Where Have All the Surgeons Gone?

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By Lynette A. Scherer, MD, FACS, CEO SAMGI

A patient arrives at the local hospital at 1:00am with severe abdominal pain. An ER physician quickly makes the diagnosis of appendicitis. Normally, treatment is simple – appendectomy is a common procedure. But a straightforward diagnosis can become harrowing when there aren’t enough surgeons to cover the ER. The patient’s pain increases as the night goes on, and when the on call doctor finally arrives hours later, the patient’s appendix has burst, complicating their condition with the risk of infection, sepsis or worse. This may sound like an extreme scenario, but similar situations are playing out all across the country due to the current shortage of general surgeons. 

Research from the Health Resources and Services Administration and the American Association of Medical colleges found a current shortage of general surgeons that will only get worse in the next 10 years. Factors contributing to the shortage include uneven geographic surgical distribution – with rural hospitals facing the most severe shortages, surgeons reaching retirement age and an aging population requiring more surgical care.

The dearth of surgeons is affecting a variety of specialties, but a lack of general surgeons with a broad acute care skillset can have an immediate impact on patient outcomes. Patients who find themselves waiting too long in the ER for care may “walk” to seek treatment at another facility. Hospitals that can’t provide timely emergency and acute care see consequences in finances, reputation and health of the surrounding community. A decline in quality measures combined with inadequate staffing may even force smaller, rural hospitals to close completely.

Clearly, hospitals of all sizes need surgeons who can perform common procedures including the aforementioned appendectomy or post-injury trauma surgery – but many find the lifestyle of a traditional general surgeon unappealing. The demanding schedule often includes full-time work at a private practice in addition to overnight on-call shifts to treat hospital patients. Surgeons who help to cover the ER might have to start the day early for elective surgery, shift their daily patient schedules to accommodate an emergency case and still have to remain on call at all hours of the night. Many surgeons would rather opt for more lucrative surgical specialty practices – or opt out of surgery altogether – to better control their schedules and improve their quality of life.

The Surgicalist Solution

The COVID-19 pandemic accelerated an already growing trend toward prioritizing work-life balance. Employees in every industry have become more aware of burnout and the mental health impacts of working too many hours or under poor conditions. It may seem impossible to reconcile the demand for general surgeons with the need for a balanced lifestyle, but a solution is closer than you might expect: the surgicalist.

Surgicalists – also known as surgical hospitalists – provide full-time surgical care as salaried hospital staff, ensuring that quality surgical care is available when needed. Because they are employed strictly in the hospital with no outside private practice, surgicalists can focus their time and attention on ER and acute care demands while working a fixed, predictable schedule. One of many potential schedule arrangements might involve working every day for two weeks straight with set hours followed by two weeks off to rest and recharge. Private practice surgeons affiliated with the hospital may continue to assist with on-call needs – but now with a more manageable schedule.

Surgicalists are assets to the ER because of their specific blend of expertise. In addition to general surgery, many are acute care specialists—an emerging surgical specialty that also involves treatment of traumatic injuries. As surgicalists, they can still enjoy the challenge of treating patients needing a high level of care while enjoying a more manageable work-life balance than traditional trauma surgeons.

The surgicalist model also benefits the hospital by integrating surgeons into the facility’s workflow. Dedicated surgicalists will adopt the hospital’s standardized procedures, follow communication protocols and oversee a patient’s care journey from admission to discharge. Often an onsite medical director is onboard to ensure that both the department and the entire hospital take full advantage of the surgicalist program. The net effects include smoother patient transitions, improved quality measures and shorter stays. With this increased efficiency, hospitals may even be able to open more beds to handle more surgical cases and increase profits.

Surgicalist Programs: What to Consider

If you’ve chosen to move forward with a surgicalist program for your hospital, you will want to know your options. While it’s possible to handle hiring and program management in-house, there are organizations that deliver and manage turn-key surgicalist programs, simplifying the start-up process, saving time and, perhaps surprisingly, typically cutting costs. A surgicalist program management firm can provide professionally developed, proven programs and recruit highly skilled, board-certified or -eligible surgeons. After all, that’s all they do, and they have their fingers on the pulse of the current marketplace.

A surgicalist management organization will guide your hospital every step of the way – including analysis before beginning the hiring process to optimize staffing and profits. An experienced firm will examine your existing emergency surgery program and patient population and use benchmarks from similar facilities nationwide to help set realistic goals. They will also study emergency surgery patient volume and treatment locations in their marketplace analysis to find effective ways to attract more patients.

A surgicalist firm will handle all aspects of staffing and hiring, including:

• Determining numbers and types of surgeons required to meet demand
• Creating job descriptions with necessary qualifications
• Setting location- and marketplace-specific compensation, including salaries, bonuses and growth potential
• Accessing a wide-reaching existing talent pool for candidates
• Screening candidates, including interviewing, checking references and on-boarding
• Planning schedules to ensure work-life balance

The work isn’t over once hiring is complete. A surgicalist management firm will continue to handle administrative aspects of the job to help keep surgeons focused on patient care. Additionally, the firm will collaborate with the hospital to develop evidence-based surgical protocols and best practice guidelines. These standardized procedures promote reliable communication among hospital staff and improve patient care coordination.

Keeping general surgeons happy and fulfilled in the workplace is a win for everybody, and a surgicalist program is a proven path toward this goal. This unique employment paradigm, with its career and lifestyle benefits, could become a model for other medical specialties. Reimagining surgical employment options may even help to curb shortage of surgeons overall, offering a sustainable solution for the future of healthcare.