The shortage begins in medical school, where the quality of candidates being attracted to surgical careers, particularly surgical specialty careers such as general surgery, has been in decline. For proof, one needs only to look at the progressively weaker performance nationally of matching interns to careers in surgical specialties. There are more positions than there are qualified candidates to fill them. Medical schools overall have had a progressively larger number of unfilled programs and individual slots, despite ever increasing numbers of graduating overseas students.
Without corrective actions, the problem of recruiting people to surgical careers is going to get worse. Fortunately, there are many potential solutions, some of which can be accomplished in the short term.
First, surgical faculties and medical schools need to emphasize the positive. They need to stress the values and rewards of a surgical career, not the least of which is the positive interaction with surgical patients. Those of us already in "the business" need to stop constantly bemoaning decreased reimbursement and regulatory headaches and instead take positive steps for change, such as lobbying health plans and lawmakers. Carrying complaints to the potential future generation of surgeons does no good.
Second, once students are accepted to medical school, we need to start channeling their experiences in a direction that could entice more of them into surgical careers. I believe that students entering the first year of medical school should be recruited for a surgical research summer program before the start of their first fall classes. Likewise, during the pre-clinical period (first and second years) of medical school, it could be productive to have clubs with a surgical emphasis. Students need to be given plenty of opportunities to establish clinical role models early on.
Third, students need to know of the strong demand for surgeons. We need to emphasize that there is a substantial shortage of surgical specialists in many fields, particularly as the baby boomer generation increasingly requires surgical services.
Fourth, we need to limit the exposure prospective students have to unhappy residents (and medical school faculty). They are part of the problem, not the solution.
Fifth, students need to be exposed to the actual lifestyle of surgical specialty group practice. A career in surgery is in no way represented by the duress of senior residency nor by the "Alice in Wonderland" sensory overload of the first-year student. Students need to understand that the real-life surgical group lifestyle includes reasonable time off, reasonable time with one's family, a gratifying array of complex cases, and generally appreciative patients.
Finally, in our medical school departments, we need to do a better job in embracing new surgical technologies for use with students. This conveys to the student a sense of excitement and reinforces the idea that they can be at the forefront of establishing therapeutic advances.
We in the medical community stand at a treacherous crossroads. In order to start bringing people back to surgical careers, we need to start taking corrective actions immediately. The future of surgery depends upon it.