• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

Association for Academic Surgery (AAS)

  • Home
  • About
    • AAS Staff
    • Contact Us
    • Foundation
  • Membership
    • Apply For Membership
    • New Member List
    • Membership Directory
    • Check Dues Balance / Pay Dues
  • Jobs
    • AAS Job Board
    • Post a Job
  • Resources
    • Assistant Professor Playbook
    • Partners
    • AAS Resources
    • Resident Research Funding Primer
  • Grants/Awards
    • AAS/AASF Fall Courses Award
    • AAS/AASF Research Awards
      • Basic Science/Translational Research Award
      • Clinical Outcomes/Health Services Research Award
      • Trainee Research Fellowship Award in Education
      • Global Surgery Research Fellowship Award
      • Joel J. Roslyn Faculty Research Award
    • Travel Awards
      • AAS/AASF Student Diversity Travel Award
      • Senior Medical Student Travel Award
      • Visiting Professorships
    • Awards FAQ’s
  • Meetings
    • Academic Surgical Congress
    • Surgical Investigators’ Course
    • AAS Fall Courses
    • International Courses
      • Fundamentals of Surgical Research Course and Scientific Writing Workshop
    • Resident Research Funding Primer
  • Publications
  • Webinars
    • Fireside Chat – Maintaining Balance & Control
    • Diversity, Inclusion & Equity Series
      • Allyship
      • PRIDE: The LGBTQ+ Community in Academic Surgery
      • Racial Discrimination in Academic Surgery
    • Academic Surgery in the Time of COVID-19 Series
      • How to Optimize your Research During the Pandemic
      • How to Optimize Educational Experiences During the Pandemic
      • Virtual Interviews
    • The Transition to Practice – Presented by Intuitive
  • Leadership
    • Current AAS Leadership
    • AAS Past Presidents
    • How to Chair
    • Committee Missions & Objectives
    • AAS Officer Descriptions
  • Blog
    • Submit a Post
  • Log In

July 10, 2014 by Dan Abbott, MD

Metrics, Money and Mentoring: How Resident Education is Taking the Brunt of Increased Pressure on Academic Faculty (and Can Leaders Re-Balance the Scales?)

There are 2 truisms about residents in training, compared to their faculty: 1) they are generally slower, and 2) they generally make more mistakes. But a third fact of resident education trumps the first two—it is the responsibility of academic surgery to graduate safe, competent general surgeons who can independently take care of patients.

Thirty years ago, that seemed to be less of an issue. But we must remember that 30 years ago, poorer-quality diagnostic studies and fewer minimally invasive techniques resulted in more surgical intervention for pathologies that today may be managed non-operatively. These cases were frequently done by residents—deservedly and often times with each other—as a result of innumerable hours in the hospital. While faculty were either in their office or at home.

Today, very clearly, residents are trained in a different environment. They cannot be in the hospital for more than 80 hours/week. Faculty is present for most, if not all, of the operative decision-making. Sophisticated technologic and operative advancements (e.g. endovascular or robotic surgery) seem to be taken out of the hands of trainees, and routinely placed in the lap of fellows or junior faculty.

But these problems are only the beginning. Practicing physicians, whether in private practice or in an academic setting, are having their outcomes reported publicly, and with great detail. This transparency will (and already is in medical subspecialties) be matched to reimbursement for surgical procedures, increasing the responsibility of supervising physicians. To compound this pressure on teaching faculty, salaries of academic surgeons are (at best) two-thirds to one-half of surgeons in private practice, as academic centers increasingly rely on departments of surgery to disproportionately account for institution-sustaining revenue. And on top of all this (and sadly mentioned last both here and in the real world), academic surgeons generally have spent more time in training than their private-practice counterparts, with a profound impact on their personal/family life. Having made so many sacrifices to qualify for and achieve a high-quality academic appointment, faculty are asked to repeatedly relinquish personal and family time for another case, another conference, or another meeting.

Obviously, not a single component of these faculty pressures are under resident control. Furthermore, most everyone would agree that residents are under-represented in matters that pertain to their autonomy and education. And as a result, residents continue to feel the brunt of policy decisions that directly impact surgical faculty but indirectly have profound influence on resident education.

Ultimately, the weight of cutting a common bile duct during a cholecystectomy cannot and should not fall on the shoulders of the resident, even if it is his or her fault. Although some may disagree, it is part of our legacy and values that the surgical faculty must carry that burden. But there must be a system by which surgical faculty can be allowed to take more time with residents, allowing them to actually do the case with graduated responsibility, so that a common bile duct doesn’t get cut, either when a resident is in training or subsequently when he or she is on their own.

Public policy is the fulcrum that can help re-balance these opposing forces—and leadership must decide where to place it. At the 2015 Academic Surgical Congress, we will be discussing these challenges facing both faculty and residents. It is our hope that these sessions will spark debate, and perhaps arrive at a consensus, about ways to improve the environment for all parties involved.

  • Bio
  • Latest Posts

Dan Abbott, MD

Daniel Abbott is an Associate Professor at the University of Wisconsin, clinically specializing in hepatobiliary and pancreatic surgery. His research focuses on optimizing resource utilization and addressing disparities in care for patients with liver, pancreas and other GI malignancies.

Latest posts by Dan Abbott, MD (see all)

  • Perspective - April 13, 2018
  • Humility and Confidence - October 31, 2017
  • Saying No - September 29, 2016

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Print

Other Posts from The Academic Surgeon:

The American Board of Surgery
The AAS Global Affairs Committee

Primary Sidebar

Log In

  • Lost your password?

AAS Commitment to Diversity in Academic Surgery

Save the Date: 2023 Academic Surgical Congress

Save the date for the 18th ASC!
February 7-9, 2023
Hilton Americas-Houston
Houston, TX
More information coming soon.  Learn more>>

2023 AAS Fall Courses

Save the Date! Saturday, October 21, 2023 Boston , MA Courses will take place immediately prior to the ACS Clinical … More Information » about Fall Courses

Footer

Association for Academic Surgery
11300 W. Olympic Blvd, Suite 600
Los Angeles, CA 90064
Phone: (310) 437-1606
Email: [email protected]

Follow Us

  • Twitter
  • Facebook
  • Instagram

© 2023 · AAS - Association for Academic Surgery