Surgical Education is in Crisis: Call for All Alumni to Get Involved, Contribute to the Foundation for Surgical Fellowships

Dear readers of Bariatric Times:

I just returned from Baltimore, Maryland, after attending the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). My congratulations to SAGES President Dr. Scott Melvin for an outstanding year as leader and to program directors Drs. Fred Brody and Santiago Horgan for an exciting and perfectly executed academic program. For me, the highlight of the meeting was the luncheon hosted by the Fellowship Council that was attended by the leadership of the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Surgery (ABS). If I may summarize my opinion about this meal, “I left the table with a bitter-sweet taste in my mouth.” The great news is that the ABS has acknowledged the outstanding job being done by the non-ACGME fellowship programs endorsed by organizations, including SAGES, the American Society for Metabolic and Bariatric Surgery (ASMBS), Society for Surgery of the Alimentary Tract (SSAT), American Society of Colon and Rectal Surgeons (ASCRS), and International Hepato-pancreato-biliary Association (HPBA), on programs in hepatobiliary, bariatric, minimally invasive, and colorectal surgeries that help prepare residents to practice surgery. The sad news, however, came from our industry partners who, understandably due to the current financial crisis and the unpredictable adjustments to be made with the upcoming healthcare reform, were forced to significantly reduce their support to the Foundation for Surgical Fellowships. To further illustrate the magnitude of this problem, if a company that produces disposable equipment has an estimated annual growth of four percent, the taxes on their products will increase by 2.4 percent. It is obvious that adjustments have to be made. So, what will happen with non-ACGME accredited fellowships? Will they disappear or perhaps just become smaller? Who will pay for postgraduate surgical education? If our leaders at the ABS are telling us that a Fellowship Council certified training program is  “vital” for a general surgery resident to prepare for prime time, it is unreasonable or impossible to reduce or eliminate this training experience. It is rumored that some are contemplating prolonging the number of years required as a surgical resident (according to the Fellowship Council Survey presented this year by Dr. Samer Mattar at the American Surgical Association meeting) from 5 to 6 years, while others would rather keep the training model the way it is and have residents spend more time during their chief year on the specialty they have chosen.
Surgical education is in crisis and there is obviously no easy solution to this problem. Hopefully (though unlikely), the United States government, hospitals, providers, and we surgeons will step up to the plate and financially support this critical time of surgical education. In addition, residencies will have to be re-engineered so that after three years of basic general surgery training, young doctors can move on to their specialties, such as colorectal, bariatrics, and acute care.
Recalling my “three-in-three training,” three general surgery residencies in three different continents—South America, Europe, and the United States—I remember my time in Argentina where we had to do post-residency training for free or work for a certain amount of years under the supervision of an expert before we could sit for a subspecialty exam. In Germany, the system was different. You could estimate that after six years of general surgery training, which included two years of orthopedics, neurosurgery, and other specialties, you would be board eligible or board certified (if you were lucky), and after that you would spend two additional years doing a subspecialty. The difference was that during residency, the salary was one of a junior attending. That allowed the chief to keep you waiting for 7 or 8 years in training (and even longer if he or she didn’t like you) before you were board eligible . But Germany has changed and they adopted the three-in-three training model as I mentioned previously.

The situation of surgical education is delicate and critical. I encourage all alumni from the Fellowship Council who now hold positions as attending surgeons to contribute to the Foundation for Surgical Fellowships and get involved so that we can maintain the funding for the non-ACGME training programs. The Fellowship Council voted unanimously that, for the time being, the number of funded fellowships will stay the same, but the amount of funding made available will have to significantly decrease.

I hope you enjoy this issue of Bariatric Times, which is terrific.

Sincerely,

Raul J. Rosenthal, MD, FACS
Editor, Bariatric Times

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