Preparedness of Surgical Graduates

To the Editor:

imageI was very saddened when I read the March edition of General Surgery News [“Are Today’s Surgical Graduates Prepared for ‘Real World’ Practice?”; “Transition to Practice”; both page 1].

As a current general surgery resident, it is disheartening to see the lack of confidence expressed by many established surgeons. All the opinions mentioned reflect the thoughts and beliefs of seasoned surgeons, who are from a different generation and either are reluctant or simply refuse to accept that times have changed.

Training is now limited by duty hours and there is nothing anyone can do about it! Many programs such as my own have learned to deal with the mandated changes in a productive fashion and continue to produce well-trained general surgeons during the five-year span.

Surgeons who feel that current trainees are not adequately trained in the current era might need to self-reflect; perhaps the problem does not lie in the duty-hour restrictions but rather in the mindset of the attending surgeons who fail to adapt to the changes.

Drs. Frederick Greene and L.D. Britt’s points are well taken, but one should not be quick to place blame with trainees or the Accreditation Council for Graduate Medical Education (ACGME) requirements. Simply put, blaming worse board pass rates on decreased work hours is not a forward way of thinking.

I have not seen any opinionative letters by current surgery residents. I, for one, feel very confident in my training, as do most of my colleagues, and have no doubt that I will be a safe and competent general surgeon after completing residency.

Also, the assumption that general surgery residents pursue fellowship training due to a perceived lack of confidence or ineptitude is wrong. Despite common beliefs, most residents pursue fellowship training simply due to the desire to specialize in a given specialty, either out of interest (hepatobiliary, cardiothoracic) or for the associated lifestyle (plastic, colorectal).

It is unfair and unjust for established general surgeons to assume that the new generation of surgical residents will not be adequately trained. There are no data to suggest or support the belief that new general surgeons are any less safe or less competent.

General surgeons and residency programs need to learn to cope with the changes, and come up with productive ways of ensuring that residents continue to be adequately trained in the same five-year period, as many programs already do.

Armin Kamyab, MD
General surgery resident, PGY4
Southfield, MI


Flawed Data on Ambulatory Surgery Centers

To the Editor:

Your recent article “Study Shows Owners of Ambulatory Surgical Centers Do More Surgery” (March 2013, page 32) makes some good points about the number of advantages that ambulatory surgery centers (ASCs) offer over hospitals when it comes to creating a superior patient and physician experience through innovation and efficiency.

Unfortunately, the article also reports findings from a study released by the Workers’ Compensation Research Institute (WCRI) in May 2012, that the national Ambulatory Surgery Center Association (see www.ascassociation.org/​AboutUs/​PressRoom/​ASCADisputesWCRIReport) and many physicians who choose to treat patients in ASCs find seriously flawed based on the researchers’ capricious assumptions about the 10-year-old data that they used for this analysis.

Specifically, while the researchers attempt to draw conclusions about the reasons that physician owners of ASCs who provide care to patients inside those ASCs may serve more patients than those who do not, none of the data used in this study actually identifies which of the physicians represented in the data are ASC owners. Instead, the researchers rely on invalid proxies that are unsupportable and unsound. Furthermore, there is nothing in the data on which the WCRI report is based that indicates the medical necessity of the procedures performed. With such incomplete information, it is difficult to reach any of the conclusions that these researchers are putting forth.

The WCRI report referenced in this article also does not consider adequately the reasons why surgeons would choose to treat more patients in a particular setting. As the physician quoted in this article explains, and I can personally attest, surgeons who elect to treat their patients in ASCs are routinely able to safely treat more patients in less time than in their local hospitals. Knowing this, it’s no surprise that surgeons working at ASCs would be able to perform more procedures. Additionally, ASCs often offer patients more convenient locations, ease in scheduling surgeries and shorter waiting times.

Considering all factors, a more valid conclusion based on the actual data at hand is that surgeons operating in a more efficient setting are able to provide care to a higher number of patients in need and to deliver a higher quality of care and service to those patients. Thousands of satisfied doctors and patients who have delivered or received care inside ASCs over many decades can attest to this—a fact with far more value than conclusions drawn based on inappropriate proxies and unsubstantiated assumptions.

David Shapiro, MD
Immediate Past President
Ambulatory Surgery Center Association
Tallahassee, Fla.