Work Loads and Practice Patterns of General Surgeons in the United States, 1995–1997

Ritchie, Wallace P.; Rhodes, Robert S.; Biester, Thomas W.

doi:10.1097/00000658-199910000-00009

Cited by 160 publications

(91 citation statements)

References 3 publications

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“…[32][33][34][35] The current American College of Surgeons Oncology Group trial evaluating sentinel lymphadenectomy requires a minimum of 30 procedures before being able to enroll patients. 36 The workload and practice patterns of general surgeons in the United States 37 indicate that approximately 13 colectomies are performed annually by general surgeons. The feasibility of learning intraoperative techniques in a timely fashion may be problematic except in high-volume settings.…”

Section: Discussionmentioning

confidence: 99%

Ex Vivo Sentinel Node Mapping in Carcinoma of the Colon and Rectum

Wong

Steineman²,

Calderia³

et al. 2001

Annals of Surgery

128

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ObjectiveIncreasing evidence supports that the sentinel node (SN) is at greatest risk for harboring metastatic disease. This study describes a novel technique to identify the SN in colorectal carcinoma. MethodsWithin 30 minutes of resection, colorectal specimens were injected submucosally with isosulfan blue in four quadrants. Blue lymphatic channels were identified in the mesentery and followed to the blue-stained SN(s), which were then harvested. The specimen was fixed in formalin and subsequently analyzed in the usual fashion. Blue-stained nodes that were negative by hematoxylin and eosin staining were further analyzed by immunohistochemical staining. ResultsDuring a 6-month period, 26 patients with adenocarcinoma of the colon and/or rectum undergoing routine resection were studied. There were 18 men and 8 women ranging in age from 29 to 86 years (median 66). Blue-stained SNs were identified in 24 of 26 specimens. The mean number of SNs identified per patient was 2.8 Ϯ 1.6. Seventy-three SNs were identified from a total of 479 lymph nodes harvested. The mean number of nodes identified per patient was 18.4 Ϯ 7. A total of 67 lymph nodes in 12 patients were identified by hematoxylin and eosin staining to have evidence of metastatic disease. Fourteen (20%) of these nodes in six patients were stained blue. However, with immunohistochemical staining, only one blue node did not have evidence of metastatic tumor in a lymphatic basin with tumor present. Four patients (29%) whose lymphatic basins were negative by hematoxylin and eosin staining were upstaged by immunohistochemical staining of the SN. ConclusionsEx vivo mapping of the colon and rectum is technically feasible and may provide a useful approach to the ultrastaging of colorectal carcinoma.

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Section: Discussionmentioning

confidence: 99%

Ex Vivo Sentinel Node Mapping in Carcinoma of the Colon and Rectum

Wong

Steineman²,

Calderia³

et al. 2001

Annals of Surgery

128

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“…Nationally, recertified surgeons did approximately 400 operations annually from 1997 to 1999, and rural surgeons had a wider scope of practice, especially in endoscopy. 32 The selected New England data follow patterns one would expect. The rural surgeons did more endoscopy (62% vs 36%) and took more trauma calls (79% vs 21%) than the urban surgeons.…”

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confidence: 68%

Whither Goest General Surgery?

Welch¹

2008

Arch Surg

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“…There is an increasing majority of surgical residents going onto subspecialty fellowships. In urban areas, general surgeons' scope of practice is limited by this burgeoning supply of subspecialist surgeons [6]. The other effect of the shortage of rural surgeons is a considerable wealth of clinical experience, including endoscopy.…”

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confidence: 99%

A new academical village

Cloud

2008

Surg Endosc

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When the rich learning environment of inpatient stays is completely plowed under, where can students be exposed to the hidden curriculum of a transparent clinical decisionmaking process [1]? Its remaining habitat is the small community practice.More patients are receiving outpatient community care. Although outpatient educational settings have their limitations (no nearby clinical and basic research, no academic culture, and no faculty consultative ''village'') [2] revenue considerations are diluting teaching and research [3].As a private solo practitioner of general surgery in a small town (population 17,000) for the past 7 years, I have had the close personal experience of another phenomenon: the disappearance of the general surgery workforce [4,5]. There is an increasing majority of surgical residents going onto subspecialty fellowships. In urban areas, general surgeons' scope of practice is limited by this burgeoning supply of subspecialist surgeons [6]. The other effect of the shortage of rural surgeons is a considerable wealth of clinical experience, including endoscopy. These small communities cannot support subspecialty practices.This confluence of factors results in a unique opportunity for academic medical centers, rural surgeons, and students and residents. The small practice environment allows close personal observation of the clinical decisionmaking process. The surgical experience is intimate and seamless.Indeed, this model offers the opportunity for the establishment of a continuum of competency involving students, residents, and practising alumni [7]. With email, text messaging, web conferencing, podcasts, and a created electronic medical records (EMR) interface, the issues of specialty consultation, conferences and lectures, and teaching and learning assessment can be successful at a distance. Academic faculty and administration must be committed to flexibility, and community physicians must be committed to the educational process. As a rural surgeon I am ready to be part of this solution and hope we are all ready to make this bold move.

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Work Loads and Practice Patterns of General Surgeons in the United States, 1995–1997

Abstract: This unique database will be useful in tracking trends over time. More importantly, it demonstrates that general surgery practice in the United States is extremely heterogeneous, a fact that must be acknowledged in any future workforce deliberations.

Cited by 160 publications

References 3 publications

Ex Vivo Sentinel Node Mapping in Carcinoma of the Colon and Rectum

Ex Vivo Sentinel Node Mapping in Carcinoma of the Colon and Rectum

Whither Goest General Surgery?

A new academical village

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