The Affordable Care Act of (ACA) 2010 may result in an increase in demand for surgery and may exacerbate any existing surgeon shortage. The purpose of this study was to examine factors associated with general surgeon workforce within counties in Tennessee in light of the ACA.Materials and methods
The Area Resource File for 2011 was utilized for this study. Counties with less than 3 active surgeons/100,000 persons were classified as shortage counties (SC). Counties with more than 6 active surgeons/100,000 persons were considered over-supply counties (OC). Demographic factors for each county were determined. Univariate and multivariable analysis was used to determine factors associated with SC.Results
There are 95 counties in the state and 45.3% were SC and 33.7% were OC. Sixty-nine (72.6%) of the counties had at least one hospital and 57 (60%) were in non-metro counties. Multivariable logistic regression analysis revealed that increasing percent uninsured in a county was positively associated with a SC. No other factors were associated with SC. To meet the cutoff of three surgeons per 100,000 in SC 23 general surgeons would be required. There was an excess of 219 general surgeons in OCs.Conclusions
There appears to be an adequate supply of general surgeons but a maldistribution exists, particularly if demand increases with the implementation of the ACA. If redistribution of surgeons does not occur through natural changes in supply and demand, careful policy changes may be considered to encourage redistribution of surgeon resources to meet demand in counties that are currently underserved. 相似文献3.
E. Christopher Ellison Timothy M. Pawlik David P. Way Bhagwan Satiani Thomas E. Williams 《Surgery》2018,163(3):553-559
Background
Assessments of the future general surgery workforce continue to project substantial shortages of general surgeons. The general surgery workforce is targeted currently to maintain a surgeon/population ratio of 6.5–7.5/100,000.Methods
We examined population and age-associated incidence of cancer to estimate the number of general surgeons needed for initial surgical treatment of the patient with cancer in the year 2035 compared with 2010. We hypothesized that the number of general surgeons needed to provide future cancer care will exceed the projections of available general surgeons based on current training numbers, as well as on population-based ratios alone.Results
The total number of new patients with cancers treated by general surgeons is projected to increase 56% (511,450 in 2010 to 798,070 in 2035). To maintain the same patient census per surgeon, it is estimated that 34,698 general surgeons will be needed. This is an increase of 9,198 over that based on current training numbers and 5,300–7,400 greater than the need projected by population growth alone.Conclusion
The analysis supports the hypothesis that an increasing incidence of cancer in the future will exceed the potential capacity of the general surgeon workforce. Regionalization of cancer care may be one solution to projected access issues. 相似文献4.
Introduction
Recent studies report a shortage of pediatric surgeons in the United States. We surveyed members of the American Pediatric Surgical Association (APSA) to estimate current workforce and demand and to provide data for workforce planning.Methods
We conducted a survey of 849 APSA members to provide workforce data on their communities as follows: the number of active, retired, or inactive APSA surgeons; non-APSA fellowship graduates; surgeons without accredited fellowship training; and the estimated demand for additional pediatric surgeons. Internet search engines identified surgeons and practices offering pediatric surgical services. The US Census Metropolitan Statistical Areas (MSAs) defined service areas with populations of 100,000 or more.Results
Of 137 MSAs with APSA members in practice, we obtained data from 113 (83%), with 247 (29%) of 849 surgeons responding. We estimate that the current pediatric surgical workforce consists of 1150 surgeons, with APSA members in active practice (60%) forming the single largest group, followed by general surgeons (21%). The percentage of active APSA surgeons was greater than the percentage of general surgeons in the 50 largest MSAs (76% vs 2%, respectively), whereas the opposite was observed in the smaller MSA ranked more than 51 in population (37% vs 46%, respectively). American Pediatric Surgical Association respondents estimated a national demand for 280 additional pediatric surgeons. Active APSA surgeons plan to delay retirement (8% of respondents) because it would leave their group or community shorthanded; 2% reported that retirement would leave the community without a pediatric surgeon.Discussion
Workforce shortage in pediatric surgery is a problem of number and distribution. Incentives to direct trainees to underserved areas are needed. General surgeons provide pediatric services in many communities. Surgical training should include additional training in pediatric surgery. 相似文献5.
Carlos Manuel Palazuelos Joaquín Alonso Martín José I. Martín Parra Marcos Gómez Ruiz José M. Maestre Carlos Redondo Figuero Julio Castillo Diego Manuel Gómez Fleitas 《Cirugía espa?ola》2014
Introduction
Advanced laparoscopic surgery requires supplementary training outside the operating room. Clinical simulation with animal models or cadavers facilitates this learning.Objective
We measured the impact on clinical practice of a laparoscopic colorectal resection training program based on surgical simulation.Material and methods
Between March 2007 and March 2012, 163 surgeons participated in 30 courses that lasted 4 days, of 35 hours (18 h in the operating room, 12 h in animal models, and 4 h in seminars). In May 2012, participants were asked via an on-line survey about the degree of implementation of the techniques in their day-to-day work.Results
Seventy surgeons (47%) from 60 different hospitals answered the survey. Average time elapsed after the course was 11.5 months (2-60 months). A total of 75% initiated or increased the number of surgeries performed after the training. The increase in practice was > 10 cases/month in 19%, and < 5 cases/month in 56% of surgeons. 38% of participants initiated this surgical approach.Conclusions
Seventy five percent of the surveyed surgeons increased the clinical implementation of a complicated surgical technique, such as laparoscopic colorectal surgery, after attending a training course based on clinical simulation. 相似文献6.
Eric O’Flynn Judith Andrew Avril Hutch Caitrin Kelly Pankaj Jani Ignatius Kakande Miliard Derbew Sean Tierney Nyengo Mkandawire Krikor Erzingatsian 《World journal of surgery》2016,40(11):2620-2627
Background
In East, Central and Southern Africa accurate data on the current surgeon workforce have previously been limited. In order to ensure that the workforce required for sustainable delivery of surgical care is put in place, accurate data on the number, specialty and distribution of specialist-trained surgeons are crucial for all stakeholders in surgery and surgical training in the region.Methods
The surgical workforce in each of the ten member countries of the College of Surgeons of East, Central and Southern Africa (COSECSA) was determined by gathering and crosschecking data from multiple sources including COSECSA records, medical council registers, local surgical societies records, event attendance lists and interviews of Members and Fellows of COSECSA, and validating this by direct contact with the surgeons identified. This data was recorded and analysed in a cloud-based computerised database, developed as part of a collaboration programme with the Royal College of Surgeons in Ireland.Results
A total of 1690 practising surgeons have been identified yielding a regional ratio of 0.53 surgeons per 100,000 population. A majority of surgeons (64 %) practise in the main commercial city of their country of residence and just 9 % of surgeons are female. More than half (53 %) of surgeons in the region are general surgeons.Conclusions
While there is considerable geographic variation between countries, the regional surgical workforce represents less than 4 % of the equivalent number in developed countries indicating the magnitude of the human resource challenge to be addressed.7.
Kenneth R. Sirinek Ross WillisRonald M. Stewart M.D. 《American journal of surgery》2014,208(6):1023-1028
Background
Practicing general surgeons are unevenly distributed across the country. This study evaluates the geographic distribution of categorical, general surgery (GS) PGYI positions per capita.Methods
Data were obtained from the 2012 National Resident Matching Program match and the 2010 US Census.Results
The mean for GS PGYI positions per 106 population was 3.85 ± .61; 27 states fell below this value. The 7 American College of Surgeons (ACS) regions ranged from a low of 1.4 ± .50 (Intermountain) to a high of 9.89 ± 4.41 (Northeast). The mean (2.18 ± .34) for the 19 state membership of the Southwestern Surgical Congress was below the mean for the country.Conclusions
There is a maldistribution of GS PGYI positions compared with state and regional populations, particularly in rural areas. This mirrors the maldistribution of practicing general surgeons across the United States. Additional GS residences and resident positions are urgently needed to correct this “Surgical Desert” of graduate surgical education. 相似文献8.
Background
Physician workforce studies indicate that more specialists contribute to higher average costs. The closely monitored pediatric surgery specialty may reflect what is occurring in other specialties.Methods
This report reviews the number of complex operations performed on infants and children in 1970, with <225 trained US pediatric surgeons, and in 2010, when there were 1,130. The number of births remained consistent during this 40-year period.Results
In 2010, approximately 10,710 complex index operations were performed on children in the United States by certified pediatric surgeons, resulting in 9.5 per surgeon annually. Data from the University of California, Los Angeles, and the Vanderbilt Children's Hospital confirm these observations.Conclusions
The progressive disparity in the number of pediatric surgeons trained and the number of complex index operations performed annually may increase costs and calls into question the ability of individual pediatric surgeons to maintain optimal competence. Consideration might be given to performing index operations at centers of excellence. 相似文献10.
Dhruvin H. Hirpara Michelle C. Cleghorn Josephine Kwong Fady Saleh Sanjeev Sockalingam Fayez A. Quereshy Allan Okrainec Timothy D. Jackson 《Obesity surgery》2016,26(8):1799-1805
Background
The objective of this study was to assess Canadian general surgeons’ knowledge of bariatric surgery and perceived availability of resources to manage bariatric surgery patients.Methods
A self-administered questionnaire was developed using a focus group of general surgeons. The questionnaire was distributed at two large general surgery conferences in September and November 2012. The survey was also disseminated via membership association electronic newsletters in November and December 2012.Results
One hundred sixty-seven questionnaires were completed (104 practicing surgeons, 63 general surgery trainees). Twenty respondents were bariatric surgeons. Among 84 non-bariatric surgeons, 68.3 % referred a patient in the last year for bariatric surgery, 79 % agreed that bariatric surgery resulted in sustained weight loss, and 81.7 % would consider referring a family member. Knowledge gaps were identified in estimates of mortality and morbidity associated with bariatric procedures. The majority of surgeons surveyed have encountered patients with complications from bariatric surgery in the last year. Over 50 % of surgeons who do not perform bariatric procedures reported not feeling confident to manage complications, 35.4 % reported having adequate resources and equipment to manage morbidly obese patients, and few are able to transfer patients to a bariatric center. Of the respondents, 73.3 % reported residency training provided inadequate exposure to bariatric surgery, and 85.3 % felt that additional continuing medical education resources would be useful.Conclusions
There appears to be support for bariatric surgery among Canadian general surgeons participating in this survey. Knowledge gaps identified indicate the need for more education and resources to support general surgeons managing bariatric surgical patients.11.
Peter Lovrics Nicole Hodgson Mary Ann O'Brien Lehana Thabane Sylvie Cornacchi Angela Coates Barbara Heller Susan Reid Kenneth Sanders Marko Simunovic 《American journal of surgery》2014
Background
The investigators designed a sustained, surgeon-directed, iterative project to improve the quality of breast cancer surgery in south central Ontario.Methods
The strategy included audit and feedback of surgeon-selected quality indicators, workshops, and tailoring interviews. Workshops were held to discuss quality improvement strategies, select quality indicators, review audited results, and select interventions for subsequent implementation. Semistructured tailoring interviews were conducted to identify facilitators and barriers to improved quality. All presentations and results were disseminated to all surgeons performing breast surgery in the study region.Results
Forty-four surgeons performing breast surgery across 12 hospitals are involved in the project. Five workshops have been held since 2005. Surgeons' enthusiasm and involvement in the project have been positive. Interim results demonstrated that over 4 audit cycles (2006–2010), the preoperative core biopsy rate increased from 73% to 92%. The tailoring interviews indicated that 18 of 21 surgeons performed preoperative core biopsies.Conclusions
This project highlights the feasibility of a surgeon-directed, iterative quality improvement strategy in breast cancer surgery. Interim results demonstrate consistent improvements in a key selected quality indicator. 相似文献12.
Carlos Moreno-Sanz Jose María Tenías-Burillo Salvador Morales-Conde Carmen Balague-Ponz Hermógenes Díaz-Luis Pablo Enriquez-Valens Juan Carlos Manuel-Palazuelos Sagrario Martínez-Cortijo Jorge Olsina-Kissler María Socas-Macias Miguel Toledano-Trincado Óscar Vidal-Pérez Juan Francisco Noguera-Aguilar José Luis Salvador-Sanchís Xavier Feliu-Pala Eduard M. Targarona-Soler 《Cirugía espa?ola》2014
Introduction
The introduction of laparoscopic surgery (LS) can be considered the most important advancement in our specialty in the past 25 years. Despite its advantages, implementation and consolidation has not been homogenous, especially for advanced techniques. The aim of this study was to analyse the level of development and use of laparoscopic surgery in Spain at the present time and its evolution in recent years.Material and methods
During the second half of 2012 a survey was developed to evaluate different aspects of the implementation and development of LS in our country. The survey was performed using an electronic questionnaire.Results
The global response rate was 16% and 103 heads of Department answered the survey. A total of 92% worked in the public system. A total of 99% perform basic laparoscopic surgery and 85,2% advanced LS. Most of the responders (79%) consider that the instruments they have available for LS are adequate and 71% consider that LS is in the right stage of development in their environment.Conclusions
Basic laparoscopic surgery has developed in our country to be considered the standard performed by most surgeons, and forms part of the basic surgical training of residents. With regards to advanced LS, although it is frequently used, there are still remaining areas of deficit, and therefore, opportunities for improvement. 相似文献13.
Vickers A Savage C Bianco F Mulhall J Sandhu J Guillonneau B Cronin A Scardino P 《European urology》2011,59(3):317-322
Background
Previous studies have shown that complications and biochemical recurrence rates after radical prostatectomy (RP) vary between different surgeons to a greater extent than might be expected by chance. Data on urinary and erectile outcomes, however, are lacking.Objective
In this study, we examined whether between-surgeon variation, known as heterogeneity, exists for urinary and erectile outcomes after RP.Design, setting, and participants
Our study consisted of 1910 RP patients who were treated by 1 of 11 surgeons between January 1999 and July 2007.Intervention
All patients underwent RP at Memorial Sloan-Kettering Cancer Center.Measurements
Patients were evaluated for functional outcome 1 yr after surgery. Multivariable random effects models were used to evaluate the heterogeneity in erectile or urinary outcome between surgeons, after adjustment for case mix (age, prostate-specific antigen, pathologic stage and grade, comorbidities) and year of surgery.Results and limitations
We found significant heterogeneity in functional outcomes after RP (p < 0.001 for both urinary and erectile function). Four surgeons had adjusted rates of full continence <75%, whereas three had rates >85%. For erectile function, two surgeons in our series had adjusted rates <20%; another two had rates >45%. We found some evidence suggesting that surgeons’ erectile and urinary outcomes were correlated. Contrary to the hypothesis that surgeons “trade off” functional outcomes and cancer control, better rates of functional preservation were associated with lower biochemical recurrence rates.Conclusions
A patient's likelihood of recovering erectile and urinary function may differ depending on which of two surgeons performs his RP. Functional preservation does not appear to come at the expense of cancer control; rather, both are related to surgical quality. 相似文献14.
E. Jason Abel R. Houston Thompson Vitaly Margulis Jennifer E. Heckman Megan M. Merril Oussama M. Darwish Laura-Maria Krabbe Stephen A. Boorjian Bradley C. Leibovich Christopher G. Wood 《European urology》2014
Background
Surgery for renal cell carcinoma (RCC) patients with inferior vena cava (IVC) thrombus above the hepatic veins is technically complex and associated with an increased risk of perioperative morbidity and mortality. However, minimal data exist that describe contemporary perioperative outcomes at major referral centers or the prognostic factors associated with poor outcomes.Objective
To determine the preoperative predictors of major complications and 90-d mortality after surgery in RCC patients who have IVC thrombus above the hepatic veins.Design, setting, and participants
We reviewed medical records of all RCC patients who had IVC tumor thrombus above hepatic veins and had had surgery between January 2000 and December 2012 at the Mayo Clinic, M.D. Anderson Cancer Center, University of Texas Southwestern Medical Center, and the University of Wisconsin Hospital.Outcome measurement and statistical analysis
Major complications recorded were defined as ≥3A according to the Clavien-Dindo system within 90 d of surgery. Univariate and multivariate analyses were used to evaluate associations of preoperative variables with risk of major complications or 90-d mortality.Results and limitations
A total of 162 patients were identified for study (level 3, 4 in 69, 93 patients, respectively, according to the Neves classification). Cardiopulmonary bypass was used in 60 of 162 patients (37.5%), and 40 patients (24.7%) had preoperative angioembolization. Major complications were reported in 55 patients (34.0%), with the most common being respiratory, cardiac, and hematologic issues. After multivariate analysis, preoperative systemic symptoms and level 4 thrombus were independently associated with increased risk of major complications. Mortality was reported in 17 patients (10.5%) within 90 d after surgery. After multivariate analysis, Eastern Cooperative Oncology Group (ECOG) performance status (PS) and low serum albumin were preoperative factors independently associated with increased risk of 90-d mortality.Conclusions
Contemporary perioperative mortality and major complication rates for RCC patients who have upper-level thrombus are 10% and 34%, respectively. Patients who have ECOG PS >1 or low serum albumin have increased risk for perioperative mortality. 相似文献15.
Raúl A. Borracci Pedro FerrainaEduardo B. Arribalzaga Ricardo L. Poveda Camargo 《Cirugía espa?ola》2014
Introduction
Since the number of applicants to residencies in general surgery in Argentina seems to be decreasing, we designed this work with the objective of studying the factors considered undesirable by students when choosing surgery as a specialty.Material and methods
Between March and April 2012, one-hundred students were surveyed with a structured questionnaire with true/false binary answers in an observational case-control design. The survey contained 26 statements that made reference to characteristics of surgery as a specialty, or about the personality and lifestyle of surgeons, as they could be perceived by students. As a control group the same survey was applied to 20 surgeons who were in contact with the students and that could represent a role model for them during their rotation in surgery.Results
Comparison between students and surgeons showed no difference in most answers, except in «surgery has poor reimbursement» (OR: 8,9; P=.0001), «there is not enough job demand» (OR: 8,1; P=.015), «surgery restrains intellectual development» (OR: 17,5; P=.014), «surgeons have too many non-scheduled activities» (OR: 9,36; P=.024), «they have a limited patient-physician relationship» (OR: 3,61; P=.009), «they have little time for family» (OR: 4,27; P=.036) and «they are exposed to infectious diseases» (OR: 5,90; P=.007).Conclusions
Women would be as interested as men in working as surgeons; a remarkable fact when considering that the surgical specialties have been predominantly filled by men. The fact that surgeons mostly coincide with the views of students means that role models should be reviewed to promote vocations. 相似文献16.
Marguerite Hoyler Samuel R. G. Finlayson Craig D. McClain John G. Meara Lars Hagander 《World journal of surgery》2014,38(2):269-280
Introduction
The global surgery workforce is in crisis in many low- and middle-income countries (LMICs). The shortage of surgery, obstetrics, and anesthesia providers is an important cause of the unmet need for surgical care in LMICs. The goal of this paper is to summarize the available literature about surgical physicians in LMICs and to describe ongoing initiatives to supplement the existing surgical workforce data.Methods
We performed a systematic search and literature review of the English-language literature regarding the number of surgeons, obstetrician–gynecologists, and anesthesiologists practicing in LMICs.Results
Literature describing the number of surgeons, obstetricians, and anesthesiologists practicing in LMICs represents a small minority of LMICs, and indicates consistently low levels of surgical physicians. Our literature search yielded comprehensive data for only six countries. No national data were found for 23 of the 57 countries considered by the World Health Organization (WHO) to be in health workforce ‘crisis.’ Across LMICs, general surgeon density ranged from 0.13 to 1.57 per 100,000 population, obstetrician density ranged from 0.042 to 12.5 per 100,000, and anesthesiologist density ranged from 0 to 4.9 per 100,000. Total anesthesiologist, obstetrician, and surgeon density was significantly correlated with gross domestic product (GDP) per capita (r 2 = 0.097, p = 0.0002).Conclusion
The global surgery workforce is in crisis, yet is poorly characterized by the current English-language literature. There is a critical need for systematically collected, national-level data regarding surgery providers in LMICs to guide improvements in surgery access and care. The Harvard Global Surgery Workforce Initiative and the WHO global surgical workforce database are working to address this need by surveying Ministries of Health and surgical professional organizations around the world. 相似文献17.
Amy L. Halverson Debra A. DaRosa David C. Borgstrom Philip R. Caropreso Tyler G. Hughes David B. Hoyt Ajit K. Sachdeva 《American journal of surgery》2014
Background
Rural surgeons have unique learning needs not easily met by traditional continuing medical education courses.Methods
A multidisciplinary team developed and implemented a skills curriculum focused on leadership and communication, advanced endoscopy, emergency urology, emergency gynecology, facial plastic surgery, ultrasound, and management of fingertip amputations.Results
Twenty-five of 30 (89%) rural surgeons who completed a follow-up course evaluation reported that the knowledge acquired during the course had improved their practice and/or the quality of patient care, particularly by refining commonly used skills and expanding the care options they could offer to their patients. The surgeons reported incorporating changes in their communication and interaction with colleagues.Conclusions
This course was successful, from participants' perspectives, in providing hands-on mentored training for a variety of skills that reflect the broad scope of practice of surgeons in rural areas. Attendees felt that their participation resulted in important behavior and practice changes. 相似文献18.
Wood AJ Clugston SC Rawlins JM Rea S Edgar DW Wood FM 《Burns : journal of the International Society for Burn Injuries》2012,38(4):487-492
Background
Burns in children present a serious challenge for patients, parents and doctors. This study aimed to investigate differences in desire for burn reconstruction in paediatric patient, parent and surgeon groups.Methods
This study is a case series (n = 21). Questionnaires were administered to patients, their parents and surgeons. Medical records were also reviewed. Data were analysed to ascertain how different factors affected desire for reconstruction between parents, patients and surgeons.Results
Surgeons and parents were more likely to desire surgery than paediatric patients (76.2 vs 61.9 vs 52.4% respectively). Surgeons were more likely to recommend surgery for pre-pubescent patients (81.8 vs 70%). All groups were more likely to desire surgery for female patients. Patients and parents desired surgery more for hidden scars. Higher VSS scores were associated with a higher desire for surgery in all groups. Agreement between patients and parents was highest (Kappa = 0.81) with poor-moderate agreement between surgeons, patients and parents (Kappa = 0.12–0.24).Conclusions
This study suggests that paediatric patients are less likely to want burn reconstruction compared to parents and surgeons. Gender and age may impact on desire for surgery. Opportunities for improving patient, parent and surgeon agreement may exist. Further research is warranted to validate these results. 相似文献19.
Background
Medical student interest in general surgery has declined, and the lack of adequate accommodation for pregnancy and parenting during residency training may be a deterrent. We explored resident and program director experiences with these issues in general surgery programs across Canada.Methods
Using a web-based tool, residents and program directors from 16 Canadian general surgery programs were surveyed regarding their attitudes toward and experiences with pregnancy during residency.Results
One hundred seventy-six of 600 residents and 8 of 16 program directors completed the survey (30% and 50% response rate, respectively). Multiple issues pertaining to pregnancy during surgical residency were reported including the lack of adequate policies for maternity/parenting, the major obstacles to breast-feeding, and the increased workload for fellow resident colleagues. All program directors reported the lack of a program-specific maternity/parenting policy.Conclusions
General surgery programs lack program-specific maternity/parenting policies. Several issues have been highlighted in this study emphasizing the importance of creating and implementing such a policy. 相似文献20.
Mark S. Hochberg Jessica BilligRussell S. Berman M.D. Adina L. KaletSondra R. Zabar M.D. Jaclyn R. FoxH. Leon Pachter M.D. 《American journal of surgery》2014