Daddy's Interview

C.R. was interviewed by the columbus newspaper a few weeks ago. The article came out this past week. Just wanted to post it online so everyone could enjoy. We are so proud of daddy!!


General surgeons needed in U.S. ... stat!
Shortage may hurt rural areas most, experts say
Thursday, January 22, 2009 3:29 AM
By Misti Crane

THE COLUMBUS DISPATCH

Dr. C.R. Hall of Ohio State University Medical Center is an exception to the trend of fewer general surgeons. He likes the challenge of caring for the sickest patients." CHRIS RUSSELL DISPATCH

Dr. C.R. Hall of Ohio State University Medical Center is an exception to the trend of fewer general surgeons. He likes the challenge of caring for the sickest patients.
Nobody wants to wait in line for an appendectomy.

But the ranks of general surgeons, those relied upon for commonplace and sometimes urgent operations, are dwindling. The trend is alarming experts who say that patients, especially those in rural areas, are going to suffer if something doesn't change.

The reasons for the shortage are varied and include such things as political decisions and the desire of more young doctors to have better control over their work and family lives.
Contributing factors:

• More people and, therefore, more patients. The U.S. population has grown by about 60 million in the past two decades, surpassing 305 million at the beginning of this year, according to estimates from the Census Bureau.

• A shrinking pool of general surgeons. The American Medical Association says the number dropped from 27,509 in 1998 to 24,902 in 2002. More-conservative estimates now put it closer to 17,000, said Dr. George Sheldon, one of the nation's foremost authorities on the surgeon shortage.

• Increasing specialization. Even those who do choose general surgery often go on to specialize in other areas.

• No more money, no more training. The federal government caps the number of trainees it will support with taxpayer dollars.

Of gravest concern from a patient perspective is what will happen to community hospitals in rural areas, said Sheldon, who directs the American College of Surgeons' Health Policy and Research Institute at the University of North Carolina.

In more than a third of the counties that are home to critical-access rural hospitals, not a single surgeon lives in the county, Sheldon said. That doesn't mean there isn't a surgeon who travels in, but the numbers aren't reassuring to those worried about what the future holds.
The number of general surgeons per 100,000 people declined more than 25 percent in 25 years, according to a study published last year in the Archives of Surgery.

The study said that nurse practitioners and others have helped fill vacancies amid physician shortages in other areas, but that couldn't work in general surgery.

The bottom line: Without more people such as Dr. C.R. Hall, the 53 million Americans who live in rural communities could end up waiting for those appendixes to come out or enduring a drive or flight to a big city to have the surgery.

Hall, chief resident in general surgery at Ohio State University Medical Center, knew he was bucking the trend when he chose general surgery.

"I thought about orthopedic surgery because I was a jock in high school," he said.
But after he spent time in an orthopedic surgery office, he changed his mind. One guy did knees, another guy did ankles, a third guy did shoulders, and that was it -- the same joint, day after day and patient after patient.

"These guys made a lot of money, but I thought it was terrible," Hall said.
General surgery was more appealing, even if some of his classmates saw it as less prestigious and lucrative -- and more demanding -- than other options.

"I like the idea of being able to take care of the sickest patients," he said. "We do gall bladders, hernias, the bread and butter of surgeries."

And the lifestyle isn't as bad as it used to be, he said.

Just ask Dr. Thomas E. Williams Jr., an Ohio State surgery professor who studies the shortage and recalls his early years in surgery as being mostly work and little play. That's when he took calls every night and heard about it from his wife.

"I was never home for dinner with my kids," Williams said.

But with multisurgeon practices, being on call isn't an every-night thing, Hall said. His job is demanding but doesn't preclude family time with his pregnant wife and 18-month-old son.
Dr. Bhagwan Satiani, a vascular surgeon at Ohio State, said young doctors seem inclined to choose "what they call controllable lifestyle specialties -- dermatology, pathology."
Dr. Thomas Hartranft, program director of Mount Carmel Health's surgical residency program, said he doesn't foresee trouble in the city but forecasts big problems elsewhere.
"There's no question they're going to be suffering."

The primary obstacle to getting more people trained and into communities is the federal cap on how many trainees the government will pay for, Hartranft said. "Most people don't want to take on more residents without some way to pay for them."

Sheldon said it's hard to quantify patient harm related to the shortage, but that's part of what his group is studying. Of special concern are trauma patients who need urgent care.
No matter the solution, the problem won't be resolved overnight, Sheldon said.

"It takes five years to train somebody. It's demanding training, and the work after you're in practice is demanding."
mcrane@dispatch.com