Lawsuits are behind surgeon shortage in USA

Lewis S. Sharps, M.D., president, Positive Physicians Insurance Exchange – Paoli, Pa.

USA TODAY’s story about the surgeon shortage hit the bull’s-eye. But numerous other issues are creating this situation (“Shortage of surgeons pinches U.S. hospitals,” Cover story, News, Tuesday).

USA TODAY’s article overlooked the effect medical malpractice has on a region’s ability to retain surgeons. As a practicing orthopedic spine surgeon and as president and founder of a physician-driven medical malpractice insurance company, I saw firsthand how rising costs stemming from the increase in liability claims created a dangerous ripple effect across Pennsylvania in 2002. Several major medical liability insurers went out of business, limiting the options for doctors. The prohibitive malpractice premiums forced many specialty doctors and practices to close or relocate to other states.

USA TODAY is correct that there is a perfect storm forming as a result of the shortage of physicians. But it has been brewing on the horizon for a decade.

Value health professionals

J.A. McErlean, M.D. – Farmington Hills, Mich.

While USA TODAY’s article touched on an important theme, it is not news to any practicing physician in the USA.

The U.S. government apparently has come to the conclusion that physicians in the USA — especially surgeons — practice medicine as a hobby and do not need reimbursements that merely keep up with inflation.

High school and college students with a proven aptitude in science and mathematics, who should be in training to be the next generation of medical leaders, learned long ago that their time and effort will be better rewarded if they become the next Bill Gates or create the next Google.

Our society has brought this very real shortage of qualified professionals upon itself. In this election year, I haven’t heard any presidential candidates properly address this crisis. The policies that they have embraced in their political careers have produced the reality of declining access to specialty medical care.

Support clinical teachers

Jeffrey L. Kaufman, M.D., associate professor of surgery, Tufts University School of Medicine – Boston

In the next five years, it is clear that we need to ramp up the number of general surgeons being trained.

This is impossible under the current teaching paradigm without massively increasing support for the education of surgical residents and fellows.

The problem is that funding for the education of surgeons goes to hospitals, but most teaching is done by experienced surgeons who do that work for free.

Given the pressures associated with insufficient staffing for general surgery and many surgical specialties, senior surgeons are increasingly forced to give up teaching time and clinical research in order to provide energy and time for fundamental patient care. If the USA needs to train more surgeons, it will be possible only if significant time is set aside for teaching. That means it is time to pay those who do the teaching. We can increase the number of students entering medical school, but if we do not have more clinical teachers, we will not achieve the goal of having excellent surgeons available for the future.

Patients are paying price

M. Tray Dunaway, M.D. – Camden, S.C.

General surgeons are the canaries in the increasingly hazardous mine of health care. Dedication to serving the needs of patients is no match to the harsh overwhelming economic forces of reimbursement cuts, relentless unfunded governmental mandates, mounting malpractice premiums and other rising overhead costs determined by a free-market system.

The steady drumbeat of rhetoric for universal health care coverage drowns out the footsteps of physicians leaving this most-demanding medical practice. Predicted shortages of general surgeons will be exacerbated when medical school graduates choose less difficult clinical careers. Medicare can force general surgeons to accept pay cuts, but it can’t force medical graduates to become general surgeons or force currently practicing general surgeons to remain clinically active. Universal health care will not occur until realistic funding for programs treats both patients and providers in a fair and equitable manner. Good health care is expensive. Great health care is more expensive. Nothing is free. Someone always pays.

In a fragile health care system devoid of general surgeons, patients will unfortunately pay the ultimate price.

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