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In Reply: I only have firsthand knowledge of data concerning the shortage in the general surgical workforce in critical access hospitals (small urban or rural hospitals) on which 54 million patients depend.¹ Over the past decade, the number of family physicians and internists has increased while the number of general surgeons has remained flat, despite an aging population.²

In response to Dr Browning, I did not lay the problems of general surgery "at the feet of primary care." Having been involved in an effort to undo the flawed sustainable growth rate system for the past decade, I know that the system is broken. In a rational world, specialties would unite to correct this flawed system, which seems cynically designed to pit specialties against each other.

The calculations for physician compensation used in the cited study of internal medicine reimbursement³ cut off in 2004 while the increases in evaluation and management . . . [Full Text of this Article]

Josef E. Fischer, MD
jfische1@bidmc.harvard.edu
Department of Surgery
Harvard Medical School
Boston, Massachusetts

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