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Turning Away from Surgery in Favor of Family

According to medical professionals, the number of general surgeons in the United States may decrease significantly if medical students continue to choose a comfortable lifestyle over unpredictable work hours.

The number of applicants to residency programs in general surgery has dropped 30 percent in the past nine years, according to studies in the March issue of the journal Archives of Surgery. The trend began in the 1980s, but according to the studies, last year was the first time the number of general surgery positions offered to U.S. medical school graduates exceeded the number of students interested.

Medical students are more likely to be female and married than they were a generation ago. And unlike large numbers of their predecessors, many actually want a life outside medicine, according to the studies. More students are entering specialties that require shorter training periods, such as anesthesiology and emergency medicine.

General surgery typically involves abdominal operations, such as appendix removal and trauma cases.

According to some doctors, the effect of the drop-off in general surgeons could be tremendous in the coming years. It could even result in deaths and health complications, as patients who need emergency surgery such as an appendectomy may have to wait hours while a surgeon is located, said Dr. Anthony Meyer, chief of surgery at the University of North Carolina in Chapel Hill and author of one of the reports.

“It can’t be fixed right away. You can’t just say we need more surgeons and turn up the spigot,” Meyer said. “When it hits, it will hit for a while.”

Joy Henningsen, 26, who is graduating from University of Alabama at Birmingham(UAB) medical school this year, expressed her view on the shortage of general surgeons.

“Long hours, being on call, and family considerations are often enoughto make some students think twice about general surgery,” Henningsen said. “Regardless of whether surgeons actually have a decreased quality of life relative to other physicians, many medical students perceive that to be the case.”

UAB’s Dr. Kirby Bland, who graduated from medical school in 1968, explained the different mindset of his generation of medical students.

“[The generation] was very work-oriented and very focused on its work more than perhaps on its family,” Bland said.

The effect is also starting to reach some subspecialties, including cardiac surgery, which could have shortages of interested medical students in the next few years, Meyer said.

The American College of Surgeons is trying to make surgery more attractive to students by encouraging medical schools to liven up the curriculum, said Dr. Thomas Russell, executive director.

Northwestern University’s medical school, like many others, is trying to reduce residents’ grueling work hours, said Dr. Richard H. Bell Jr., the 57-year-old chief of surgery at Northwestern Memorial Hospital in Chicago. He said the school is also arranging for students to go into the operating room to see the technical artistry that so attracted him to surgery.

Becoming a general surgeon takes five years of residency training, two years more than fields such as dermatology. That is in addition to four years each of medical school and undergraduate education.

A generation ago, general surgeons could set up practice after those five years and perform all kinds of operations. In theory, they still can, but with the growing number of subspecialties such as heart surgery and pediatric surgery, many general surgeons cannot compete until they seek four or five additional years of training in one of those fields, Bell said.

The extra training means most will not start their careers until their mid-30s or later, which deters many women who want to have children, Bell said. Today, almost half of U.S. medical school graduates are women, compared with less thana third in 1974.

American Medical Association figures show the number of general surgeons grewsteadily in the 1970s and ’80s but slipped from 38,376 in 1990 to 36,650 in 2000. Last year, 68 residency positions in general surgery were left untaken. They eventually were filled, many with foreign medical school graduates, a trend that is expected to continue, Bland said.

Bland predicted that even more general surgery positions will go unfilled this year. That will be determined on Match Day next Thursday, when medical students nationwide are matched with residency programs.

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