Genomics: The Next Big Thing in Mining the Genome Women's Health: Communicating Breast Cancer Risk and Means of Prevention Oral Biology: The Mouth's Microbes Could Hold Clues to Early Cancer Detection Genetics: Rearrangement of DNA Shown to Cause Certain Lymphomas Structural Biology: Molecular Jumping Jack Shows Off Moves Minority Health: Drug Abuse and Bioterrorism Among Issues Raised by Minority Fellows The Summer Bookshelf: Recent Books by Faculty of HMS, HSDM, and HSPH Cloning Study Creates Tissues for Transplantation Heart Protection by Corticosteroids Bypasses Gene Regulation Anti-aging Mechanism Shown in Yeast, May Be Similar in People Proceedings of the HMS Faculty Council Actor Ford Named Global Environmental Citizen Portraits of HMS Women Faculty Leaders Unveiled Human Genome Chief Forecasts Blue Skies for Medical Genomics HOLLIS Gets New Look, Features Alpert Prize Winners Reveal Secrets of the Heart HMS Junior Faculty Receive Armenise Awards Biosecurity Conference Addresses Bioterrorism Threat Barger Speaker Urges Advocacy New Howard Hughes Investigators Chosen for Patient-oriented Research HMS Presents Faculty Awards Honors and Advances Where Have All the Surgeons Gone? Front Page

FORUM Where Have All the Surgeons Gone? Tarayn Grizzard Photo by Jeff CLeary This week, alchemy will happen here at HMS once again. Mere students will walk across the stage on graduation day and leave the tent as physicians--with all the social, cultural, and legal implications commensurate with the title. True, most will enter additional years of training and aren't yet obliged to be infallible. But still, the transformation is heady and a bit unreal, despite the rituals that surround the event. In addition to the speeches and pomp-and-circumstance processionals, HMS students this spring will recite a variation on the Hippocratic Oath, a contract they enter into as they formally begin their professional lives. Each class helps develop its own version of the oath to recite on graduation day. The traditional oath is rarely used in modern medical school graduations. One reason is that many aspects of the original Hippocratic Oath are incongruent with modern medical practice. For instance, it requires that physicians swear that they will not "use the knife on the body ... even to cut the stones therein." Surgery of any kind in ancient times was (for good reason, given the lack of anesthetics) deemed barbaric and a violation of the human body. This is, of course, not the case in modern times, and most oaths remove this segment. A Mismatched Residency Yet, looking at the postgraduate choices made by the HMS Class of 2002, as well as national surgical residency fill rates, one has to wonder about the current status of surgery within medicine. General surgery seems to be particularly unpopular this year, and this isn't a huge departure from the match lists of the past several years. In fact, fill rates for general surgery residencies are down for the third year in a row, and HMS in particular has far more students entering surgical subspecialties such as ophthalmology and urology than general surgery. This year, only 10 students matched in general surgery, while 26 matched in surgical subspecialties. This difference seems even greater when one looks at the relatively large numbers of general surgical residency slots nationwide compared to the smaller number of subspecialty slots, not to mention that general surgeons are the backbone of most hospitals. Many experts in surgery and in medical education are beginning to wonder what would happen to hospitals and patients alike if there weren't enough general surgeons to go around. Preventing a future dearth of general surgeons is an important priority for medical educators, and part of this effort is identifying the factors that may discourage students from entering general surgery residencies. A major factor that discourages many students from entering general surgery is the typical schedule. General surgery residencies are notoriously rigorous, with 90- to 120-hour work weeks on average and numerous intensive weeks without a nonwork day. Most students who are committed to surgery would prefer to match in a field such as orthopedics or otolaryngology, where the first one to two years are spent on the intensive, sleep-depriving general surgery service and the rest on subspecialty service with a slightly lighter workload. In addition, many surgical subspecialties such as orthopedics have more manageable lifestyles after residency than does general surgery. Looking at the lifestyle constraints and the workload of many general surgeons, it's tough to blame surgically minded medical students for attempting to specialize early and thus avoid some of the most draining and psychologically hazardous training that medicine has to offer. Balance on a Knife's Edge But it does leave medical educators and hospitals alike with an enormous dilemma: how to balance reduced residency work hours with the demands of a busy, intense specialty. Compounding the issue is the rising number of general surgery residencies that do not fill all of their first-year slots or lose residents during or after the internship year, leaving even more work for those left behind. Given the current climate about work hours nationally--pending federal legislation, cohort studies on work hours' effects on patient care, and the like--general surgery residency programs have even more pressure to consider ways to reduce overall hours. This pressure may be a good thing. Facing the difficulties and expense of reform now may be the saving grace for the specialty that is one of the workhorses of the American medical system. --Tarayn Grizzard, who is completing her second-year as a medical student at HMS