New data demonstrate that marital status, children, and gender appear to have a powerful effect on the career planning of general surgery residents.Graduate surgical education has changed significantly during the past 20 years. Several events have changed the landscape considerably, including the elimination of the pyramidal training system in 1983, the institution of the Accreditation Council for Graduate Medical Education core competencies in 1999, and the 80-hour work week mandate in 2003. As a result, there have been many new fast-track residencies and a rapid increase in the number of specialty fellowships, especially in minimally invasive surgery. These changes reflect a growing interest in tailoring traditional general surgery to the desire of residents who want to obtain specialty training. This has created a generation gap between current trainees and experienced surgeons in practice.

In addition, specialization has emerged as a growing trend that might jeopardize the future of general surgery. According to published research, many factors play a role, including the changing demographics of medical schools and surgery residency programs, residency types, and early exposure through research that is performed during residency. “Gender-related studies on specialty training have historically focused on increasing the female surgeon pool,” says Julie Ann Sosa, MD, MA. “These studies highlight issues surrounding maternity leave, child care, female faculty role models, and shorter training programs. Unfortunately, there’s a paucity of research addressing the influence of external support systems, such as family, on surgical trainees’ plans to specialize during or after their residencies.”
New Survey Highlights

In the May 2010 Archives of Surgery, Dr. Sosa and colleagues conducted a nationwide survey of all categorical general surgery residents in the United States to identify factors that motivate residents to specialize. “More specifically, we examined the influences of marriage, family, and gender on residents’ perception of the need for specialization during and after residency,” Dr. Sosa says. The survey asked general surgery residents about their motivations for pursuing surgery as a career, their views on specialization, self-assessments of their performance, and perceptions of the current and future status of general surgery.

“A key finding was that 55.1% of respondents believed that the modern general surgeon must be specialty trained in order to be successful.”

More than half (51.3%) of general surgery residents who were surveyed in the study were married, while 23.6% were in a relationship and 22.6% were single. Another 25.4% of residents had children. More than a quarter (28.7%) of residents expressed concern that general surgery as a discipline was becoming obsolete, but women were less likely than men to agree with this statement. “A key finding was that 55.1% of respondents believed that the modern general surgeon must be specialty trained in order to be successful,” says Dr. Sosa (Figure 1). “This feeling was more common among men than women, single residents than married residents, and residents without children than those with children.” Another 78.1% of respondents associated specialty training with a better income, and 62.3% associated it with a better lifestyle.

“Single residents and those without children were more likely to believe in the necessity of specialty training,” Dr. Sosa notes. “Men and women with children believed that specialty training was associated with a better income, compared with colleagues without children. Overall, married women and women with children were twice as likely as their male counterparts to believe that specialty training has a positive effect on lifestyle [Figure 2].”

Interpreting the Data

The Archives of Surgery study by Dr. Sosa and colleagues raises some interesting questions about the beliefs of trainees and their intent to seek specialty training. “Each fellowship experience is unique,” says Dr. Sosa, “and provides varying potential for greater income and flexibility with lifestyle desires. Studies on the role of external support systems and attitudes toward career decision-making have been limited in medicine. Much of the literature has focused on recommendations rather than research to promote a balance between professional careers in medicine—especially surgery—and family. It would be beneficial to conduct more research in which resident characteristics among those considering post-residency training were stratified with the impact of marriage and children on the rigors of residency and fellowship.”
Dr. Sosa and colleagues note in their study that a pertinent follow-up analysis could seek to identify specific characteristics and trends of fellows in their designated specialty-training programs which include marital status, family factors, and gender. “This additional information may help guide specialty programs in becoming sensitive to balancing surgical careers with lifestyle desires,” Dr. Sosa says. “Ultimately, each trainee will seek a pathway in graduate surgical education that will give them the necessary skill sets for optimizing patient care, receiving adequate compensation, and achieving a flexible lifestyle. Understanding how these factors influence residents is critical to identifying, recruiting, and retaining the best and brightest candidates.”

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Median first-year guranteed compensation was greater for specialty-care physicians in multispecialty practices than in single-specialty practices acording to the Medical Group Management Association’s (MGMA’s) Physician Placement Starting Salary Survey: 2011 Report Based on 2010 Data …Read Full Article

By Jim Dwyer

At Bronx-Lebanon, a hospital that exists only by the grace and taxed fortunes of the people of New York State, the chief executive was paid $4.8 million in 2007 and $3.6 million in 2008, records show. At NewYork-Presbyterian, a hospital system that receives nearly half a billion dollars annually in public money, the chief executive was paid $9.8 million in 2007 and $2.8 million in 2008.

In an urgent search to cut the state’s health care costs and lift revenue, a task force came up with a plan to increase the cost of a hospital stay by $5 and to limit housekeeping services for the disabled in their homes.

One area of plump costs, however, remained undisturbed: executive suites where salaries and compensation run into the millions of dollars, even at the most financially struggling hospitals.

A proposal to allow public financing for only the first $1 million in wages for an executive died before it even reached the task force. “It was classic how it was killed,” said Judy Wessler, director of the Commission on the Public’s Health System, an advocacy group that had suggested the limits.

“We submitted the proposal in writing, met with the state staff members about it, then testified for our two minutes at a hearing,” Ms. Wessler said. “Then in the written summary of all the 4,000 proposals, they twisted the wording of ours so that it would be impossible to implement. Then they said it was not viable, so it wasn’t even put up for a vote.”

State officials acknowledged that the proposal had been drastically changed from its original meaning, but did not explain how that happened. In an e-mail exchange provided by Ms. Wessler, Jason A. Helgerson, the state’s Medicaid director, apologized “for not having had the time to do all we wish to do.” Mr. Helgerson was not available for an interview on Tuesday, a spokeswoman said.

The subject of executive wages would have been familiar to the task force, many of whose members came from the health care industry. One had worked as a consultant for Mount Sinai Medical Center, which received $250 million in Medicaid and paid its chief executive $2.7 million in 2008. A co-chairman of the task force, Michael Dowling, was paid $2.4 million in 2008 by North Shore-Long Island Jewish Health System, which received about $220 million from Medicaid.

UNDER current policies, the State Health Department monitors executive salaries, though much of the compensation data the hospitals provide to the state do not jibe with the tax forms that they must file. In any event, the state does not regulate the salaries, viewing them as decisions that are entirely up to the hospitals’ boards.

“Basically, the state does not set compensation rates for private businesses, even if taxpayer funding is a major revenue stream,” said Claudia Hutton, a spokeswoman for the Health Department. “We don’t have any authority to set compensation levels or even to advise.”

New legislation proposes to give that authority to the state.

Assemblywoman Deborah J. Glick, a Democrat from Manhattan, is sponsoring a bill that would limit executive salaries at publicly financed hospitals to $250,000. She suggested it would be in keeping with some other recent initiatives of Gov. Andrew M. Cuomo.

“The governor is fond of caps,” Ms. Glick said. “He has suggested a cap on the salary of educational superintendents at $175,000. There are caps on pain and suffering for those who have been the victims of medical malpractice.”

Ms. Glick’s district includes Greenwich Village, where St. Vincent’s Hospital Manhattanclosed last year in a blizzard of problems. “I had a hospital that existed for 160 years, and there were many issues with it,” she said. “It also had some level of poor management in its final year.”

The top 10 executives took home about $6 million that year. They may have gone out of business, but they didn’t go cheap.

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