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Monday, February 18th 2008

General Surgery Be Done

It was fun, especially on trauma call. But beyond trauma call it was a pretty repetitive service. My home surgical residency program, admittedly merely through faculty report, has the single highest average number of lap choles performed per graduate. I’m not sure that’s really a selling point (although the laparoscopic cholecystectomy is one of the most popular operations in this country), but I do believe it.

On the slowest general surgery service (one to two ORs depending on the day, one fifth year, one second year, two interns) in the hospital (average probably 8-12 cases a week) and with three other students to split up the cases I probably was scrubbed into 12-15 lap choles in six weeks or about two a week. I think a disproportionate number fell to me. While lap choles probably did literally make up the majority of our service, it wasn’t like they represented 90% of the operative load. Even so that seems like there were a lot of choles.

Indeed, I’m pretty sure with my attending on the other side of the table I could perform a lap chole right now with the complication risk about the same as when my junior resident on the service did it.

I will mention one health policy issue which I’ve come to appreciate and it concerns the way we handle trauma. I’m really naive about the issue, but I think as long as we’re throwing around proposals for further government funding of health care that we might also consider the way we fund trauma in this country. It goes beyond EMTALA. We need to seriously consider some kind’ve national trauma insurance pool (I’m sure there are proposals out there) and even consider further mandates to hospitals for Medicare participation (I’m being serious, despite the complications of doing such).

As I said, this among all health policy issues I’m terribly unversed in. But here’s the anecdote from where I’m from. We’ve got an overcrowded private hospital marketplace (we really do compared to other major metropolitan areas) and the only Level I trauma center is the county hospital. During my six weeks, the trauma medcom transfers we got bordered on ridiculous at times.

The way trauma is reimbursed compared to the massive costs, from what I understand, is a major deterrent to the rise of private Level I centers. And yet high end trauma centers at private, non-academically affiliated hospitals clearly exist (although I get a sense they’re dwindling).

Correct me if I’m wrong but I think that most of the private facilities work by saying, “Well, you want to be the ortho group who has privileges at our hospital then you’re going to take, not only call for your group, but trauma call for the hospital as well…and of course we’ll compensate you handsomely.”

With the growing concern over lifestyle that doesn’t seem like a real popular deal with the surgeons and other providers necessary to staff a Level I trauma center. And it might be that the hospital competition in my community and comparative lack of surrounding surgical specialists (especially neurosurgeons) is actually a problem in private hospitals raising trauma centers down here.

If you know how any of this works please post a comment. I’d love to be better informed, and despite my religious online health policy reading I’ve yet to stumble across a lot on trauma.