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Anderson C, Duggan B, Colgate C, Bhatia M, Gray B. How far We Go For Surgery: Distance to Pediatric Surgical Care in Indiana. J Pediatr Surg 2024; 59:1444-1449. [PMID: 38582703 DOI: 10.1016/j.jpedsurg.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/26/2024] [Accepted: 03/10/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Despite increasing numbers of pediatric surgery training programs, access to pediatric surgical care remains limited in non-academic and rural settings. We aimed to characterize demographic and patient factors associated with increased distance to selected pediatric surgical procedures in Indiana. METHODS This IRB-approved retrospective review analyzed pediatric patients undergoing appendectomy, cholecystectomy, umbilical hernia repair, pyloromyotomy, and video assisted thoracic surgery (VATS) procedures from 2019 through 2021. Data was obtained from an electronic medical record warehouse and the Indiana Hospital Association. Travel distance was calculated as driving distance between patient address and hospital ZIP codes. Statistics were performed in R, with p < 0.05 indicating significance. RESULTS There were 6835 operations performed, and half of all operations (46%) were performed at institutions with fellowship-trained pediatric surgeons. The median travel distance for all operations was 13 miles (range 0-182); the shortest was for laparoscopic appendectomy (9 miles, IQR[0-20]). The longest distances were for pyloromyotomy (51 miles, IQR[14-84]) and VATS procedures (57 miles, IQR[13-111]), of which, nearly all were performed at tertiary pediatric care centers (97% and 93%, respectively). There was a significant linear and quadratic effect of age on travel distance (p < 0.001), with younger patients requiring farther travel. On multivariable linear regression, age and procedure type had the largest effect on travel distance (Eta squared 0.03, p < 0.001). CONCLUSION Younger age and more specialized procedures, including VATS and pyloromyotomy, were associated with increased travel distance. This highlights regionalization of these procedures to urban areas with pediatric care centers, while others are performed closer to home. LEVEL OF EVIDENCE III TYPE OF STUDY: Retrospective comparative study.
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Affiliation(s)
- Cassandra Anderson
- Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202-3082, USA; Section of Pediatric Surgery, Riley Hospital for Children, 705 Riley Hospital Drive RI2500, Indianapolis, IN, 46202, USA.
| | - Ben Duggan
- Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202-3082, USA
| | - Cameron Colgate
- Center for Outcomes Research in Surgery, Indiana University School of Medicine, 410 W 10th Street, HITS, Suite 2000, Indianapolis, IN, 46202, USA
| | - Manisha Bhatia
- Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202-3082, USA; Section of Pediatric Surgery, Riley Hospital for Children, 705 Riley Hospital Drive RI2500, Indianapolis, IN, 46202, USA
| | - Brian Gray
- Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202-3082, USA; Section of Pediatric Surgery, Riley Hospital for Children, 705 Riley Hospital Drive RI2500, Indianapolis, IN, 46202, USA
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2
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Searns JB, Hall M, Birkholz M, Hubbell BB, Kern-Goldberger AS, Markham JL, Rolsma SL, Shah SS, Wang ME, O’Leary ST, Dominguez SR, Parker SK, Kronman MP. Outcomes of Early Surgical Procedures for Children With Acute Hematogenous Osteomyelitis. Pediatrics 2024; 154:e2023065397. [PMID: 38903048 PMCID: PMC11211689 DOI: 10.1542/peds.2023-065397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 06/22/2024] Open
Affiliation(s)
- Justin B. Searns
- Sections of Hospital Medicine
- Infectious Disease, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
| | - Meghan Birkholz
- Infectious Disease, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Brittany B. Hubbell
- Department of Pediatrics, University of Cincinnati, and Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Jessica L. Markham
- Division of Hospital Medicine, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, and Children’s Mercy Kansas City, Kansas City, Missouri
| | - Stephanie L. Rolsma
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Samir S. Shah
- Department of Pediatrics, University of Cincinnati, and Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Marie E. Wang
- Division of Pediatric Hospital Medicine, Stanford University School of Medicine, and Lucile Packard Children’s Hospital Stanford, Stanford, California
| | - Sean T. O’Leary
- Infectious Disease, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Samuel R. Dominguez
- Infectious Disease, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Sarah K. Parker
- Infectious Disease, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Matthew P. Kronman
- Section of Infectious Diseases, Department of Pediatrics, University of Washington, Seattle, Washington
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Fahy AS, Klima DA, Gillam MM, Aprahamian CJ, Kim SS, Kokoska ER, Teeple EA, Weiss RG, Escobar MA. Locum Tenens and Pediatric Surgery: A Position Statement and Practice Guidelines From the American Pediatric Surgical Association (APSA). J Pediatr Surg 2024:S0022-3468(24)00298-7. [PMID: 38806318 DOI: 10.1016/j.jpedsurg.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/25/2024] [Accepted: 04/30/2024] [Indexed: 05/30/2024]
Abstract
The American Pediatric Surgical Association (APSA) Practice Committee endorsed by the Board of Governors presents a Position Statement on the role of locum tenens in the practice of pediatric surgery. The Practice Committee also presents a set of guidelines for locum tenens practice. These recommendations highlight safe practice and quality care that protects the patient as well as the pediatric surgeon by offering best practice standards, defining optimal resources and establishing parameters by which hospitals and locum tenens agencies should abide. These guidelines are intended to foster discussion and contract negotiation as well as inform decision making for a) pediatric surgeons considering locum tenens opportunities, b) host organizations (hospitals and practices) seeking the coverage of a pediatric surgeon, and c) locum tenens companies vetting both surgeons and hospitals for appropriateness of such coverage. This Position Statement and foundational set of guidelines align with APSA's Vision (all children receive the highest quality surgical care) and Mission (to provide the best surgical care to our patients and families by supporting an inclusive community through education, discovery and advocacy).
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Affiliation(s)
| | | | | | | | - Stephen S Kim
- Inova LJ Murphy Children's Hospital, Fairfax, VA, USA
| | - Evan R Kokoska
- Peyton Manning Children's Hospital, Indianapolis, IN, USA
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Emil S, Langer JC, Blair G, Aspirot A, Brisseau G, Hancock BJ. The Canadian Pediatric Surgery Workforce: A 10-year Prospective Assessment. J Pediatr Surg 2024; 59:757-762. [PMID: 38395684 DOI: 10.1016/j.jpedsurg.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/18/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND The Canadian Association of Paediatric Surgeons launched a 10-year prospective assessment of the Canadian pediatric surgery workforce and training environment, beginning in 2013. The results of the first 5 years (2013-2017) were previously published. Here, we present the results of the last 5 years (2018-2022), and the cumulative results of the past decade. METHODS With IRB approval, a web-based survey was sent to all pediatric surgery division chiefs in Canada each year (2013-2022). The survey gathered workforce data on pediatric surgery practices, as well as data regarding fellowship graduates from Canadian training programs. RESULTS Complete responses were received from all 18 divisions (100% response rate). Over the decade studied, the number of pediatric surgeons and full-time equivalent positions increased from 73 to 81, and 65 to 82, respectively. Thirty positions were vacated (15 retirement, 6 new Canadian practice, 8 leaving Canada, 1 other), and 38 were filled (20 new Canadian fellowship graduates, 8 Canadian surgeons moving from other sites in Canada, 10 surgeons coming from outside Canada). Seventy-five fellows completed training eligible for North American certification, including 34 Canadians, 31 Americans, and 10 non-North American foreign nationals (9 of whom left North America after training). The proportion of Canadian graduates who desired, but could not find, a Canadian position improved from 44% in the first 5 years to 20% in the second 5 years. CONCLUSIONS The Canadian pediatric surgery workforce has experienced a modest increase over a decade. A mismatch still exists between Canadian pediatric surgery graduates and attending staff positions, but the situation has improved during the last 5 years. TYPE OF STUDY Survey. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Sherif Emil
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Jacob C Langer
- Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Geoffrey Blair
- Division of Pediatric Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Ann Aspirot
- Division of Pediatric Surgery, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Guy Brisseau
- Division of Pediatric Surgery, Sidra Medicine, Doha, Qatar
| | - B J Hancock
- Division of Pediatric Surgery, Children's Hospital of Winnipeg, Winnipeg, Manitoba, Canada
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5
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Shah NR, Price A, Mobli K, O'Leary S, Radhakrishnan RS. Temporal Trends of Neonatal Surgical Conditions in Texas and Accessibility to Pediatric Surgical Care. J Surg Res 2024; 296:29-36. [PMID: 38215674 DOI: 10.1016/j.jss.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/13/2023] [Accepted: 12/15/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Texas consistently accounts for approximately 10% of annual national births, the second highest of all US states. This temporal study aimed to evaluate incidences of neonatal surgical conditions across Texas and to delineate regional pediatric surgeon accessibility. METHODS The Texas Birth Defects Registry was queried from 1999 to 2018, based on 11 well-established regions. Nine disorders (30,476 patients) were identified as being within the operative scope of pediatric surgeons: biliary atresia (BA), pyloric stenosis (PS), Hirschsprung's disease, stenosis/atresia of large intestine/rectum/anus, stenosis/atresia of small intestine, tracheoesophageal fistula/esophageal atresia, gastroschisis, omphalocele, and congenital diaphragmatic hernia. Annual and regional incidences were compared (/10,000 births). Statewide pediatric surgeons were identified through the American Pediatric Surgical Association directory. Regional incidences of neonatal disorder per surgeon were evaluated from 2010 to 2018 as a surrogate for provider disparity. RESULTS PS demonstrated the highest incidence (14.405/10,000), while BA had the lowest (0.707/10,000). Overall, incidences of PS and BA decreased significantly, while incidences of Hirschsprung's disease and small intestine increased. Other diagnoses remained stable. Regions 2 (48.24/10,000) and 11 (47.79/10,000) had the highest incidence of neonatal conditions; Region 6 had the lowest (34.68/10,000). Three rural regions (#2, 4, 9) lacked pediatric surgeons from 2010 to 2018. Of regions with at least one surgeon, historically underserved regions (#10, 11) along the Texas-Mexico border consistently had the highest defect per surgeon rates. CONCLUSIONS There are temporal and regional differences in incidences of neonatal conditions treated by pediatric surgeons across Texas. Improving access to neonatal care is a complex issue that necessitates collaborative efforts between state legislatures, health systems, and providers.
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Affiliation(s)
- Nikhil R Shah
- Division of Pediatric Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, Texas.
| | - Anthony Price
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Keyan Mobli
- Division of Pediatric Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Sean O'Leary
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Ravi S Radhakrishnan
- Division of Pediatric Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, Texas
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Silvestre J, Weldeslase TA, Wilson RH. Assessing Trends in Supply and Demand for Pediatric Surgery Training. JOURNAL OF SURGICAL EDUCATION 2023; 80:1113-1120. [PMID: 37316429 DOI: 10.1016/j.jsurg.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/06/2023] [Accepted: 05/15/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE This study assessed the supply and demand for Pediatric Surgery training in the U.S. from 2008 to 2022. We hypothesized that in the Pediatric Surgery Match: match rates would increase over time; U.S. MD Graduates would have higher match rates than non-U.S. MD Graduates; and fewer applicants would match at one of their top fellowship choices. DESIGN This was a retrospective cohort study of Pediatric Surgery Match applicants (2008-2022). Cochran-Armitage tests elucidated temporal trends and chi square tests compared outcomes by applicant archetype. SETTING Accreditation Council for Graduate Medical Education (ACGME)-accredited Pediatric Surgery training programs in the United States and non-ACGME-accredited programs in Canada. PARTICIPANTS A total of 1,133 applicants for Pediatric Surgery training. RESULTS From 2008 to 2012, growth in the annual number of fellowship positions (34-43, 27% increase) exceeded growth in number of applicants (62-69, 11% increase) (p < 0.001). Over the study period, the applicant-to-training ratio peaked at 2.1 to 2.2 in 2017 to 2018 and decreased to 1.4 to 1.6 in 2021 to 2022. The annual match rate for U.S. MD Graduates increased from 60% to 68% (p < 0.05), but decreased from 40% to 22% (p < 0.05) for non-U.S. MD Graduates. In 2022, there was a 3.1-fold difference in match rates between U.S. MD and non-U.S. MD Graduates (68% vs 22%, p < 0.001). The percentage of applicants that matched at their first choice (25%-20%, p < 0.001), second choice (11%-4%, p < 0.001), and third choice (7%-4%, p < 0.001) fellowships decreased over the study period. The percentage of applicants that matched at their fourth choice to least desirable fellowship increased from 23% to 33% (p < 0.001). CONCLUSIONS The demand for Pediatric Surgery training peaked in 2017 to 2018 and has decreased since. However, the Pediatric Surgery Match remains competitive especially for non-U.S. MD Graduates. More research is needed to understand barriers to matching into Pediatric Surgery for non-U.S. MD Graduates.
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Affiliation(s)
- Jason Silvestre
- Perelman School of Medicine, Philadelphia, Pennsylvania; Children's National Hospital, Washington, DC.
| | | | - Robert H Wilson
- Howard University College of Medicine, Washington, DC; Children's National Hospital, Washington, DC
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7
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Skinner S, Verhoeff K, Purich K, Dhaliwal R, Strickland M, Perry T. Canadian Pediatric Surgeon Workforce: Characterization of Training, Trends Over Time, and 10-year Model for Pediatric Surgery Need. J Pediatr Surg 2023:S0022-3468(23)00164-1. [PMID: 36934002 DOI: 10.1016/j.jpedsurg.2023.02.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/24/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Graduate and fellowship training trends for Canadian pediatric surgeons remain uncharacterized. Similarly, updated workforce planning for pediatric surgeons is required. We aimed to characterize graduate degree and fellowship trends for Canadian pediatric surgeons, with modelling to inform workforce planning. METHODS We performed a cross sectional observational study evaluating Canadian pediatric surgeons in January 2022. Surgeon demographics collected included year of medical degree (MD) conferment, MD location, fellowship location, and graduate degree achievement. Our primary outcome was to evaluate training characteristics over time. Secondary outcomes evaluated surgeon supply and demand from 2021 to 2031. Supply was extrapolated from current Canadian pediatric surgery fellows assuming static fellowship matriculation, while retirement was estimated using a 31-, 36-, or 41-year career following MD conferral. RESULTS Of included surgeons (n = 77), 64 (83%) completed fellowship training in Canada and 46 (60%) have graduate degrees. No surgeons graduating ≤1980 hold graduate degrees, compared to 8 (100%) surgeons with MD ≥ 2011 (p < 0.001). Similarly, more surgeons with MD ≥ 2011 appear to have a Canadian MD (n = 7, 87.5%) and Canadian fellowship (n = 8, 100%). Modelling predicts that 19-49 (25%-64%) surgeons will retire between 2021 and 2031, while 37 fellows will graduate with intention to work in Canada, creating between a 12 surgeon deficit up to an 18 surgeon surplus depending on career length. CONCLUSIONS Trends in graduate degree achievement and fellowship location suggest increasing competition for Canadian pediatric surgery positions. Additionally, a substantial number of Canadian-trained fellows will need positions outside of Canada in the next decade. Overall, results support previous work demonstrating saturation of the Canadian pediatric workforce. LEVEL OF EVIDENCE Level IV. ACGME COMPETENCY ADDRESSED Medical Knowledge.
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Affiliation(s)
| | - Kevin Verhoeff
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Kieran Purich
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | | | - Matt Strickland
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Troy Perry
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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Zanini A, von Sochaczewski CO, Basson S, Brisighelli G, Di Cesare A, Gabler T, Gentilino V, Gopal M, Grieve A, Harrison D, Patel N, Westgarth-Taylor C, Withers A, Loveland JA. Globalization in Pediatric Surgical Training: The Benefit of an International Fellowship in a Low-to-Middle-Income Country Academic Hospital. Eur J Pediatr Surg 2022; 32:363-369. [PMID: 34407553 DOI: 10.1055/s-0041-1734029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE A relative oversupply of pediatric surgeons led to increasing difficulties in surgical training in high-income countries (HIC), popularizing international fellowships in low-to-middle-income countries (LMIC). The aim of this study was to evaluate the benefit of an international fellowship in an LMIC for the training of pediatric surgery trainees from HICs. METHODS We retrospectively reviewed and compared the prospectively maintained surgical logbooks of international pediatric surgical trainees who completed a fellowship at Chris Hani Baragwanath Academic Hospital in the last 10 years. We analyzed the number of surgeries, type of involvement, and level of supervision in the operations. Data are provided in mean differences between South Africa and the respective home country. RESULTS Seven fellows were included. Operative experience was higher in South Africa in general (Δx̅ = 381; 95% confidence interval [CI]: 236-656; p < 0.0001) and index cases (Δx̅ = 178; 95% CI: 109-279; p < 0.0001). In South Africa, fellows performed more index cases unsupervised (Δx̅ = 71; 95% CI: 42-111; p < 0.0001), but a similar number under supervision (Δx̅ = -1; 95% CI: -25-24; p = 0.901). Fellows were exposed to more surgical procedures in each pediatric surgical subspecialty. CONCLUSION An international fellowship in a high-volume subspecialized unit in an LMIC can be highly beneficial for HIC trainees, allowing exposure to higher caseload, opportunity to operate independently, and to receive a wider exposure to the different fields of pediatric surgery. The associated benefit for the local trainees is some reduction in their clinical responsibilities due to the additional workforce, providing them with the opportunity for protected academic and research time.
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Affiliation(s)
- Andrea Zanini
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Christina Oetzmann von Sochaczewski
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.,Clinic and Policlinic for Paediatric Surgery, University of Mainz, Mainz, Germany
| | - Sonia Basson
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Giulia Brisighelli
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Antonio Di Cesare
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.,Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Policlinico Milano, Italy
| | - Tarryn Gabler
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Valerio Gentilino
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.,Unit of Pediatric Surgery, Woman and Child Department, Filippo del Ponte Hospital - ASST Sette Laghi, Varese, Italy
| | - Milan Gopal
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.,Department of Pediatric Surgery, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
| | - Andrew Grieve
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Derek Harrison
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Nirav Patel
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Chris Westgarth-Taylor
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Aletha Withers
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Jerome A Loveland
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
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Martin AE, McEvoy CS, Lumpkins K, Scholz S, DeRoss AL, Emami C, Phillips MR, Qureshi F, Gray BW, Safford SD, Healey PJ, Alaish SM, Dunn SP. Employment search, initial employment experience, and career preferences of recent pediatric surgical fellowship graduates: An APSA survey, part of the right child/right surgeon initiative. J Pediatr Surg 2022; 57:86-92. [PMID: 34872735 DOI: 10.1016/j.jpedsurg.2021.09.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND APSA's Right Child/Right Surgeon Initiative addresses issues concerning patient access to appropriate pediatric surgical care and workforce distribution. The APSA Workforce Committee sought to understand the experiences and motivations of recent graduates of Pediatric Surgery Training Programs entering the workforce. METHODS Using APSA membership databases, we identified members who completed fellowship training from 2010 to 2019. An online survey was created using Survey Monkey, and invitations to participate were sent via email. RESULTS 144 of 447 invited participants responded (32% response rate). 91% of respondents participated in dedicated research prior to fellowship, but only 64% perform research during their employment. 23% completed an additional clinical fellowship, but only 54% currently practice within the second field. When asked to identify the top three factors used to choose a position, the most common responses were "location or geography" (71%), "available mentorship" (53%), and "compensation and benefits" (37%). Describing their first position, 77% reported working in an academic institution, 78% reported working in a metropolitan/urban area, and 55% reported working in a free-standing children's hospital. 94% participate in General Surgery resident education, and 49% are faculty within a Pediatric Surgery fellowship. Overall, 92% of respondents were able to find the type of employment position that they had wanted. CONCLUSION In our survey the overwhelming majority of young pediatric surgeons found the type of job they desired. Most report beginning their practice in more populated, urban areas within academic institutions. Geographic location and work environment played heavily into their employment decisions. These preferences could contribute to continued disparity in access to pediatric surgeons between urban and rural America and to dilution of experience for urban surgeons. Possible solutions include alternative incentive programs for employment in less populated areas or new training models for general surgeons in rural areas to train in fundamentals of Pediatric Surgery.
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Affiliation(s)
- Abigail E Martin
- Division of Pediatric Surgery, Department of Surgery, Nemours Children's Hospital Delaware, 1600 Rockland Rd., Wilmington, DE 19803, United States of America.
| | - Christian S McEvoy
- Department of Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, United States of America
| | - Kimberly Lumpkins
- Division of Pediatric Surgery & Urology, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Stefan Scholz
- Division of General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States of America
| | - Anthony L DeRoss
- Department of Pediatric Surgery, Cleveland Clinic, Cleveland, OH, United States of America
| | - Claudia Emami
- Pediatric Surgeon, General Surgery Section Chief, Huntington Memorial Hospital, Pasadena, CA, United States of America
| | - Michael R Phillips
- Division of Pediatric Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Faisal Qureshi
- Division of Pediatric Surgery, Department of Surgery, UT Southwestern Medical School, Dallas, TX, United States of America
| | - Brian W Gray
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Shawn D Safford
- Division of Pediatric Surgery, Penn State Health Children's Hospital, Hershey, PA, United States of America
| | - Patrick J Healey
- Department of Surgery, Seattle Children's Hospital University of Washington, Seattle, WA, United States of America
| | - Samuel M Alaish
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Stephen P Dunn
- Division of Pediatric Surgery, Department of Surgery, Nemours Children's Hospital Delaware, 1600 Rockland Rd., Wilmington, DE 19803, United States of America
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10
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Metzger GA, Cooper J, Lutz C, Jatana KR, Nishimura L, Deans KJ, Minneci PC, Halaweish I. The value of telemedicine for the pediatric surgery patient in the time of COVID-19 and beyond. J Pediatr Surg 2021; 56:1305-1311. [PMID: 33648729 PMCID: PMC7894074 DOI: 10.1016/j.jpedsurg.2021.02.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/19/2021] [Accepted: 02/08/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Prior to COVID-19, the use of telemedicine within pediatric surgery was uncommon. To curb the spread of the virus many institutions restricted non-emergent clinic appointments, resulting in an increase in telemedicine use. We examined the value of telemedicine for patients presenting to a pediatric surgery clinic before and after COVID-19 METHODS: Perspectives and the potential value of telemedicine were assessed by surveying patients or caregivers of patients being evaluated by a general pediatric surgeon in-person prior to COVID-19 and by patients or caregivers of patients who completed a telemedicine appointment with a pediatric surgical provider during the COVID-19 period. RESULTS The pre-COVID survey was completed by 57 respondents and the post-COVID survey by 123. Most respondents were white and were caregivers 31-40 years of age. Prior to COVID-19, only 26% were familiar with telemedicine, 25% reported traveling more than 100 miles and >50% traveled more than 40 miles for their appointment. More than 25% estimated additional travel costs of at least $30 and in 43% of households, at least one adult had to miss time from work. Following a telemedicine appointment during the COVID-19 period, 76% reported the care received as excellent, 86% were very satisfied with their care, 87% reported the appointment was less stressful for their child than an in-person appointment, and 57% would choose a telemedicine appointment in the future. CONCLUSION For families seeking an alternative to the in-person encounter, telemedicine can provide added value over the traditional in-person encounter by reducing the burden of travel without compromising the quality of care. Telemedicine should be viewed as a viable option for pediatric surgery patients and future research directed toward optimizing the experience for patients and providers. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Gregory A. Metzger
- The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer Cooper
- The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Carley Lutz
- The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kris R. Jatana
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Leah Nishimura
- The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Katherine J. Deans
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA,The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Peter C. Minneci
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA,The Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Ihab Halaweish
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
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11
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Cairo SB, Pu Q, Malemo Kalisya L, Fadhili Bake J, Zaidi R, Poenaru D, Rothstein DH. Geospatial Mapping of Pediatric Surgical Capacity in North Kivu, Democratic Republic of Congo. World J Surg 2021; 44:3620-3628. [PMID: 32651605 DOI: 10.1007/s00268-020-05680-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite recent attention to the provision of healthcare in low- and middle-income countries, improvements in access to surgical services have been disproportionately lagging. METHODS This study analyzes the geographic variability in access to pediatric surgical services in the province of North Kivu, Democratic Republic of Congo (DRC). On-site data collection was conducted using the Global Assessment of Pediatric Surgery tool. Spatial distribution of providers was mapped using the Geographical Information System and open-sourced spatial data to determine distances traveled to access surgical care. RESULTS Forty facilities were evaluated across 32 health zones; 68.9% of the provincial population was within 15 km of these facilities. Eleven facilities met a minimum World Health Organization safety score of 8; 48.1% of the population was within 15 km of corresponding facilities. The majority of children were treated by someone with specific pediatric surgery training in only 4 facilities; one facility had a trained pediatric anesthesia provider. Fifty-seven percent of the population was within 15 km of a facility with critical care and emergency medicine (EM) capabilities. There was one pediatric critical care provider and no pediatric EM providers identified within the province. Location-allocation assessment is needed to combine geographic area with potential for greatest impact and facility assessment. CONCLUSIONS Limitations in access to surgical care in the DRC are multifactorial with poor resources, few formally trained surgical providers, and near-absent access to pediatric anesthesiologists. The study highlights the deficits in the capacity for surgical care while demonstrating a reproducible model for assessment and identification of ways to improve access to care.
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Affiliation(s)
- Sarah B Cairo
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA. .,Department of Surgery, Maine Medical Center, Portland, ME, USA.
| | - Qiang Pu
- Department of Geography, University At Buffalo, The State University of New York, Buffalo, NY, USA
| | - Luc Malemo Kalisya
- HEAL Africa Hospital, COSECSA Training Program, Goma, North Kivu Province, Democratic Republic of Congo
| | - Jacques Fadhili Bake
- HEAL Africa Hospital, COSECSA Training Program, Goma, North Kivu Province, Democratic Republic of Congo
| | - Rene Zaidi
- HEAL Africa Hospital, COSECSA Training Program, Goma, North Kivu Province, Democratic Republic of Congo
| | - Dan Poenaru
- Department of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - David H Rothstein
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA.,Department of Surgery, University At Buffalo, The State University of New York, Buffalo, NY, USA
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12
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Metzger G, Jatana K, Apfeld J, Deans KJ, Minneci PC, Halaweish I. State of telemedicine use in pediatric surgery in the USA—where we stand and what we can gain from the COVID-19 pandemic: a scoping review. WORLD JOURNAL OF PEDIATRIC SURGERY 2021; 4:e000257. [DOI: 10.1136/wjps-2020-000257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/02/2021] [Accepted: 02/21/2021] [Indexed: 12/26/2022] Open
Abstract
BackgroundWithin the last decade, the use of telemedicine within in primary care in the USA has greatly expanded; however, use remains uncommon in surgical specialties. The spread of Coronavirus disease 2019 (COVID-19) prompted healthcare institutions to limit in-person contact, resulting in an increase in telemedicine across all specialties, including pediatric surgery. The aims of this review were to evaluate potential barriers that limited the use of telemedicine in pediatric surgery prior to the COVID-19 period and to define how best to incorporate its use into a pediatric surgical practice going forward.MethodsA scoping review was performed to identify gaps in the literature pertaining to the use of telemedicine within general pediatric surgery in the USA prior to the outbreak of COVID-19. Next, a focused evaluation of the legislative and organizational policies on telemedicine was performed. Lastly, findings were summarized and recommendations for future research developed in the context of understanding and overcoming barriers that have plagued widespread adoption in the past.ResultsDespite evidence of telemedicine being safe and well received by adult surgical patients, a total of only three studies representing original research on the use of telemedicine within pediatric surgery were identified. Legislative and organizational policies regarding telemedicine have been altered in response to COVID-19, likely resulting in an increase in the use of telemedicine among pediatric surgeons.ConclusionsTelemedicine offers a safe and effective option for patients seeking an alternative to the in-person clinic appointment. The increased utilization of telemedicine during the COVID-19 pandemic will provide an opportunity to learn how best to leverage the technology to decrease disparities and to overcome previous barriers.
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13
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Alganabi M, Pierro A. Becoming an academic pediatric surgeon scientist in Canada. Semin Pediatr Surg 2021; 30:151015. [PMID: 33648711 DOI: 10.1016/j.sempedsurg.2021.151015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pediatric surgeon scientists in Canada and broadly North America occupy a unique role balancing both clinical practice and surgical research. The path to becoming an academic pediatric surgeon scientist is one that is lengthy but highly rewarding. There are excellent opportunities for young surgeons to become academic pediatric surgeons represented by the Doctor of Medicine (MD) / Doctor of Philosophy (PhD) and the Surgeon Scientist Training Programs (SSTP). Meeting the demands for clinical practice often takes precedence over research training in healthcare, leading to a potential shortage of academic pediatric surgeons in Canada and North America. This shortage often leads to increased reliance on international research collaborations and imported talent to continue to advance the field. Protecting the research academic time is essential to a fruitful progression in academic pediatric surgery.
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Affiliation(s)
- Mashriq Alganabi
- Division of General and Thoracic Surgery, Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Agostino Pierro
- Division of General and Thoracic Surgery, Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada..
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14
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Analysis of Orthopaedic Job Availability in the United States Based on Subspecialty. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e20.00195. [PMID: 33986211 DOI: 10.5435/jaaosglobal-d-20-00195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND The number of orthopaedic residency graduates pursuing additional subspecialty training has increased along with the percentage of advertised jobs requiring fellowship. As such, the implications of fellowship training on job availability and marketability may impact their choice of subspecialty. The purpose of this study was to evaluate job availability in the United States for general orthopaedics and orthopaedic subspecialties. METHODS Job advertisements in 2019 were reviewed from the career center databases of the Journal of Bone and Joint Surgery, American Academy of Orthopaedic Surgeons, as well as of individual subspecialty societies. Job listings were cross referenced to identify unique jobs within the United States, which were categorized by the orthopaedic training required, practice type, and location. To assess job availability, a ratio of fellows to job listings was calculated based on the number of matched candidates for nine subspecialty fellowships and the number of residency graduates entering general practice in 2019. RESULTS A total of 466 unique job listings were identified with 114 generalist and 352 subspecialist positions. The subspecialties with the lowest number of fellows per advertised job were foot and ankle (1.1), adult reconstruction (2.0), and trauma (2.1). The subspecialties with the highest number of fellows per advertised job were sports medicine (6.3), shoulder and elbow (5.8), and oncology (5.7). Job availability for general orthopaedics was higher than for any subspecialty. The highest percentage of positions advertised were hospital employed jobs compared with private practice and academic positions. CONCLUSIONS Job availability for fellowship graduates varies notably based on orthopaedic subspecialty. At this time, generalists and subspecialists trained in foot and ankle, adult reconstruction, and trauma seem to be in greatest demand. The reason for the differences in demand is likely multifactorial. Our findings should be considered by orthopaedic residents pursuing fellowship training in addition to weighing both personal interest and financial considerations in their subspecialty choice.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to describe education, training, certification of fellows in pediatric surgical critical care (PSCC). PSCC is a small but unique specialty within surgery. Education curricula focus on pediatric intensive care, neonatal intensive care, surgical intensive care, and pediatric surgical acute care. Attention is focused on the current state of SCC certification via the American Board of Surgery and future possibilities that could be implemented. RECENT FINDINGS Because of the uniqueness of the specialty, the little literature that exists focuses on fellow experience including carrier plans, curricula at different programs and how the training is used in practice. There has been debate over the need for the development of a unified process to train, test, and certify critical care physicians of all programs. This could lead to a common 'test' that serves as the basis for critical care medicine certification from the myriad of American Medical Specialty Boards. SUMMARY Training in PSCC offers surgeons a unique skill set to treat the most critically ill and injured children in our society. These surgeons can make large contributions to children's hospitals and to adult trauma centers that take care of injured children.
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16
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Prenatal stress increases IgA coating of offspring microbiota and exacerbates necrotizing enterocolitis-like injury in a sex-dependent manner. Brain Behav Immun 2020; 89:291-299. [PMID: 32688025 PMCID: PMC7919389 DOI: 10.1016/j.bbi.2020.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/13/2022] Open
Abstract
Necrotizing enterocolitis (NEC) is an intestinal inflammatory disease with high morbidity and mortality that affects almost exclusively premature infants. Breast milk feeding is known to substantially lower NEC incidence, and specific components of breast milk, such as immunoglobulin (Ig) A, have been identified as mediating this protective effect. On the other hand, accumulating evidence suggests dysbiosis of the neonatal intestinal microbiome contributes to NEC pathogenesis. In mice, neonates can inherit a dysbiotic microbiome from dams that experience stress during pregnancy. Here we show that while prenatal stress lowers fecal IgA levels in pregnant mice, it does not result in lower levels of IgA in the breast milk. Nevertheless, coating of female, but not male, offspring microbiota by IgA is increased by prenatal stress. Accordingly, prenatal stress was found to alter the bacterial community composition in female neonates but not male neonates. Furthermore, female, but not male, offspring of prenatally stressed mothers exhibited more severe colonic tissue damage in a NEC-like injury model compared to offspring with non-stressed mothers. Our results point to prenatal stress as a possible novel risk factor for NEC and potentially reveal new avenues in NEC prevention and therapy.
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Knotts CM, Prange EJ, Orminski K, Thompson S, Richmond BK. The Provision of Acute Pediatric Surgical Care by Adult Acute Care General Surgeons : Is There a Learning Curve? Am Surg 2020; 86:1640-1646. [PMID: 32683921 DOI: 10.1177/0003134820933251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND At our hospital, acute surgical care of children aged 6 and older is managed by adult acute care surgeons. Previously published data from a 10-year experience with this model demonstrated no differences in outcomes when compared with pediatric surgical benchmark data. This study assesses for the effects of a learning curve in the care of pediatric patients by comparing outcomes of patients treated in the first three years with those treated in the last 3 years during a 10-year experience with this model. DESIGN This was a retrospective study of pediatric patients aged 6 and older who underwent an emergent or urgent, nontrauma surgical procedure by a general surgeon. Data was obtained via chart review and descriptive statistics were compared between patients operated on between January 1, 2009-January 1, 2012 and January 1, 2016-January 1, 2019. RESULTS In all, 208 cases were performed in the early cohort and 192 cases in the late cohort. Appendectomy was the most common procedure in both intervals (88% early, 94.8% late). Although there was a significant decrease in open procedures in the later cohort (22.6% vs 4.7%, P < .001), there was no significant change in disease-specific complications or negative appendectomies. No consults to a fellowship-trained pediatric surgeon were required during either time period, although one was available if needed. CONCLUSIONS Our data demonstrated a decrease in the number of open procedures in the later cohort. This may be due to an increased comfort level with pediatric laparoscopy over time. However, no significant changes in outcomes were observed. This study supports that acute care general surgeons can provide comparable care to pediatric patients within this age demographic and that although a learning curve, appears to exist with respect to pediatric laparoscopy, it is insignificant in terms of its effect on overall outcomes.
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Affiliation(s)
- Chelsea M Knotts
- 12355Department of Surgery, West Virginia University/Charleston Division, Charleston, WV, USA
| | - Edward J Prange
- 12355West Virginia University School of Medicine/Charleston Division, Charleston, WV, USA
| | - Krysta Orminski
- 12355West Virginia University School of Medicine/Charleston Division, Charleston, WV, USA
| | - Stephanie Thompson
- 20205Charleston Area Medical Center Health Education and Research Institute, Charleston, WV, USA
| | - Bryan K Richmond
- 12355Department of Surgery, West Virginia University/Charleston Division, Charleston, WV, USA
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18
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Dow T, McGuire C, Crawley E, Davies D. Application rates to surgical residency programs in Canada. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e92-e100. [PMID: 32802231 PMCID: PMC7378160 DOI: 10.36834/cmej.58444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE The purpose of this study is to identify if the previously reported declining interest in surgery amongst medical students persists, and also to provide more descriptive analysis of trends by surgical specialty and medical school. Our hypothesis is that the previously reported decreasing interest in surgery remains constant for some surgical disciplines. METHODS The Canadian Resident Matching Service and the Association of Faculties of Medicine of Canada provided data for this study. Several metrics of interest in surgery, including overall application trends, applications by discipline, and rankings by school of graduation were evaluated. Descriptive statistics and linear regression modeling were used. RESULTS Between 2007 and 2017 the number of non-surgical residency positions and Canadian medical graduates increased significantly. However, the number of surgical residency positions and applications to surgical programs did not change significantly. The number of rankings to orthopedic and vascular surgery decreased significantly. Likewise, applicants to general, orthopedic, plastic, otolaryngology, and vascular surgery decreased significantly. Vascular surgery saw a significant decrease in first choice rankings. Total rankings to surgical programs increased significantly at McGill, with no significant change at other Canadian institutions. CONCLUSIONS The findings of this study suggest that while the number of applicants to surgical residency positions has been consistent, it is not keeping pace with the growing number of both CMGs and non-surgical residency positions. Furthermore, by using other measures of medical student interest in surgical specialties, such as the total number of rankings to a specialty through the residency matching process, the total number of applicants applying to a surgical discipline and the total number of first choice ranks that each surgical discipline received, we have demonstrated that there is a possible declining interest in some surgical discipline.
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Affiliation(s)
- Todd Dow
- Faculty of Medicine, Dalhousie University, Nova Scotia, Canada
| | - Connor McGuire
- Division of Plastic Surgery, Department of Surgery, Dalhousie University, Nova Scotia, Canada
| | - Emma Crawley
- Faculty of Medicine, Dalhousie University, Nova Scotia, Canada
| | - Dafydd Davies
- Faculty of Medicine, Dalhousie University, Nova Scotia, Canada
- Division of Paediatric General & Thoracic Surgery, Department of Surgery, Nova Scotia, Canada
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19
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Emil S, Langer JC, Blair G, Miller G, Aspirot A, Brisseau G, Hancock BJ. The Canadian pediatric surgery workforce: A 5-year prospective study. J Pediatr Surg 2019; 54:1009-1012. [PMID: 30795911 DOI: 10.1016/j.jpedsurg.2019.01.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/27/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND In 2014, a survey study of the Canadian pediatric surgery workforce predicted a need for 2 new pediatric surgeons/yr. in Canada. We sought to assess these predictions and evaluate the status of the workforce. METHODS With IRB approval, a web-based survey was sent to pediatric surgery division chiefs in Canada each year (2013-2017). The survey data included: number of practicing pediatric surgeons, full time equivalent (FTE) positions, and fellowship graduates. RESULTS There was a 100% response rate (18 divisions). From 2013 to 2017, the number of practicing pediatric surgeons and FTE positions increased (73 to 78, and 64.6 to 67.5, respectively). Eleven positions were vacated (4 retirement, 7 new practice), and 18 were filled. Eight were filled by new Canadian graduates, 7 by Canadians previously working in Canada or abroad, and 3 by European surgeons. Thirty-eight fellows completed training in Canada, including 24 non-Canadians who all left Canada. Nine Canadians who started practicing immediately after fellowship took positions in Canada (5) and the US (4). CONCLUSIONS Predictions made in 2014 were largely accurate. There has been modest growth in the Canadian pediatric surgery workforce over the last 5 years. A significant mismatch continues to exist between Canadian pediatric surgery graduates and attending staff positions. TYPE OF STUDY Survey. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Sherif Emil
- Department of Pediatric Surgery, McGill University Faculty of Medicine &The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Jacob C Langer
- Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Blair
- Division of Pediatric Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Grant Miller
- Division of Pediatric Surgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ann Aspirot
- Division of Pediatric Surgery, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Guy Brisseau
- Division of Pediatric Surgery, Sidra Medicine, Doha, Qatar
| | - B J Hancock
- Division of Pediatric Surgery, Children's Hospital of Winnipeg, University of Manitoba, Winnipeg, Manitoba, Canada
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Nadel JL, Scott RM, Durham SR, Maher CO. Recent trends in North American pediatric neurosurgical fellowship training. J Neurosurg Pediatr 2019; 23:517-522. [PMID: 30611157 DOI: 10.3171/2018.10.peds18106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/29/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to evaluate trends in pediatric neurosurgical fellowship training in North America. METHODS From a database maintained by the Accreditation Council for Pediatric Neurosurgery Fellowships (ACPNF), all graduates of ACPNF-accredited pediatric neurosurgery fellowships were identified, and an Internet search was conducted to determine sex, undergraduate and graduate degrees, location and dates of residency and fellowship training, current practice/employment environment, American Board of Neurological Surgery (ABNS) or Fellowship of the Royal College of Surgeons certification status, American Board of Pediatric Neurological Surgery (ABPNS) certification status, and extent of current pediatric-focused practice. The graduates were further studied to determine whether they had completed a neurosurgical residency at a program with an affiliated ACPNF-accredited pediatric neurosurgery fellowship program, and their residency training programs were further classified by whether the program was ranked in the top 50 by NIH funding awards. Each fellowship graduate's current practice was also ranked in a similar fashion. RESULTS There were 391 graduates of ACPNF-accredited pediatric neurosurgery fellowship programs from 1993 to 2018. The number of graduates per year has grown steadily over time, as has the percentage of women, now over 40% compared to zero in the first 3 years of fellowship accreditation in the mid-1990s. Approximately 71% of graduating fellows have a pediatric-focused practice, but only 63% went on to attain ABPNS certification. Of all graduates practicing in the United States, 68% practice in academic settings. Ninety-five percent of graduating fellows who were ABNS board eligible were ABNS certified. CONCLUSIONS A study of the graduates of accredited pediatric neurosurgical fellowships from 1993 to 2018 has revealed a growth in the number of graduates from ACPNF-accredited fellowship programs over time. A substantial portion of graduates will practice at least some adult neurosurgery and not go on to obtain ABPNS board certification.
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Affiliation(s)
- Jeffrey L Nadel
- 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - R Michael Scott
- 2Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Susan R Durham
- 3Department of Neurosurgery, University of Vermont, Burlington, Vermont
| | - Cormac O Maher
- 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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Reich DA, Herbst KW, Campbell BT. The recent evolution of the breadth of practice for pediatric surgeons in the United States, 2005-2014. Pediatr Surg Int 2019; 35:517-522. [PMID: 30607543 DOI: 10.1007/s00383-018-04433-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Our objective was to determine if there was an association between subspecialist supply and a specific sub-set of procedures performed by pediatric surgeons over a 10-year period. METHODS Data source was the Pediatric Health Information Systems database. Included were patients < 12 years who underwent one of nine outpatient surgical procedures between 1/1/2005 and 12/31/2014. Procedures were grouped into categories: pediatric surgery cases (PS), overlapping otolaryngology cases (OO), and overlapping urology cases (OU). Outcomes were number of cases performed by pediatric surgeons per pediatric surgeon, and proportion of cases performed by pediatric surgeons. Linear regression was used to test for association and temporal trends. RESULTS Included were 193,695 procedures, 18.9% PS, 4.8% OO, and 76.3% OU. There was a strong association between specialty supply and number of cases performed by pediatric surgeons. Temporally, there was no change in proportion of pediatric surgeons who performed PS cases (R2 = 0.08, p = 0.08), but a downward trend in proportion of OO (R2 = 0.82, p < 0.001) and OU cases. (R2 = 0.79; p < 0.001.) CONCLUSION: We found an association between physician supply and pediatric surgeon case type, and a reduction in OO and OU cases performed by pediatric surgeons. These findings suggest a narrowing of case-mix for pediatric surgeons.
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Affiliation(s)
- Daniel A Reich
- Department of Pediatric Surgery, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA
| | - Katherine W Herbst
- Department of Pediatric Surgery/Department of Research, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA.
| | - Brendan T Campbell
- Department of Pediatric Surgery, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA
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Dell A, Numanoglu A, Arnold M, Rode H. Pediatric surgeon density in South Africa. J Pediatr Surg 2018; 53:2065-2071. [PMID: 29366506 DOI: 10.1016/j.jpedsurg.2017.11.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/07/2017] [Accepted: 11/26/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND There are limited data regarding the available pediatric surgical workforce in South Africa and their employment prospects on completion of their specialist training. METHODS This aim of this study was to quantify and analyze the pediatric surgical workforce in South Africa as well as to determine their geographic and sector distribution. This involved a quantitative descriptive analysis of all registered specialist as well as training pediatric surgeons in South Africa. RESULTS The results showed 2.6 pediatric surgeons per one million population under 14 years. More than half (69%) were male and the median age was 46.8 years. There were however, more female surgical registrars currently in training. The majority of the pediatric surgical practitioners were found in Gauteng, followed by the Western Cape and Kwa-Zulu Natal. The majority of specialists reportedly worked in the public sector, however the number of public sector pediatric surgeons available to those without health insurance fell below those available to private patients. CONCLUSION Interprovincial differences as well as intersectoral differences were marked indicating geographic and socioeconomic maldistribution of pediatric surgeons. Addressing this maldistribution requires concerted efforts to expand public sector specialist posts. STUDY TYPE Descriptive audit LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Angela Dell
- Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town, South Africa.
| | - Alp Numanoglu
- Department of Paediatric Surgery, University of Cape Town Health Sciences Faculty, Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa
| | - Marion Arnold
- Department of Paediatric Surgery, University of Cape Town Health Sciences Faculty, Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa
| | - Heinz Rode
- Department of Paediatric Surgery, University of Cape Town Health Sciences Faculty, Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa
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Farmer DL. Audacious Goals - 2.0 The Global Initiative for Children's Surgery. J Pediatr Surg 2017; 53:S0022-3468(17)30629-2. [PMID: 29173774 DOI: 10.1016/j.jpedsurg.2017.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 10/05/2017] [Indexed: 12/17/2022]
Abstract
This is the Presidential Address given at the 48th Annual Meeting of the American Pediatric Surgical Association (APSA) held in Hollywood, Florida, from May 4-7, 2017.
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Affiliation(s)
- Diana Lee Farmer
- Department of Surgery, University of California, Davis School of Medicine, UC Davis Children's Hospital.
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Abstract
High salaries indicate a demand for pediatric surgeons in excess of the supply, despite only a slight growth in the pediatric-age population and a sharp increase in numbers of trainees. Top-level neonatal intensive care units require 24-hour-7-day pediatric surgical availability, so hospitals are willing to pay surgeons a premium and engage high-priced locum tenens surgeons to fill vacancies in coverage. With increased supply comes an erosion of the numbers of cases performed by trainees and surgeons in practice. Caseloads may be inadequate to gain expertise and maintain skills. A quality initiative sponsored by the American College of Surgeons and the American Pediatric Surgical Association will discourage underresourced community facilities and surgeons without specialty training from performing operations on children, mostly common conditions such as appendicitis. This will further increase demand for specialty-trained practitioners. Receiving less attention are considerations of value, the ratio of quality per dollar cost. Cost concerns, paramount among buyers of health care (businesses, insurance companies, and governmental health agencies), will prefer community hospitals that have lower cost structures than specialty children's facilities. Less recognized are the costs to families, who for a myriad of reasons would prefer closer alternatives. Cost considerations support providing pediatric surgical services in local facilities. Quality considerations may be addressed by a tiered system where top centers would care for conditions that require technical expertise and advanced modalities. Evidence indicates that pediatric surgeons already direct such cases to more specialized centers.
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Affiliation(s)
- Don K. Nakayama
- Department of Surgery, Florida International University, Sacred Heart Medical Group, Pensacola, Florida
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25
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Pediatric surgical capacity in Africa: Current status and future needs. J Pediatr Surg 2017; 52:843-848. [PMID: 28168989 DOI: 10.1016/j.jpedsurg.2017.01.033] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 01/23/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND African pediatric surgery (PS) faces multiple challenges. Information regarding existing resources is limited. We surveyed African pediatric surgeons to determine available resources and clinical, educational, and collaborative needs. METHODS Members of the Pan-African Pediatric Surgical Association (PAPSA) and the Global Pediatric Surgery Network (GPSN) completed a structured email survey covering PS providers, facilities, resources, workload, education/training, disease patterns, and collaboration priorities. RESULTS Of 288 deployed surveys, 96 were completed (33%) from 26 countries (45% of African countries). Median PS providers/million included 1 general surgeon and 0.26 pediatric surgeons. Median pediatric facilities/million included 0.03 hospitals, 0.06 ICUs, and 0.17 surgical wards. Neonatal ventilation was available in 90% of countries, fluoroscopy in 70%, TPN in 50%, and frozen section pathology in 35%. Median surgical procedures/institution/year was 852. Median waiting time was 40days for elective procedures and 7 days? for emergencies. Weighted average percent mortality for key surgical conditions varied between 1% (Sierra Leone) and 54% (Burkina Faso). Providers ranked collaborative professional development highest and direct clinical care lowest priority in projects with high-income partners. CONCLUSIONS The broad deficits identified in PS human and material resources in Africa suggest the need for a global collaborative effort to address the PS gaps. LEVEL OF EVIDENCE Level 5, expert opinion without explicit critical appraisal.
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Butler EK, Tran TM, Nagarajan N, Canner J, Fuller AT, Kushner A, Haglund MM, Smith ER. Epidemiology of pediatric surgical needs in low-income countries. PLoS One 2017; 12:e0170968. [PMID: 28257418 PMCID: PMC5336197 DOI: 10.1371/journal.pone.0170968] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/13/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE According to recent estimates, at least 11% of the total global burden of disease is attributable to surgically-treatable diseases. In children, the burden is even more striking with up to 85% of children in low-income and middle-income countries (LMIC) having a surgically-treatable condition by age 15. Using population data from four countries, we estimated pediatric surgical needs amongst children residing in LMICs. METHODS A cluster randomized cross-sectional countrywide household survey (Surgeons OverSeas Assessment of Surgical Need) was done in four countries (Rwanda, Sierra Leone, Nepal and Uganda) and included demographics, a verbal head to toe examination, and questions on access to care. Global estimates regarding surgical need among children were derived from combined data, accounting for country-level clustering. RESULTS A total of 13,806 participants were surveyed and 6,361 (46.1%) were children (0-18 years of age) with median age of 8 (Interquartile range [IQR]: 4-13) years. Overall, 19% (1,181/6,361) of children had a surgical need and 62% (738/1,181) of these children had at least one unmet need. Based on these estimates, the number of children living with a surgical need in these four LMICs is estimated at 3.7 million (95% CI: 3.4, 4.0 million). The highest percentage of unmet surgical conditions included head, face, and neck conditions, followed by conditions in the extremities. Over a third of the untreated conditions were masses while the overwhelming majority of treated conditions in all countries were wounds or burns. CONCLUSION Surgery has been elevated as an "indivisible, indispensable part of health care" in LMICs and the newly formed 2015 Sustainable Development Goals are noted as unachievable without the provision of surgical care. Given the large burden of pediatric surgical conditions in LMICs, scale-up of services for children is an essential component to improve pediatric health in LMICs.
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Affiliation(s)
- Elissa K Butler
- Department of Surgery, University of Washington, Seattle, WA, United States of America
| | - Tu M Tran
- Duke University Global Health Institute, Durham, NC, United States of America
| | - Neeraja Nagarajan
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Joseph Canner
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Anthony T Fuller
- Duke University Division of Global Neurosurgery and Neuroscience, Durham, NC, United States of America.,Duke University School of Medicine, Durham, NC, United States of America
| | - Adam Kushner
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Michael M Haglund
- Duke University Global Health Institute, Durham, NC, United States of America.,Duke University Division of Global Neurosurgery and Neuroscience, Durham, NC, United States of America.,Duke University School of Medicine, Durham, NC, United States of America.,Department of Neurosurgery, Duke University Medical Center, Durham, NC, United States of America
| | - Emily R Smith
- Duke University Global Health Institute, Durham, NC, United States of America.,Duke University Division of Global Neurosurgery and Neuroscience, Durham, NC, United States of America
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Krishnamurthy VD, Gutnick J, Slotcavage R, Jin J, Berber E, Siperstein A, Shin JJ. Endocrine surgery fellowship graduates past, present, and future: 8 years of early job market experiences and what program directors and trainees can expect. Surgery 2017; 161:289-296. [DOI: 10.1016/j.surg.2016.06.069] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/05/2016] [Accepted: 06/27/2016] [Indexed: 12/21/2022]
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Abstract
Inspiration and innovation go hand in hand. Throughout history tragedies, including those personal and life altering, have inspired susceptible minds to find innovative ways to educate and tackle difficult problems. This address is first about origins. It weaves the story of how incredible individuals and events have shaped similar circumstances into not only our profession of pediatric surgery beginning with William E. Ladd, but also the emergency and trauma care system in this country. The address circles back to look at the past and future of our profession of pediatric surgery. Predictive models forecast that we are training too many pediatric surgeons in the traditional sense. The address describes how we might envision a paradigm shift in training using a different model and capitalizing on the talents of more young surgeons who want to take care of children. We are an incredible profession, but many have abdicated a need to include trauma patients and critical care in their practice of pediatric surgery. The model would include different pathways of training, enable more surgeons to be capable in aspects of children's surgical care, and provide optimal general surgical care for more children in the United States. This is an opportunity to redefine Ladd's path.
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Pandian TK, Ubl DS, Habermann EB, Moir CR, Ishitani MB. Obesity Increases Operative Time in Children Undergoing Laparoscopic Cholecystectomy. J Laparoendosc Adv Surg Tech A 2016; 27:322-327. [PMID: 27875102 DOI: 10.1089/lap.2016.0167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Few studies have assessed the impact of obesity on laparoscopic cholecystectomy (LC) in pediatric patients. MATERIALS AND METHODS Children who underwent LC were identified from the 2012 to 2013 American College of Surgeons' National Surgical Quality Improvement Program Pediatrics data. Patient characteristics, operative details, and outcomes were compared. Multivariable logistic regression was utilized to identify predictors of increased operative time (OT) and duration of anesthesia (DOAn). RESULTS In total, 1757 patients were identified. Due to low rates of obesity in children <9 years old, analyses were limited to those 9-17 (n = 1611, 43% obese). Among obese children, 80.6% were girls. A higher proportion of obese patients had diabetes (3.0% versus 1.0%, P < .01) and contaminated or dirty/infected wounds (15.1% versus 9.4%, P < .01). Complication rates were low. The most frequent indications for surgery were cholelithiasis/biliary colic (34.3%), chronic cholecystitis (26.9%), and biliary dyskinesia (18.2%). On multivariable analysis, obesity was an independent predictor of OT >90 (odds ratio [OR] 2.02; 95% confidence interval [95% CI] 1.55-2.63), and DOAn >140 minutes (OR 1.86; 95% CI 1.42-2.43). CONCLUSIONS Obesity is an independent risk factor for increased OT in children undergoing LC. Pediatric surgeons and anesthesiologists should be prepared for the technical and physiological challenges that obesity may pose in this patient population.
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Affiliation(s)
- T K Pandian
- 1 Division of Subspecialty General Surgery, Department of Surgery, Mayo Clinic , Rochester, Minnesota
| | - Daniel S Ubl
- 2 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic , Rochester, Minnesota
| | - Elizabeth B Habermann
- 2 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic , Rochester, Minnesota
| | - Christopher R Moir
- 3 Division of Pediatric Surgery, Department of Surgery, Mayo Clinic , Rochester, Minnesota
| | - Michael B Ishitani
- 3 Division of Pediatric Surgery, Department of Surgery, Mayo Clinic , Rochester, Minnesota
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Hoyer DP, Kaiser GM, Cicinnati V, Radunz S, Braun F, Greif-Higer G, Schulze M, Schmidt HJ, Paul A, Beckebaum S. Training, work, and lifestyle of transplant physicians and surgeons in Germany. Clin Transplant 2016; 30:1046-52. [PMID: 27291870 DOI: 10.1111/ctr.12786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND International data on training, work, and lifestyle of transplant physicians and surgeons are scarce. Such data might help in development of uniform education paths and provide insights for young clinicians interested in this field. This study aimed at the evaluation of these data in all transplant-associated medical disciplines. METHODS A survey on professional and academic training, workload, and lifestyle was generated. The questionnaire was distributed to all members of the German Transplant Association (DTG), utilizing the tool SurveyMonkey(®) . RESULTS A total of 127 members of the DTG responded (male/female 66.1%/33.9%, 45.8±10.3 years). The majority had been working in transplant medicine for more than 10 years (61.9%). Fifteen respondents (11.8%) obtained an official European certification (European Union of Medical Specialists). A total of 57 (48.3%) respondents worked full time on research during training. The research focus was clinical for most respondents (n=72, 61.5%). An average working time of 62±1.5 h/wk was reported. Fifty-eight percent of all respondents complained of inadequate remuneration and 50% reported inadequate acknowledgment of their professional performance. CONCLUSION This is the first study reporting characteristics of training, work, and lifestyle in an interdisciplinary cohort of German transplant physicians and surgeons. Enormous efforts in clinical and research work were reported, associated with high rates of professional and financial dissatisfaction.
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Affiliation(s)
- Dieter P Hoyer
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.
| | - Gernot M Kaiser
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Vito Cicinnati
- Department of Transplantation Medicine, University Hospital Münster, Münster, Germany.,Department of Internal Medicine, Gastroenterology and Hepatology, St. Josef-Krankenhaus, Essen, Germany
| | - Sonia Radunz
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Felix Braun
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Gertrud Greif-Higer
- Department of Psychosomatics and Psychotherapy, University Hospital Mainz, Mainz, Germany
| | - Maren Schulze
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Hartmut J Schmidt
- Department of Transplantation Medicine, University Hospital Münster, Münster, Germany
| | - Andreas Paul
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Susanne Beckebaum
- Department of Transplantation Medicine, University Hospital Münster, Münster, Germany.,Department of Internal Medicine, Gastroenterology and Hepatology, St. Josef-Krankenhaus, Essen, Germany
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Talutis S, McAneny D, Chen C, Doherty G, Sachs T. Trends in Pediatric Surgery Operative Volume among Residents and Fellows: Improving the Experience for All. J Am Coll Surg 2016; 222:1082-8. [DOI: 10.1016/j.jamcollsurg.2015.11.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 11/19/2015] [Accepted: 11/19/2015] [Indexed: 11/16/2022]
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Stiles PJ, Helmer SD, Ward JG, Reyes J, Harrison PB, Haan JM. Pediatric trauma system models: do systems using adult trauma surgeons exclusively compare favorably with those using pediatric surgeons after initial resuscitation with an adult trauma surgeon? Am J Surg 2015; 210:1063-8; discussion 1068-9. [PMID: 26482516 DOI: 10.1016/j.amjsurg.2015.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 08/20/2015] [Accepted: 08/24/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND A shortage of pediatric surgeons exists. The purpose of this study was to evaluate pediatric outcomes using pediatric surgeons vs adult trauma surgeons. METHODS A review was conducted at 2 level II pediatric trauma centers. Center I provides 24-hour in-house trauma surgeons for resuscitations, with patient hand-off to a pediatric surgery service. Center II provides 24-hour in-house senior surgical resident coverage with an on-call trauma surgeon. Data on demographics, resource utilization, and outcomes were collected. RESULTS Center I patients were more severely injured (injury severity score = 8.3 vs 6.2; Glasgow coma scale score = 13.7 vs 14.3). Center I patients were more often admitted to the intensive care unit (52.2% vs 33.5%) and more often mechanically ventilated (12.9% vs 7.7%), with longer hospital length of stay (2.8 vs 2.3 days). However, mortality was not different between Center I and II (3.1% vs 2.4%). By logistic regression analyses, the only variables predictive of mortality were injury severity score and Glasgow coma scale score. CONCLUSION As it appears that trauma surgeons' outcomes compare favorably with those of pediatric surgeons, utilizing adult trauma surgeons may help alleviate shortages in pediatric surgeon coverage.
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Affiliation(s)
- P J Stiles
- Department of Surgery, The University of Kansas School of Medicine - Wichita, 929 N. Saint Francis St., Room 3082, Wichita, KS 67214, USA
| | - Stephen D Helmer
- Department of Surgery, The University of Kansas School of Medicine - Wichita, 929 N. Saint Francis St., Room 3082, Wichita, KS 67214, USA; Department of Medical Education, Via Christi Hospital Saint Francis, 929 N. Saint Francis St., Room 3082, Wichita, KS, USA
| | - Jeanette G Ward
- Department of Trauma Services, Via Christi Hospital Saint Francis, 929 N. Saint Francis St., Room 2514, Wichita, KS 67214, USA
| | - Jared Reyes
- Department of Surgery, The University of Kansas School of Medicine - Wichita, 929 N. Saint Francis St., Room 3082, Wichita, KS 67214, USA
| | - Paul B Harrison
- Department of Trauma Services, Wesley Medical Center, 550 N. Hillside, Wichita, KS 67214, USA
| | - James M Haan
- Department of Surgery, The University of Kansas School of Medicine - Wichita, 929 N. Saint Francis St., Room 3082, Wichita, KS 67214, USA; Department of Trauma Services, Via Christi Hospital Saint Francis, 929 N. Saint Francis St., Room 2514, Wichita, KS 67214, USA.
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Judhan RJ, Silhy R, Statler K, Khan M, Dyer B, Thompson S, Richmond B. The Integration of Adult Acute Care Surgeons into Pediatric Surgical Care Models Supplements the Workforce without Compromising Quality of Care. Am Surg 2015. [DOI: 10.1177/000313481508100916] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute care of children remains a challenge due to a shortage of pediatric surgeons, particularly in rural areas. In our institutional norm, all cases in patients age six and older are managed by dedicated general surgeons. The provision of care to these children by these surgeons alleviates the impact of such shortages. We conducted a five-year retrospective analysis of all acute care pediatric surgical cases performed in patients aged 6 to 17 years by a dedicated group of adult general surgeons in a rural tertiary care hospital. Demographics, procedure, complications, outcomes, length of stay, and time of consultation/operation were obtained via chart review. Elective, trauma related, or procedures performed by a pediatric surgeon were excluded. Descriptive statistics are reported. A total of 397 cases were performed by six dedicated general surgeons during the study period. Mean age was 11.5 ± 3.1 years. In all, 100 (25.2%) were transferred from outlying facilities and 52.6 per cent of consultations/operations occurred at night (7P–7A), of which 33.2 per cent occurred during late night hours (11P–7A). On weekends, 34.0 per cent occurred. Appendectomy was the most commonly performed operation (n = 357,89.9%), of which 311 were laparoscopic (87.1%). Others included incision/drainage (4.5%), laparoscopic cholecystectomy (2.0%), bowel resection (1.5%), incarcerated hernia (0.5%), small bowel obstruction (0.5%), intraabdominal abscess drainage (0.3%), resection of intussusception (0.3%), Graham patch (0.3%), and resection omental torsion (0.3%). Median length of stay was two days. Complications occurred in 23 patients (5.8%), of which 22(5.5%) were the result of the disease process. These results parallel those published by pediatric surgeons in this age group and for the diagnoses treated. Models integrating dedicated general surgeons into pediatric call rotations can be designed such that quality of pediatric care is maintained while providing relief to an overburdened pediatric surgical workforce.
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Affiliation(s)
- Rudy J. Judhan
- Department of Surgery, West Virginia University/Charleston Division, Charleston, West Virginia
| | - Raquel Silhy
- Department of Surgery, West Virginia University/Charleston Division, Charleston, West Virginia
| | - Kristen Statler
- Department of Surgery, West Virginia University/Charleston Division, Charleston, West Virginia
| | - Mija Khan
- West Virginia University School of Medicine, Charleston, West Virginia; and
| | - Benjamin Dyer
- Department of Surgery, West Virginia University/Charleston Division, Charleston, West Virginia
| | - Stephanie Thompson
- Charleston Area Medical Center Health Education and Research Institute, Charleston, West Virginia
| | - Bryan Richmond
- Department of Surgery, West Virginia University/Charleston Division, Charleston, West Virginia
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Global comparison of pediatric surgery workforce and training. J Pediatr Surg 2015; 50:1180-3. [PMID: 25783299 DOI: 10.1016/j.jpedsurg.2014.11.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 11/03/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The number of pediatric surgeons and their distribution vary greatly throughout the world. The purpose of this study is to examine potential influential factors including the length of education and training, pediatric population, birth rate, and gross domestic product (GDP) per capita. METHODS An internet search was conducted to determine the duration of education from grade school to pediatric surgery fellowship, number of pediatric surgeons, birth rate, GDP, and population under 15 years of age in 15 countries. The number of pediatric surgeons per million children was correlated with these factors. RESULTS The number of pediatric surgeons per million children varied from 0.51 to 29.3. The total length of education from grade school to completion of pediatric surgery training ranged from 23 to 29 years. There was no correlation between pediatric surgeons per million children with the duration of training. The number of pediatric surgeon per million children was inversely correlated with the birth rate. There was a positive correlation between the GDP per capita and pediatric surgeons per million children. CONCLUSION There is a tremendous variability in pediatric surgeons around the world. There appears to be a significant shortage of pediatric surgeons in countries with a high birth rate and low GDP per capita.
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Muensterer OJ, Bronstein ME, Mackenzie R, Snyder CW, Carachi R. Factors associated with passing the European Board of Paediatric Surgery Exam. Pediatr Surg Int 2015; 31:671-6. [PMID: 25971523 DOI: 10.1007/s00383-015-3719-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE The European Board of Paediatric Surgery (EBPS) includes a written Part 1 and an oral/practical Part 2 component. The goal of this study was to describe the EBPS examination candidate pool, and to determine factors associated with successfully passing the examination. METHODS A database including all registered candidates for the EBPS exams since 2005 was constructed. Queried information included demographics, training location, language proficiency, and written/oral scores. Logistic regression analysis was performed to elucidate variables predictive of examination success. RESULTS Until 2013, a total of 370 candidates registered for the part 1 examination and 147 successfully passed part 2. Pass rates for part 1 were 68, 65, 20, and 0 % on first, second, third, and forth attempts, respectively. Pass rates for part 2 were 79 % for both first and second attempts. Training in a single country was associated with passing Part 1 (p = 0.048), while having completed at least some training in an English-speaking country increased the chance of passing Part 2 (p < 0.01). CONCLUSION The pool of EBPS examination candidates is highly diverse and international. First- and second-attempt pass rates are similar for both parts. Candidates who completed all their training in non-English-speaking countries may wish to consider additional English language practice to increase their chances of success.
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Nolan TL, Kandel JJ, Nakayama DK. Quality and Extent of Locum Tenens Coverage in Pediatric Surgical Practices. Am Surg 2015. [DOI: 10.1177/000313481508100428] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The prevalence and quality of locum tenens coverage in pediatric surgery have not been determined. An Internet-based survey of American Pediatric Surgical Association members was conducted: 1) practice description; 2) use and frequency of locum tenens coverage; 4) whether the surgeon provided such coverage; and 5) Likert scale responses (strongly disagree, disagree, neutral, agree, strongly agree) to statements addressing its acceptability and quality (two x five contingency table and χ2 analyses, significance at P < 0.05). Three hundred sixteen of 1163 members (27.2% response rate) responded. One-fourth (24.1%) used a locum tenens regularly. Reasons were long-term inability to recruit a full-time surgeon (35.2%) and short-term vacancies (32.4%). One-fifth (20.4%) did locum tenens work; one-fourth (27.0%) plan to do so in the future. Two-thirds (64.2%) believe that surgical care in a locum tenens situation does not provide the same level of care as a full-time community-based surgeon. Most support locum tenens for short-term coverage (87.3%) and recruitment problems (72.1%), but not long-term vacancies (38.8%; P < 0.001) or permanent coverage (27.0%; P < 0.001). Locum tenens coverage is an established feature of pediatric surgery. Most view it as a stopgap solution to the surgical workforce shortage.
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Affiliation(s)
- Tracy L. Nolan
- Mercer University School of Medicine, Macon, Georgia; the
| | - Jessica J. Kandel
- University of Chicago School of Medicine, Chicago, Illinois; and the
| | - Don K. Nakayama
- West Virginia University School of Medicine, Morgantown, West Virginia
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Abstract
Employment, either by an academic entity or a hospital, is increasingly becoming a feature of surgical practice. Independent practices receive indirect subsidies to support their revenue. A survey of the extent of employment and the forms of indirect subsidies by which hospitals support independent practices, not previously done, would be of interest to all clinicians. A 2012 Internet survey of pediatric surgeons, asking practice description, hospital support, governance and management, conditions of compensation, selected contractual obligations, and arrangements for part-time coverage was conducted. Response rate was 21.8 per cent (253 of 1,163). Employed surgeons comprised 80 per cent: 60 per cent academic (152 of 253) and 20 per cent nonacademic (51). Only eight per cent (19) were in private practice. Half (47% [106 of 226]) had administrative tasks. One-fifth (20% [45 of 223]) was in a system without physician input in governance. The rest were in practices with physicians involved in management: on boards of directors (35% [78]), in management positions (31% [69]), and entirely physician-run (14% [31]). Most salaries were independent of external benchmarks. Productivity measures, when applied to compensation (54% [117 of 218]), used relative value units (71% [83 of 117]) more often than revenue production (29% [34]). Patient contact minimums (4% [nine of 217]) and penalties were less common (20% [43 of 218]) than bonus provisions (53% [116 of 218]). Most surgeons in private practice (75% [14 of 19]) received nonsalary hospital support. Pediatric surgery reflects the current trend of physician employment and hospital subsidies. Surgeon participation in governance and strategic system decisions will be necessary as healthcare systems evolve.
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Affiliation(s)
- Wolfgang Stehr
- Children's Hospital and Research Center at Oakland, Oakland, California
| | - Don K. Nakayama
- Department of Surgery, West Virginia University School of Medicine, Morgantown, West Virginia
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Pediatric surgeons' attitudes toward regionalization of neonatal surgical care. J Pediatr Surg 2014; 49:1475-9. [PMID: 25280649 DOI: 10.1016/j.jpedsurg.2014.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/25/2014] [Accepted: 03/04/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND/PURPOSE Research has suggested that high-risk pediatric surgical patients have better outcomes when treated in resource-rich children's environments. Surgical neonates are a particularly high-risk population and some suggest that regionalization might be a strategy to improve clinical outcomes in neonatal surgical patients. We conducted a national survey of pediatric surgeons in the United States to explore their attitudes toward regionalization of neonatal surgical care. METHODS Members of the American Pediatric Surgical Association were asked to participate in an anonymous online survey to assess both attitudes toward regionalization, as well as perceptions of the importance of various resources in providing optimal care for surgical neonates. RESULTS Overall, 56.2% of participants favored regionalization. Surgeons whose practice was part of a training program tended to favor regionalization more, as did those from larger group practices and those who practiced at free-standing children's hospital. In addition, surgeons from larger groups and those involved with training programs more strongly favored the premise that a higher level of resource commitment should be available to treat surgical neonates. CONCLUSIONS The impact of any national strategy to improve neonatal surgical outcomes will be large and multi-faceted. While the majority of pediatric surgeons favor regionalization, our findings demonstrate variation in this view and highlight the necessity for surgeon involvement and education that will be critical in this effort.
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Emil S, Blair G, Langer JC, Miller G, Aspirot A, Brisseau G, Hancock BJ. A survey-based assessment of the Canadian pediatric surgery workforce. J Pediatr Surg 2014; 49:678-81. [PMID: 24851747 DOI: 10.1016/j.jpedsurg.2014.02.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/13/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND There is significant lack of information regarding the Canadian pediatric surgery workforce. METHODS An IRB-approved survey aimed at assessing workforce issues was administered to pediatric surgeons and pediatric surgery chiefs in Canada in 2012. RESULTS The survey was completed by 98% of practicing surgeons and 13 of the 18 division chiefs. Only 6% of surgeons are older than 60 years, and only a fifth anticipate retirement over the next decade. The workforce is stable, with 82% of surgeons unlikely to change current positions. Surgical volume showed essentially no growth during the 5-year period 2006-2010. The majority of surgeons felt they were performing the right number or too few cases and anticipated minimal or no future growth in their individual practices or that of their group. Based on anticipated vacancies, the best estimate is a need for 20 new pediatric surgeons over the next decade. This need is significantly surpassed by the current output from the Canadian training programs. CONCLUSIONS The Canadian pediatric surgery workforce is currently saturated. The mismatch between the number of graduating trainees and the available positions over the next decade has significant repercussions for current surgery and pediatric surgery residents wishing to practice in Canada.
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Affiliation(s)
- Sherif Emil
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
| | - Geoffrey Blair
- Division of Pediatric Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jacob C Langer
- Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Grant Miller
- Division of Pediatric Surgery, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Ann Aspirot
- Division of Pediatric Surgery, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Guy Brisseau
- Division of Pediatric Surgery, IWK Health Center, Dalhousie University, Halifax, NS, Canada
| | - B J Hancock
- Division of Pediatric Surgery, Children's Hospital of Winnipeg, University of Manitoba, Winnipeg, MB, Canada
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Sømme S, Bronsert M, Morrato E, Ziegler M. Frequency and variety of inpatient pediatric surgical procedures in the United States. Pediatrics 2013; 132:e1466-72. [PMID: 24276846 DOI: 10.1542/peds.2013-1243] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Pediatric surgical procedures are being performed in a variety of hospitals with large differences in surgical volume. We examined the frequency and variety of inpatient pediatric surgical procedures in the United States by hospital type and geographic region using a nationally representative sample. METHODS The 2009 Kids' Inpatient Database for patients <18 years old was used to calculate surgical frequencies by using International Classification of Diseases, Ninth Revision, Clinical Modification, (ICD-9-CM) codes. We performed stratified analysis by hospital type (free-standing children's hospital, children's unit within an adult hospital, and general hospital) and geographic region (South, West, Midwest, Northeast) to compare frequencies of surgical procedures. RESULTS A total of 216 081 procedures were projected for 2009 with the top 20 procedures accounting for >90% of cases. As many as 40% of all pediatric inpatient surgical procedures are being performed in adult general hospitals. Infrequent complex low-volume neonatal surgical procedures (pullthrough for Hirschsprung disease, surgery for malrotation, esophageal atresia repair, and diaphragmatic hernia repair) were 6.8 to 16 times more likely to occur in a children's hospital. Significant regional variation in procedure frequency rates occurred for appendectomy and cholecystectomy. CONCLUSIONS This report is the first to characterize pediatric surgical inpatient volume in the United States. Such data may influence the distribution of pediatric surgeons, number of trainees, and training curricula for pediatric surgeons, pediatricians, general surgeons and other surgical specialists who might operate on children. In addition, it raises the question of whether complex pediatric surgical procedures should preferably be performed at dedicated high volume children's hospitals.
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Affiliation(s)
- Stig Sømme
- Children's Hospital Colorado, B323, 13123 E 16th Ave, Aurora, CO 80045.
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Nusrat S, Bielefeldt K. Fundoplication for gastroesophageal reflux disease: regional variability and factors predicting operative approach. Dis Esophagus 2013; 27:719-25. [PMID: 24118395 DOI: 10.1111/dote.12150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We have recently shown that the majority of patients undergoing fundoplication in the United States are women. Based on these findings, we hypothesized that nonbiological factors contribute to the decisions on surgical reflux therapy. Using State Inpatient Databases of the Agency for Healthcare Research and Quality, we extracted annual fundoplication rates, sex distribution, age cohorts, racial background, and insurance coverage. To account for potential differences in state populations, the results were normalized and correlated with Census data, adult obesity rates, median income, poverty rates, and physician workforce within the state. Fundoplication rates varied fivefold between states, ranging from 4.1±0.1 per 100,000 in New Jersey to 21.8±0.4 per 100,000 in Oregon. Higher poverty rates and a higher fraction of Caucasians within a state independently predicted higher fundoplication rates. While the majority of operations were performed laparoscopically, surgical approaches also differed between states with rates of laparoscopic ranging from 52.3±1.8% in Oklahoma to 87.4±1.7% in Hawaii. A lower number of pediatric and Medicaid-insured patient and a higher fraction of privately insured patients best predicted higher rates of laparoscopic surgery. Our study shows significant regional variation in surgical reflux management, which cannot be explained by differences in disease mechanisms. Insurance coverage and racial background influenced the likelihood of surgery, suggesting a role of financial incentives.
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Affiliation(s)
- Salman Nusrat
- Division of Digestive Diseases, Department of Medicine, University of Oklahoma Health Science Center, Pittsburgh, Pennsylvania, USA
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Gow KW, Drake FT, Aarabi S, Waldhausen JH. The ACGME case log: general surgery resident experience in pediatric surgery. J Pediatr Surg 2013; 48:1643-9. [PMID: 23932601 PMCID: PMC4235999 DOI: 10.1016/j.jpedsurg.2012.09.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 08/19/2012] [Accepted: 09/05/2012] [Indexed: 10/26/2022]
Abstract
BACKGROUND General surgery (GS) residents in ACGME programs log cases performed during their residency. We reviewed designated pediatric surgery (PS) cases to assess for changes in performed cases over time. METHODS The ACGME case logs for graduating GS residents were reviewed from academic year (AY) 1989-1990 to 2010-2011 for designated pediatric cases. Overall and designated PS cases were analyzed. Data were combined into five blocks: Period I (AY1989-90 to AY1993-94), Period II (AY1994-95 to AY1998-99), Period III (AY1999-00 to AY2002-03), Period IV (AY2003-04 to AY2006-07), and Period V (AY2007-08 to AY2010-11). Periods IV and V were delineated by implementation of duty hour restrictions. Student t-tests compared averages among the time periods with significance at P < .05. RESULTS Overall GS case load remained relatively stable. Of total cases, PS cases accounted for 5.4% in Period I and 3.7% in Period V. Designated pediatric cases declined for each period from an average of 47.7 in Period I to 33.8 in Period V. These changes are due to a decline in hernia repairs, which account for half of cases. All other cases contributed only minimally to the pediatric cases. The only laparoscopic cases in the database were anti-reflux procedures, which increased over time. CONCLUSIONS GS residents perform a diminishing number of designated PS cases. This decline occurred before the onset of work-hour restrictions. These changes have implications on the capabilities of the current graduating workforce. However, the case log does not reflect all cases trainees may be exposed to, so revision of this list is recommended.
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Affiliation(s)
- Kenneth W. Gow
- Corresponding author. 4800 Sand Point Way NE, Seattle, WA 98105. Tel.: +1 206 987 1177; fax: +1 206 987 3925. (K.W. Gow)
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Abstract
OBJECTIVE To develop a projection model to forecast the head count and full-time equivalent supply of surgeons by age, sex, and specialty in the United States from 2009 to 2028. SUMMARY BACKGROUND DATA The search for the optimal number and specialty mix of surgeons to care for the United States population has taken on increased urgency under health care reform. Expanded insurance coverage and an aging population will increase demand for surgical and other medical services. Accurate forecasts of surgical service capacity are crucial to inform the federal government, training institutions, professional associations, and others charged with improving access to health care. METHODS The study uses a dynamic stock and flow model that simulates future changes in numbers and specialty type by factoring in changes in surgeon demographics and policy factors. RESULTS : Forecasts show that overall surgeon supply will decrease 18% during the period form 2009 to 2028 with declines in all specialties except colorectal, pediatric, neurological surgery, and vascular surgery. Model simulations suggest that none of the proposed changes to increase graduate medical education currently under consideration will be sufficient to offset declines. CONCLUSIONS The length of time it takes to train surgeons, the anticipated decrease in hours worked by surgeons in younger generations, and the potential decreases in graduate medical education funding suggest that there may be an insufficient surgeon workforce to meet population needs. Existing maldistribution patterns are likely to be exacerbated, leading to delayed or lost access to time-sensitive surgical procedures, particularly in rural areas.
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Loe WA, Guzzetta PC, Lessin MS, Nakayama DK. Proposed standards for use of locum tenens coverage in pediatric surgery practices. J Pediatr Surg 2013; 48:700-1. [PMID: 23480937 DOI: 10.1016/j.jpedsurg.2013.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 01/14/2013] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
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Dunlop JC, Meltzer JA, Silver EJ, Crain EF. Is nonperforated pediatric appendicitis still considered a surgical emergency? A survey of pediatric surgeons. Acad Pediatr 2012; 12:567-71. [PMID: 22980729 DOI: 10.1016/j.acap.2012.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 08/16/2012] [Accepted: 08/17/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the beliefs and preferences of pediatric surgeons regarding the emergent nature of nonperforated appendicitis. METHODS An electronic mailing was sent to all 1052 members of the American Pediatric Surgical Association (APSA) inviting participation in a 26-item survey, which was administered by Survey Monkey (www.surveymonkey.com). Chi-square and Mann-Whitney tests were used for bivariate analysis. Spearman's rho was used for nonparametric correlation. RESULTS Four hundred eighty-four pediatric surgeons (46%) responded to the survey. Few respondents (4%) considered nonperforated appendicitis to be a surgical emergency. A minority (14%) would come in from home to perform an overnight appendectomy. Most (92%) believe that postponing overnight appendectomy until daytime does not result in a clinically significant increase in perforation. Respondents endorsed surgeon fatigue (56%) and limited operating room availability (56%) most often among factors that would make them more likely to postpone surgery. Sixty-eight percent reported no departmental guideline regarding delay of overnight appendectomy. CONCLUSIONS Most pediatric surgeons in our study believe nonperforated appendicitis is not a surgical emergency and prefer to postpone overnight appendectomy.
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Affiliation(s)
- John C Dunlop
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
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Nakayama DK, Dalton ML. Department of Surgery, Mercer University School of Medicine, and the Medical Center of Central Georgia. Am Surg 2012. [DOI: 10.1177/000313481207800527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Don K. Nakayama
- Medical Education–Surgery, Mercer University School of Medicine, Medical Center of Central Georgia, Macon, Georgia
| | - Martin L. Dalton
- Medical Education–Surgery, Mercer University School of Medicine, Medical Center of Central Georgia, Macon, Georgia
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Florence LS, Feng S, Foster CE, Fryer JP, Olthoff KM, Pomfret E, Sheiner PA, Sanfey H, Bumgardner GL. Academic careers and lifestyle characteristics of 171 transplant surgeons in the ASTS. Am J Transplant 2011; 11:261-71. [PMID: 21219568 DOI: 10.1111/j.1600-6143.2010.03381.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This manuscript reports the demographics, education and training, professional activities and lifestyle characteristics of 171 members of the American Society of Transplant Surgeons (ASTS). ASTS members were sent a comprehensive survey by electronic mail. There were 171 respondents who were 49 ± 8 years of age and predominantly Caucasian males. Female transplant surgeons comprised 10% of respondents. ASTS respondents underwent 15.6 ± 1.0 years of education and training (including college, medical school, residency and transplantation fellowship) and had practiced for 14.7 ± 9.2 years. Clinical practice included kidney, pancreas and liver organ transplantation, living donor surgery, organ procurement, vascular access procedures and general surgery. Transplant surgeons also devote a significant amount of time to nonsurgical patient care, research, education and administration. Transplant surgeons, both male and female, reported working approximately 70 h/week and a median of 195 operative cases per year. The anticipated retirement age for men was 64.6 ± 8.6 and for women was 62.2 ± 4.2 years. This is the largest study to date assessing professional and lifestyle characteristics of abdominal transplant surgeons.
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Affiliation(s)
- L S Florence
- Department of Surgery, Swedish Medical Center, Swedish Organ Transplant Program, Seattle, WA, USA
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Fisk PE. Letter to the editor regarding pediatric surgery workforce. J Pediatr Surg 2010; 45:1069-70; author reply 1070, discussion 1070-2. [PMID: 20438956 DOI: 10.1016/j.jpedsurg.2010.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Accepted: 01/16/2010] [Indexed: 10/19/2022]
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Chirdan LB, Ameh EA, Abantanga FA, Sidler D, Elhalaby EA. Challenges of training and delivery of pediatric surgical services in Africa. J Pediatr Surg 2010; 45:610-8. [PMID: 20223329 DOI: 10.1016/j.jpedsurg.2009.11.007] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Revised: 11/07/2009] [Accepted: 11/12/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND The practice of pediatric surgery in Africa presents multiple challenges. This report presents an overview of problems encountered in the training of pediatric surgeons as well as the delivery of pediatric surgical services in Africa. METHODS A returned structured self-administered questionnaire sent to pediatric surgeons practicing in Africa was reviewed and analyzed using SPSS version 11.5 (SPSS, Chicago, IL). RESULTS Forty-nine (57%) of 86 questionnaires were returned from 8 countries. Great variability in the requirements and training of pediatric surgeons, even within the same country, was found. Many surgical colleges are responsible for standardization and board certification of pediatric surgeons across Africa. There were 6 (12%) centers that train middle level manpower. Twenty-six (53%) participants have 1 to 2 trainees, whereas 22 (45%) have irregular or no trainee. A pediatric surgical trainee needs 2 to 4 (median, 2) years of training in general surgery to be accepted for training in pediatric surgery, and it takes a trainee between 2 to 4 (median, 3) years to complete training as a pediatric surgeon in the countries surveyed. The number of pediatric surgeons per million populations is lowest in Malawi (0.06) and highest in Egypt (1.5). Problems facing adequate delivery of pediatric surgical services enumerated by participants included poor facilities, lack of support laboratory facilities, shortage of manpower, late presentation, and poverty. CONCLUSION The training of pediatric surgical manpower in some African countries revealed great variability in training with multiple challenges. Delivery of pediatric surgical services in Africa presents problems like severe manpower shortage, high pediatric surgeon workload, and poor facilities. Standardization of pediatric surgery training across the continent is advocated, and the problems of delivery of pediatric surgical services need to be addressed urgently, not only by health care planners in Africa but by the international community and donor agencies, if the African child is to have access to essential pediatric surgical services like his or her counterpart in other developed parts of the world.
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Affiliation(s)
- Lohfa B Chirdan
- Pediatric Surgery Unit, Department of Surgery, Jos University Teaching Hospital, Jos, PMB 2076, Jos, Nigeria.
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