#APSA 50: Robert E. Gross Debate
With Dr. Kathy Burnwhite & Dr. Andrea Hayes-Jordan & Dr. Dan Ostlie & Dr. Doug Barnhart · hosted by Dr. Alexander Gibbons & Dr. Alexander Gibbons · StayCurrentMD
Cued at 3:35 · stops at 4:20 · press play
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Between 2015 and 2030, the pediatric surgery workforce will increase by 45%
The number of index cases is staying the same and in some entities actually dropping
In a recent 4-year period, the number of pediatric urologists increased 53%
In the same 4 years, pediatric ENT increased 73%
Clear-cut scientific evidence shows that volume increases quality
Applicants spend an average of $20,000 to apply for pediatric surgery fellowship, more than half their after-tax income for a year
50% of pediatric surgery fellowship applicants fail to match
1 in 5 pediatric surgery fellows fail their pediatric surgery boards
Every single pediatric surgery operation saves lives - if the surgeon weren't there, the child would die
Saving a child saves generations - that child goes on to have children who have children
VA ECMO provides immediate gratification - you take a baby with 30% sats who is blue, put in cannulas, and achieve 100% sats with the baby pinking up
One-third of pediatric surgery cases come from being on call
93% of all pediatric surgeons in the United States are dependent on some sort of hospital support through affiliation agreements, directorships, or call contracts
Hospital reimbursement is DRG-based, not professional fees, and DRGs are based on Medicare
In Miami, uninsured Medicaid patients in children's hospitals have gone from 30% to 70% over the last 25 years
Phoenix Children's Hospital Medicaid population increased from 45% to 54% in the last 4 years, an 18% increase
There is no reason fellows can't participate in a national curriculum with one or two lectures a week taught by national experts
This year's class of fellows is the first group required to submit a case log with requirements by area and complexity to sit for pediatric surgery boards
In 20 years, concerns about fellowship numbers growing have been heard at program directors meetings and from the RRC and American Board of Surgery, but nothing has been done
The RRC approves programs based on algorithmic criteria with 0-5% interest in the health of pediatric surgery as a specialty
The American Board of Surgery's entire goal is to certify whether individuals are safe surgeons, regardless of where or how they trained
In the United States, there are 18 pediatric surgeons per 1 million children nationally
In states like North Dakota, South Dakota, and Montana, sometimes there is one pediatric surgeon for 5 million people
Resident case volumes have not changed as fellowships have been added, according to RRC data
There is significant variation between high volume and low volume training programs, and the distribution has not changed as programs have been added
80% of general surgery residents are going into subspecialties, with programs begging people to be general surgeons
The pediatric surgery board, ACGME, and program directors now meet on a regular basis to work through training and workforce issues
Pediatric surgery training is 9 years for most people: 4 years medical school, 5 years general surgery, 2 years fellowship, with 2 years of research required to match
Between 44% and 58% of physicians, depending on specialty, have experienced burnout according to a 2019 American Physicians survey of 19,000 physicians
About 15% of surveyed physicians had either thought about or knew somebody else that wanted to commit suicide
Among 39,000 surgeons surveyed in the Journal of the American College of Surgeons, trauma surgeons have the highest burnout rate and pediatric surgeons have the lowest
The audience poll shifted from 80% opposed to the resolution before the debate to 60% opposed afterward