Getting the science right on the surgeon workforce issue

In this article we summarize the perspectives given by a range of health policy researchers as presented at the fifth annual meeting of the Surgical Outcomes Club at the annual meeting of the American College of Surgeons in Chicago, Illinois, on October 11, 2009. During that session, the participants reviewed 3 main areas that are summarized here: history of physician/surgeon workforce policy, current beliefs, recent policy activity, and issues related to forecasting/planning the future surgical workforce.     

从外科医师到外科学家

一名刚完成接受外科专业培训,考试合格的外科医师,他的前面有两条路可供他选择：坏的道路和好的道路。如果向坏的道路走,他可以到达两个终点。（1）不良外科医师：这些医师以医学知识来欺骗病人钱财,或夸大病情,从中获利;（2）低劣外科医师：他们使用不达标或已淘汰的知识和技术治疗病人。另一条道路是向好的道路,但走这条道路是要不断进行终身学习和评核。最终能否成为一名合格或优秀的外科医师,主要靠的是自己的天赋和个人所付出的努力。一名优秀的外科医师如果只是通过手术,他的一生只能造福有限的病人。但是如果一名外科医师通过医学研究,找出一套新学说、新技术,就可使更多的病人受益。能够称为外科宗师,要求能把新学说发扬光大,成家成派。更要有高尚人格和品德,令人敬佩。     

Occupational radiation exposure to the surgeon

Increased use of intraoperative fluoroscopy exposes the surgeon to significant amounts of radiation. The average yearly exposure of the public to ionizing radiation is 360 millirems (mrem), of which 300 mrem is from background radiation and 60 mrem from diagnostic radiographs. A chest radiograph exposes the patient to approximately 25 mrem and a hip radiograph to 500 mrem. A regular C-arm exposes the patient to approximately 1,200 to 4,000 mrem/min. The surgeon may receive exposure to the hands from the primary beam and to the rest of the body from scatter. Recommended yearly limits of radiation are 5,000 mrem to the torso and 50,000 mrem to the hands. Exposure to the hands may be higher than previously estimated, even from the mini C-arm. Potential decreases in radiation exposure can be accomplished by reduced exposure time; increased distance from the beam; increased shielding with gown, thyroid gland cover, gloves, and glasses; beam collimation; using the low-dose option; inverting the C-arm; and surgeon control of the C-arm.     

How to retrain the cardiothoracic surgeon

It is both an exciting and challenging time for cardiothoracic surgeons. Declining case volumes and diminishing reimbursement are causing a major disruption in the way practicing cardiothoracic surgeons approach their specialty and graduating cardiothoracic surgery residents seek employment. However, new advances in the treatment of cardiovascular diseases, such as endoluminal grafting for diseases of the thoracic aortic, are rapidly becoming available. It will take a significant commitment on behalf of busy practicing cardiothoracic surgeons to 'retrain' and develop the necessary skill-set to become proficient in catheter-based therapies and other emerging therapeutic modalities. We review the factors that contributed to the rise of cardiothoracic surgery as a specialty, the current state of the specialty and the potential that endovascular surgery offers cardiothoracic surgeons and examine the obstacles and solutions for retraining cardiothoracic surgeons.     

寄语青年外科医生

青年外科医生一般都是2000年后的毕业生，年龄在25～30岁之间，他们都还处于积累临床实践经验的成长过程中。如何使他们成为一个优秀的外科医生，很好地挑起承上启下的艰巨担子，主要是要靠他们自己的勤奋和努力。在我近70年的外科生涯中，深深体会到要成为一个优秀的外科医生必须达到三个要求：     

Ancillary services available to the orthopedic surgeon

The delivery of high quality medical services is approaching a crisis situation in the United States. As physician reimbursements decline and overhead increases, orthopedic surgeons must seek additional sources of revenue to remain financially viable and control the quality of medical care that they deliver. The orthopedic surgeon group is well positioned to control its own service lines and deliver excellent patient care as a result. This article reviews the possibilities of multiple types of ancillary service lines available for the orthopedic group practice.     

Occupational hazards to the pregnant orthopaedic surgeon

The number of female orthopaedic residents and orthopaedic surgeons has increased substantially. Concerns have been raised regarding the effect of the work environment on the health of the female orthopaedic surgeon and her fetus or neonate. Occupational risks, and specifically risks to the pregnant orthopaedic surgeon, are becoming an important issue in medicine. Such risks include exposure to methylmethacrylate (MMA), anesthetic gases, blood-borne pathogens, radiation, emotional stress, and physical stress. Awareness of and knowledge about such exposures are needed for the pregnant orthopaedic surgeon to make informed decisions about her occupational exposures and to be proactive about her own and her child's health.     

Getting to the heart of the matter

A 60-year-old woman returned from visiting a cousin in Texas. For the past 6 weeks, she had not been feeling well and had lost almost 30 lb. She had frequent night sweats, although she did not recall having taken her temperature. Upon evaluation in the emergency department, results of physical examination were notable for cachexia and poor dentition. She was noted to have pyuria, and therapy was initiated for a urinary tract infection. Results of blood cultures performed the same day were positive for gram-positive cocci, and vancomycin therapy was initiated. She developed difficulty in seeing to her, left and a computed tomographic scan of the brain was performed; results were interpreted as negative. A transesophageal echocardiogram showed a 3-cm mass attached the posterior leaflet of the mitral valve. Initial interpretation was of an atrial myxoma. One of the authors was asked to consult on the case and noted bilateral conjunctival hemorrhages (Figure 1). Subsequently, the blood culture isolate was identified as Streptococcus mitis. Magnetic resonance imaging confirmed multiple cerebral infarcts consistent with embolic origin. The patient underwent emergent cardiac surgery, and her mitral valve was replaced with a bioprosthetic valve. She successfully completed a 4-week course of antibiotic therapy for her endocarditis.     

A surgeon returns to Vietnam

A return visit to Vietnam 5 years after the end of the war shows a grave lack of medical facilities and supplies; however, those left from 1975 are being optimally utilized with greatly expanded personnel. The efforts expended in Vietnam by American physicians and the United States government have not been wasted.