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The Future of General Surgery
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To the Editor: In his Commentary predicting the imminent demise of the traditional general surgeon, Dr Fischer1 contends that one of the main reasons for the declining number of surgical residents who pursue a career as a generalist is "redistribution of funds from proceduralists to primary care physicians."
Although I agree with Fischer's concern regarding potential ill effects on society of this decline in broadly trained surgeons, I disagree that a focus on chronic diseases and better reimbursement for primary care specialties are to blame. There is a widening income gap between primary care and other physicians, and the Medicare Resource-Based Relative Value Scale system may be biased against nonprocedural specialties for many reasons.2 Also, Medicare uses a formula to limit overall increases in spending, which leads to cuts across the board in physician reimbursements.3 Furthermore, if Fischer's contentions are true, there should be increased competition for residency positions in . . . [Full Text of this Article]
Alyssa C. Browning, MD
alyssa.browning@vanderbilt.edu
Division of Clinical Pharmacology
Vanderbilt University Medical Center
Nashville, Tennessee
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