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PubMedDate not supplied

Paying surgeons less can cost more.

Fees for physicians' services represent only a small component of total health care costs. Complementary costs (particularly hospital charges for surgical treatment) are a far more substantial portion of total costs, and may be 10 times larger than surgical fees. Because surgeons have considerable influence over the demand for surgery, and because the complementary costs do not cost the surgeon at all, marginally lowering surgeons' fees can, paradoxically, increase total health care costs, even if net payments to surgeons go down. This is because surgeons may respond to a decrease in their per-case reimbursements by performing more surgery to maintain their status-quo income. This phenomenon is known as physician income homeostasis. A health care payer may benefit by paying surgeons more to perform tasks that do not have high associated costs, such as outpatient nonoperative care, research, or teaching. In this fashion, faced with declining surgical fees, the surgeon will maintain his or her income not by performing more expensive surgery, but rather by doing more nonoperative work.

Cost Control↗
PubMed1975

Has medical history importance for surgeons?

Surgeons will do well to remember that the two most important contributions to the growth and extension of surgery came from two disciplines, not then regarded as the most innovative. Anesthesia came from dentistry, the work primarily of W.T.G. Morton of Boston; prophylactic surgical antisepsis originated with the obstetrician Semmelweis, who developed a scheme of prophylactic chemical antisepsis that still remains the core of surgical antisepsis. In the mid 1880's, largely as a result of the work of Chamberland and others of the Pasteur school, surgeons in France and Germany substituted thermal for chemical antisepsis, whenever applicable. Whereas Lister's influence was tremendous in fostering acceptance of antisepsis by surgeons, by the end of his professorial career he had begun his capitulation to prophylactic antisepsis, which was complete by 1896 to the very practices that Semmelweis had proved the value of almost five decades previously. These were 19th century innovations. The greatest boon to surgery's advance in this century has been control of cellulitic infections through chemotherapeutic agencies, the sulfonamides and antibiotics. The tremendous upsurge of interest in research at the end of World War II brought surgeons to a fuller realization of the significant part they could play in the advance of their discipline. Intimate alignment of surgeons with physiologists of the circulation begot intracardiac surgery, a significant innovation with consequences of tremendous import for greater medicine's advance. Today, surgeons attacking the problem of tissue transplantation are aligning themselves with biochemists, geneticists, immunologists, experimental pathologists, and pharmacologists in their broad approach to the phenomenon of allograft rejection. The great extension of vascular surgery since World War II has made jewelers of surgeons of small tubular structures. The technical phases of these demanding operative procedures have largely been overcome. Solution of the biologic rejection phenomenon is awaited eagerly by all investigators, a discovery that will greatly enhance predictable success of transfer of skin as well as of organs. When will surgery experience another great catalytic forward thrust like that achieved through anesthesia, prophylactic antisepsis, and the antibiotics? No discipline in medicine can exist alone without privation. For its continuing advancement, surgery is dependent upon close and intimate relationships with many other medical disciplines. Apart from the enlightenment provided by a searching examination of the origins of our surgical discipline, the earnest and persistent pursuer will discover a lively pleasure and satisfaction that accrues as a special dividend.

Amputation, Surgical↗
PubMed2001

Follow-up after attempted curative surgery for colorectal cancer; postal survey of New Zealand surgeons' practice.

AIMS: The role of follow-up after attempted curative resection of colorectal cancer (CRC) is not clearly defined. We wished to establish the frequency, duration and type of follow-up practised by New Zealand surgeons. METHODS: A postal survey was performed of surgeons on the General Medical Register, asking about the follow-up of asymptomatic patients after potential curative surgery. RESULTS: The response rate was 66%(107/163). There was wide variability in the frequency, duration and type of the indicated follow-up practice. 97% of surgeons followed their patients on average four monthly for the first year. At five years, 79% of surgeons followed their patients. Routine blood tests were performed 54%, while serum carcinoembryonic antigen (CEA) levels were measured by 56% of surgeons for the first two years. 41% performed abdominal imaging in the first two years. 97% of surgeons screened the remaining colon (88% by colonoscopy). 90% performed colonic screening three to five yearly. CONCLUSIONS: Follow-up after potential curative surgery for CRC appears to be widely practised in New Zealand. There is, however, considerable variation between surgeons in the frequency, duration and type of follow-up. This may reflect the conflicting evidence in the literature on the value of follow-up. The outcome of current large prospective randomised trials may confirm whether or not such follow-up is worthwhile and what form it should take.

Carcinoembryonic Antigen↗
PubMed2001

[Surgeons in Krakow between WWI and WWII].

During the war time when Polish borders had not been established yet, apart from having two surgical departments Jagiellonian University, Krakow had surgical departments in the Bonifratow, Izraelicki and Military Hospitals. More surgical departments were opened up in later years in pubic Health System Hospitals, among them were Narutowicz at near Pradnicka street and Sisters of Mercy at Lea street. Other well-known Krakow surgeons operated in smaller, private surgeries, such as: Dom Zdrowia (House of Health) or Zwiazkowy (Union) Clinic. At that time only 30 Surgeons worked in Kraków. They were outstanding specialists with a broad practice. Among them were Maksymilian Rutkowski, Jan Glatzel, Stanislaw Nowicki, Michal Hladij. Gradually, younger surgeons started to join them. they were: Jan Kowalczyk, Jerzy Jasienski, Stanislaw Kania, Wladyslaw Laszczak, Jozef Bugusz, Jozef Gasinski. Many of them who worked in the surgical hospitals in Krakow, left the city after obtaining a professorship (like Kornel Michejda, professor at the University of Wilno) or became heads of wards, like Zygmunt Drobniewicz, Alfons Mackowski and Tadeusz Guschlbauer. All of these surgeons were highly respected by the medical community as well as by the general public in their respective town and surrounding areas. A large income allowed that best of them to fund and supply their own wards. Occasionally, however, among the less successful surgeons, an uncompromising competition for patients developed. These events were disapproved and condemned by the medical establishment. Many surgeons led an active life outside of their profession. A surgeon with an exceptionally colorful personality was Jan Glatzel: witty, highly intelligent, a connoisseur of fine art, book lover with an active social life. Maksymilian Rutkowski was active in charitable organizations, helping to support Bratnia Pomoc Medykow. Michal Hladij, president of KS Cracovia, vice president of Krakowski Klub Automobilowy rendered his service to restore monumental cauldron in Rdzawka on the hillside of Obidowa. Others, like Dr Jozef Friszer, a former assistant in the Surgical Hospital, who also came from Krakow, later became and influential politician and the last prime Minister of the Second People's Republic.

Academic Medical Centers↗
PubMed2003

Appendectomies in rural hospitals. Safe whether performed by specialist or GP surgeons.

OBJECTIVE: To compare outcomes of appendectomies performed in rural hospitals by specialist surgeons and GP surgeons. DESIGN: Retrospective analysis of the Canadian Institute for Health Information's (CIHI) Discharge Abstract Database (DAD) 1996-1999. SETTING: Rural hospitals in Ontario, Saskatchewan, Alberta, and British Columbia. PARTICIPANTS: All surgeons who performed appendectomies in these hospitals during the study period. MAIN OUTCOME MEASURES: Mortality; diagnostic accuracy, perforation, and repeat laparotomy rates; length of stay; and need for transfer to another acute-care institution. RESULTS: Specialist surgeons performed 3624 appendectomies; GP surgeons performed 963. Rates of comorbidity, diagnostic accuracy, and transfer, and mean lengths of stay were similar for patients of GP and specialist surgeons. Patients operated on by specialists were older and more likely to have perforations and to require second intra-abdominal or pelvic procedures. Triage to a specialist, older age, and comorbidity all independently predicted perforation. Only perforation predicted a second intra-abdominal or pelvic procedure. CONCLUSION: Appendectomy is a safe procedure in rural hospitals, whether performed by specialist or GP surgeons. Some difficult cases are routinely referred to specialists.

Adolescent↗
PubMed2003

In-hospital mortality and morbidity after surgical treatment of unruptured intracranial aneurysms in the United States, 1996-2000: the effect of hospital and surgeon volume.

OBJECTIVE: We sought to determine the risk of adverse outcome after contemporary surgical treatment of patients with unruptured intracranial aneurysms in the United States. Patient, surgeon, and hospital characteristics were tested as potential outcome predictors, with particular attention to the surgeon's and hospital's volume of care. METHODS: We performed a retrospective cohort study with the Nationwide Inpatient Sample, 1996 to 2000. Multivariate logistic and ordinal regression analyses were performed with endpoints of mortality, discharge other than to home, length of stay, and total hospital charges. RESULTS: We identified 3498 patients who were treated at 463 hospitals, and we identified 585 surgeons in the database. Of all patients, 2.1% died, 3.3% were discharged to skilled-nursing facilities, and 12.8% were discharged to other facilities. The analysis adjusted for age, sex, race, primary payer, four variables measuring acuity of treatment and medical comorbidity, and five variables indicating symptoms and signs. The statistics for median annual number of unruptured aneurysms treated were eight per hospital and three per surgeon. High-volume hospitals had fewer adverse outcomes than hospitals that handled comparatively fewer unruptured aneurysms: discharge other than to home occurred after 15.6% of operations at high-volume hospitals (20 or more cases/yr) compared with 23.8% at low-volume hospitals (fewer than 4 cases/yr) (P = 0.002). High surgeon volume had a similar effect (15.3 versus 20.6%, P = 0.004). Mortality was lower at high-volume hospitals (1.6 versus 2.2%) than at hospitals that handled comparatively fewer unruptured aneurysms, but not significantly so. Patients treated by high-volume surgeons had fewer postoperative neurological complications (P = 0.04). Length of stay was not related to hospital volume. Charges were slightly higher at high-volume hospitals, partly because arteriography was performed more frequently than at hospitals that handled comparatively fewer unruptured aneurysms. CONCLUSION: For patients with unruptured aneurysms who were treated in the United States between 1996 and 2000, surgery performed at high-volume institutions or by high-volume surgeons was associated with significantly lower morbidity and modestly lower mortality.

Adolescent↗
PubMed2003

Surgical management of the rheumatoid hand: consensus and controversy among rheumatologists and hand surgeons.

OBJECTIVE: Rheumatoid arthritis (RA) is a common cause of debilitating hand deformities, but management of these deformities is controversial, characterized by large variations in the surgical rates of common RA hand procedures. We conducted a national survey evaluating potential differences in physicians' management of RA hand deformities. METHODS: We mailed a survey instrument to a random national sample of 500 rheumatologists and 500 hand surgeons in the US. We evaluated physicians' attitudes toward the other specialties' management of common RA hand deformities and toward the indications for performing rheumatoid hand surgery. RESULTS: We found 70% of rheumatologists consider hand surgeons deficient in understanding the medical options available for RA, while 73.6% of surgeons believe rheumatologists have insufficient knowledge of the surgical options for RA hand diseases. However, 66.9% of surgeons and 79.5% of rheumatologists had no exposure to the other specialty during training. The 2 physician groups disagree significantly on the indications for commonly performed RA hand procedures such as metacarpophalangeal joint arthroplasty (p < 0.001), small joint synovectomy (p < 0.001), and distal ulna resection (p = 0.001). When physicians do not agree with others' management of RA hand deformities, only 62.4% of surgeons and 61.9% of rheumatologists relay their concern to the other specialty. CONCLUSION: Rheumatologists and hand surgeons have minimal interdisciplinary training, communicate with each other infrequently, and significantly disagree on the indications for RA hand surgery. Research must focus on the surgical outcomes of RA hand procedures and on improving communication between rheumatologists and hand surgeons.

Arthritis, Rheumatoid↗
PubMed2004

Accuracy in diagnosis of acute appendicitis by comparing serum C-reactive protein measurements, Alvarado score and clinical impression of surgeons.

OBJECTIVE: To compare the accuracy of a surgeon's clinical diagnosis of acute appendicitis with Alvarado's predictive model and C-reactive protein (CRP) measurements. METHOD: The records of 231 adult patients between 14-75 years admitted to the hospital with suspected appendicitis from August 1999 to November 2001 were studied prospectively. Serum CRP measurements (217 patients) and Alvarado scores (231 patients) were performed before operations but were not taken into account prior to the decision to perform a laparotomy to compare the surgeon's clinical diagnosis. RESULTS: Based on the surgeon's clinical diagnosis, 193 patients underwent surgery, and 38 patients were observed. Histopathologic findings found acute appendicitis, confirming the surgeon's clinical impression, in 178 patients (positive predictive value = 92%) and normal appendix in 15 patients. Of the observed patients, 8 subsequently underwent operation for appendicitis (negative predictive value = 79%). Compared with the surgeon's clinical diagnosis (sensitivity 96% and specificity 67%), diagnosis based on an Alvarado score of > or = 7 had a lower sensitivity (79%) and that based on CRP of > 10 mg/l a much lower sensitivity (62%) and lower specificity (56%). Overall accuracy of these three diagnostic modalities were 90 per cent, 72 per cent and 61 per cent, respectively. However, median serum CRP value increased from 5 mg/l (range 3-188 mg/l) in patients with normal appendix, to 14 mg/l (range 3-222 mg/l) in patients with non-perforated appendicitis and 65 mg/l (range 3-213 mg/l) in patients with perforated or gangrenous appendicitis. CONCLUSION: The clinical assessment in diagnosing appendicitis by an experienced surgeon remains reliable and superior to either Alvarado score or CRP measurement. Nevertheless, Alvarado score and serum CRP measurements may be of value to the inexperienced surgeon, and a high Alvarado score and serum CRP should not be ignored.

Acute Disease↗
PubMed2004

[Use of preventive strategies by surgeons and HIV exposure].

The objective of this study was to estimate how often surgeons use surgical gowns, masks, gloves and eyewear in the context of occupational exposure to HIV. The authors also wanted to determine what factors were associated with the use of these strategies. Generally surgeons reported infrequent use of preventive strategies. Regular use of double gloving was reported only by 8.5% of respondents, eye protection by 23%. About three-quarters of surgeons reported they always used masks and gowns, 86%--single gloves. Doctors who used eye protection regularly had less blood contacts via conjunctiva per year than surgeons who used such protection seldom or never (mean = 17.6 SD 52.2 vs mean = 21.5 SD 73.6; p<0.003). The older surgeons were more likely than the other respondents to use preventive strategies (p<0.01). Also, the orthopaedic surgeons more than the others adopted such strategies (p<0.0007). To improve the situation, efforts will need to be done to motivate the surgeons to adopt preventive strategies through adequate education system. Improving the comfort of barrier precautions and making them available may also increase the compliance with protection against HIV in the operation room.

Adult↗
PubMed2004

Survey of oral and maxillofacial surgeons' offices in Virginia: anesthesia team characteristics.

This survey assesses whether oral and maxillofacial surgeons in the state of Virginia are prepared for inspection of their offices. A survey asking pertinent questions on the availability of specific equipment and the educational qualifications of the anesthesia care team was developed and sent to 155 offices. Seven questions were asked regarding the availability of nurses, types of life support training, (formal or informal), the surgeons and anesthesia care personnel, and the presence of a defibrillator. Questionnaires were short and simple to encourage compliance with the study guidelines. A total of 128 (82.6%) questionnaires were returned. Only 42 of 128 (32.8%) offices employed nurses, and 6 of the 42 nurses were not considered as part of the anesthesia care team. Only 36 of 128 (28.1%) of the offices had assistants with formal anesthesia assistant course training from the American Association of Oral and Maxillofacial Surgeons (AAOMS) or the American Dental Society of Anesthesiology (ADSA). However, 93% of the assistants who participated in the anesthesia had current basic life support training (BLS) training, and 74% of the surgeons had current advanced cardiac life support (ACLS) training. The AAOMS Office Emergency Manual was present in 118 of 128 offices (92.2%), and 124 of 128 offices (96.9%) had defibrillators. The survey suggests that the surgeons are well prepared from the standpoint of having a defibrillator present and the AAOMS Office Emergency Manual available as a template for the team to use in order to answer questions that the inspection team may ask of the primary anesthesia care provider and surgeon. The majority of the surgeons had current ACLS certification, and the office anesthesia assistants had current BLS training. Most of the assistants did not have formal course training, which indicates that on-the-job training is probably the norm. Less than one third of the offices had nurses.

Anesthesia, Dental↗
PubMed2005

[Quality monitoring of colon surgeons' volume of operations].

INTRODUCTION: The number of operations performed by a surgeon is a predictor of the outcome of colon/rectum resection. Therefore it is relevant to monitor the surgeons' volume of work and the number of patients' complications in order to secure both an adequate number and high quality. MATERIALS AND METHODS: Using data from the Danish National Patient Registry and Danish Colon Cancer Group's database, we located hospital departments that had performed colon/rectum surgery in 2003 and asked them whether they monitored surgeons' volume of work and the number of patients' complications and whether they considered those data relevant to the patients or their GPs. RESULTS: Thirty-nine departments had performed colon/rectum resection; 27 of them responded. Eight departments (36%) had defined a standard for the number of operations per surgeon, while only four used the data to determine the surgeons' volume of work. 68% found data concerning the department's volume of operations relevant to both GPs and patients, while 23% thought that those data were not relevant to GPs or patients. 64% found the data concerning surgeons' volume to be irrelevant to both GPs and patients. None of the departments had informed the GPs or the patients about their results. DISCUSSION: It is remarkable that very few hospital departments actually collect and use data to secure adequate volume and quality. It is necessary to increase the focus on surgeons' volume of operations in order to secure high quality.

Clinical Competence↗
PubMed1979

Oral surgeons in geographic regions and selected metropolitan areas.

Region of practice location and size of the metropolitan area where a practice is located have been considered important manpower variables. This report of The Manpower Survey of Oral Surgery in 1974 described the relationship of these two variables to various other characteristics of the practice of oral surgery. Geographic region of the respondents and population of the practice location appeared to influence each other to some extent. There was a small but significant relationship between geographic region and age for 2,251 oral surgeons as well as for the 1,584 in full-time private practice. A similar relationship was observed between population of trade area and age. In each situation, the relationship was not consistent enough to describe a definite trend in the relationship. Both geographic region and population of trade area were associated to a small extent with variations in the professional income of oral surgeons. In New England oral surgeons seemed to earn less than expected whereas in the East North Central states they earned more than expected. There was a significant relationship between geographic region, population of trade area, and type of practice. In the eastern part of the United States, there was a tendency for fewer oral surgeons than statistically expected to establish a solo practice. There was some relationship between geographic region and hours devoted to practice for all oral surgeons as well as for those in full-time private practice. Three regions, West North Central, West South Central, and South Atlantic, had significantly more oral surgeons than statistically expected working more than 50 hours/week, whereas three other regions, East North Central, Mountain, and Pacific, had significantly fewer than statistically expected working more than 50 hours/week. In most areas except New England and the West North Central states, geographic region had no association with the average amount of inpatient or outpatient services the respondents provided. Geographic region appeared to influence the average number of surgical procedures performed. It also had some relationship to the incorporation of dental practice and the distribution of dental staff at the principle hospital used by the respondents. According to the 1974 estimated population for calculating the expected frequencies, there were more active members than expected in the American Society of Oral Surgeons in the New England, Middle Atlantic, and Pacific states and fewer than expected in the West North Central, East South Central, and Mountain states. More respondents than expected on the west coast took two weeks or less of vacation whereas more respondents than statistically expected on the east coast took more than three weeks of vacation.

Adult↗
PubMed1986

Radiation exposure risk to the surgeon during operative angiography.

Intraoperative angiography has become an essential adjunct to reconstructive vascular surgery. Therefore, radiation exposure and its potential risks to the performing surgeon need to be known. To study this, we designed experimental and clinical tests quantifying the radiation exposure to the surgeon during different intraoperative angiograms. Radiation exposure to various parts of the surgeon's body was quantified by thermoluminescence dosimetry. During each exposure a surgeon standing one foot from the x-ray tube received an absorbed dose equivalent to 0.24 to 1.4 millirems, which is about half that of an intraoperative cholangiogram. With 5 000 millirems considered the maximum permissible dose, this would imply that an upper limit of about 3 500 intraoperative angiograms each year (68 each week) could be performed safely. Comparatively, abdominal angiography carried the most significant risk (p = 0.01) and peripheral angiography was the least hazardous. Fluoroscopy increased radiation exposure more than four times that of nonfluoroscopic procedures (p = 0.05). The surgeon's extremities received the greatest dose, followed by the eyes and neck, suggesting the need for individual monitoring devices for those parts to be worn by surgeons who perform operative angiograms more frequently than average. Our study indicates that the radiation dose received by the surgeon during operative angiography, especially that of peripheral vessels, is minimal. Operative arteriography is not only a simple and readily available diagnostic tool, but it is quite a safe procedure if applied correctly.

Angiography↗
PubMed1984

Hepatitis B as an occupational disease of surgeons.

Hepatitis B is an occupational hazard of great magnitude to the practicing surgeon or surgeon-in-training. Knowledge of the basic serologic and clinical events which occur in the various forms of hepatitis B is important for effective care of patients and for understanding the personal risk involved in surgical practice. Evidence of prior infection from hepatitis B is present in more than 25 per cent of surgeons who are actively practicing. Although the risk of acquiring hepatitis as a surgeon is high (about 5 per cent per year), the majority of instances are asymptomatic. The risk to patients who are cared for by a chronically antigenemic surgeon would appear to be extremely low, and, thus, the chronic presence of surface antigen is not an indication for cessation of operating or patient care. The newly released vaccine against hepatitis is efficacious and safe, and immunization of surgeons who are seronegative is strongly recommended. Rapid progress is being made in the understanding of the transmission, treatment and prevention of type B viral hepatitis. The practicing surgeon is urged to stay informed of new developments regarding this occupational disease.

Acute Disease↗
PubMed1978

[Surgical therapy of axial hiatal hernias and reflux disease. 1. Results of an inquiry among Swiss surgeons in 1977].

Of the 153 heads of surgical departments in Switzerland, 152 joined in an inquiry into diagnostic procedures, surgical indications, and types of procedure in the treatment of axial hiatal hernia and reflux disease. Fundoplication is by far the most frequent procedure. Of the modifications performed in complicated reflux disease, 34% are controversial. Surgery for hiatal hernia and reflux disease is performed 3 times less frequently in the German part of Switzerland than in the other parts. German-speaking surgeons ascribe to themselves a greater willingness to perform preoperative diagnostic procedures--endoscopy, radiological and non-radiological tests of esophageal function--than the surgeons of the other parts of Switzerland. However, the German-speaking surgeons are more reluctant than the other surgeons to perform surgery in patients with esophagitis. The German-speaking surgeons are even more reluctant to perform surgery on the basis of subjective symptoms. Axial hiatal hernia is considered a relative indication for surgery by half of Swiss surgeons. Only a few surgeons consider this condition an absolute indication for surgery.

Cardia↗
PubMed1995

"Adult" trauma surgeons with pediatric commitment: a logical solution to the pediatric trauma manpower problem.

Pediatric trauma care by "adult" surgeons is debated, despite the paucity of pediatric trauma surgeons; 424 patients < or = 17 admitted to a Level I Center run by "adult" surgeons were analyzed. Demographics mirrored NPTR (mean ISS 11.5; mean age 10). "Adult" critical care surgeons treated MTOS-comparable patients with outcomes comparable to MTOS. Among other specialists, only neurosurgeons saw a MTOS-comparable population. Nonoperative protocols for solid organ injury were used appropriately. Z for all patients was +0.17 with M 0.908. Ps was 0.951; acute survival was 0.958 with 18 deaths (mean Ps 0.158). There were two unexpected survivors and one unexpected death; 73% of survivors had age-appropriate locomotion. Pediatric trauma outcomes by "adult" surgeons compare favorably to national standards. The recommendation that pediatric trauma care be directed by pediatric surgeons should be qualified in view of such outcomes and the paucity of pediatric trauma surgeons.

Adolescent↗
PubMedDate not supplied

Twenty-four-hour ambulatory electrocardiographic monitoring of surgeons.

The objective of the present study was to study the heart rate, presence of arrhythmia, and changes in the ST segment of surgeons with 24-hour ambulatory electrocardiographic monitoring. Eleven surgeons of several specialties were evaluated. All surgeons had one to three operations on the day of the recording. Heart rate, presence of arrhythmia, and changes in the ST segment were determined during the following surgeons' activities: operation, sleeping, car driving, patient appointment, and eating. There was a difference in the mean heart rate among the activities (p = 0.0004). The lowest mean heart rate was registered during sleeping and the highest during operation. Two surgeons had arrhythmias: one had premature ventricular contractions (0.6% of total ventricular contractions) and the other rare premature atrial contractions (0.05% of total atrial contractions) in addition to isolated premature ventricular contractions (< 0.1% of total ventricular contractions). There was no significant difference in frequency of arrhythmia during the activities (p = 0.7150). One patient had periods of inverted T waves. It is concluded that the heart rate of surgeons increases significantly during surgery and that the occurrence of cardiac arrhythmias is not increased in surgeons with no cardiovascular disease during surgery.

Adult↗
PubMed1995

Attitudes toward trauma care of surgeons practising in Ontario.

OBJECTIVE: To assess the attitudes of practising surgeons in the province of Ontario toward issues in trauma care management. DESIGN: A survey by questionnaire. SETTING: The study was carried out in a university-affiliated hospital. The survey respondents generally practised in a nonteaching setting; 48% were over the age of 50 years; 81% worked in an institution with 24-hour in-house physician coverage for the emergency department. SUBJECTS: All 2294 surgeons registered with the Ontario Medical Association were surveyed by completion and return of a questionnaire; 191 surgeons were registered in Ontario but were not practising in the province and were excluded from the survey. Questionnaires were completed by 575 surgeons, but 49 were no longer in active practice, so 526 responses form the basis of this analysis. RESULTS: The response rate to the questionnaire was 27%. One-third of the respondents wished to treat no trauma patients at all; 47% believed that trauma patients had a negative impact on their surgical practice; only 19% considered that trauma patients had a positive impact. Surgeons had negative attitudes toward trauma because of the night and weekend profile of trauma, its effect on elective surgical practice, the poor rate of reimbursement for time spent in trauma management, and the potential medicolegal liability of trauma cases. CONCLUSIONS: These results suggest that there are few surgeons in Ontario who are truly committed to providing care to the injured patient. Strategies to overcome the perceived negative aspects of trauma care must be addressed because a crisis in the availability of surgeons to provide this care seems inevitable.

Adult↗