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Medical Profession Alarmed by Future Shortage of Surgeons - 2002-03-29


This is the time of year when medical students across the United States find out where they will work for the residency or training part of their education. If a recent trend continues, the number of students interested in becoming surgeons will again decline. Medical educators say there is no shortage of surgeons yet, but they are concerned.

About 150 medical students from the University of Illinois-Chicago gathered recently at a downtown Chicago restaurant for the annual "Match Day" celebration. On "Match Day," fourth-year medical students, like Ramit Mendi, find out where they will spend their residencies. "I am hoping to be in Chicago," he said. "I am going for radiology. It is becoming a more competitive specialty now, and I am hoping I match somewhere around here."

A few tables away, Etoi Grant-Davenport says she was hoping to be placed at a hospital in Los Angeles for her residency in pathology. "I was always interested in forensics, and I was thinking about doing forensic psychiatry," she said. "When I found out psychiatry was not for me, I looked into forensic pathology. I really, really love it."

She noted she did not consider becoming a surgeon. "My idea is that surgery is a little bit more malignant [difficult] of a residency to go through, unless you have a passion for it," she said. "People might be turning away from it because they might not want to go through everything you have to do to be a surgeon."

An article in the journal Archives of Surgery, says the number of medical students applying for residencies, or training programs, in general surgery is down 30 percent from 1993. It says the downward trend actually began in the late 1980s, when roughly 1,600 medical students applied annually for about 1,000 general surgery residencies. Last year was the first in which the number of general surgery residencies available to U.S. students exceeded the number of students applying for them. Sixty-eight positions were left open, though they were eventually filled by foreign-born students.

The head of the University of Illinois-Chicago's general surgery residency program, Dr. Jose Cintron, emphasizes surgery is a tough program and it is not for everyone. "Probably, general surgery and all the surgical specialties has a reputation for having long duty hours due to our commitment to continuity to patient care," he said.

It takes at least five years of residency training to become a surgeon, and that is on top of four years of medical school. In recent years, more students have been applying for specialties requiring shorter training periods, like anesthesiology and emergency medicine.

The longer training time for aspiring surgeons is one possible reason the Archives' study cites for the decline in surgery program applications. It suggests other students might be put off by the longer and often unpredictable working hours of a general surgeon.

UIC student Sewit Ambe says she knows surgery is a demanding profession, but is pursuing it anyway. "I like the fact that general surgery offers various fields," she adds. "Even after you are done with general surgery, there are things you can do with it. I am interested in practicing abroad, overseas, going to Africa and serving over there for awhile."

The American Medical Association says there are about 2,000 fewer surgeons in the United States today than there were in 1990. UIC's Dr. Cintron stresses that is not a cause for alarm just yet but is a cause for concern. "General surgeons take care of the bread-and-butter of a lot of surgical conditions out there: hernias, ruptured appendixes, gall bladders," he explains. "Those are general surgeons doing all of those procedures."

Some medical schools are considering shortening the long hours surgery residents have to work during one shift. But Dr. Cintron says major changes to surgery programs could take time.

The Archives of Surgery says if there is a shortage of surgeons ahead, it is probably about ten years away. Dr. Cintron says rural parts of the United States would likely be the first to notice it. Communities with only one hospital and a small number of surgeons might find it more difficult to replace a doctor who is retiring.