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The newly founded Alliance of Surgeons has published its manifesto. Young surgeons demand greater access to operating tables, pay rises and more training opportunities. They also appeal to other surgeons and resident doctors to join the National Physicians’ Union. What are general surgeons fighting for?
- The Agreement of Surgeons started the fight to repair the deepening collapse in general surgery in Poland
- The total number of general surgeons in Poland is slightly over 9, i.e. 2,3 per 10. citizens. This is definitely not enough
- On average, a surgeon in Poland is 58,5 years old
- The lack of general surgeons poses a risk to patients
Young people don’t want to be surgeons
The spokesman for the Alliance of Surgeons, Daniel Łuszczewski, told Medonet that currently around 40 people have signed up for the organization, but this number changes every day. During the first meeting in Warsaw, the Alliance of Surgeons issued a manifesto and started the fight to repair the deepening collapse in general surgery in Poland. The organizational meeting to which heads of departments and clinics of general surgery will be invited is scheduled for January 2020. Then the Covenant Action Plan will also be developed.
As we read at the beginning of the manifesto, the total number of general surgeons in Poland is slightly over 9, i.e. 2,3 per 10. citizens. This is definitely not enough. On average, a surgeon in Poland is 58,5 years old. When it comes to the total number of surgeons, according to Eurostat data (for 2017), there were 20 592 surgeons in Poland. For comparison, in 2017 there were 60 467 surgeons, in Germany 97 707, in Spain 44 728, and in France 31 756 .
The facts are that for several years, general surgery as a specialization has been enjoying less and less interest. Why is it like that?
– Young doctors starting their specialization are not interested in the work of surgeons, and our group is aging very much. When I started work eight years ago, surgery was a more popular specialization, but for several years it has been changing significantly. The last resident of general surgery showed up in 2013 at a large specialist hospital with which I work. In the clinic where I work, which has always been popular among residents, no one has come to the clinic for three years – explains Dr. Bogna Prusowska, a specialist in general surgery.
Many factors contribute to the decline in general surgery interest among young doctors. Prusowska began her studies in 2004, she received her specialization in general surgery a month ago.
– 15 years of education, and not because my road was especially extended. What do we get in return for several years of gaining knowledge? First, a very low salary. In Poland, general surgical procedures are rated very low, which translates into relatively lower remuneration of general surgeons – explains Prusowska.
The valuation is what the fund pays to the hospital for the patient’s stay in the hospital during the treatment of the medical entity. If complications arise during treatment, the hospital does not receive additional money, as it only evaluates one procedure that has taken place. If patients with complications are admitted to the hospital, it usually does not end with one operation. All this means that there is not enough money to pay general surgeons well.
Young doctors observe all this and do not want to work in conditions of underfunding, underestimation and lack of access to modern methods of surgical treatment. There is also a big problem with that. One of the points of the manifesto is “the development of existing simulation centers and the creation of new free-of-charge training centers where young surgeons can learn live laparoscopy and work in rapid response teams”.
General surgery – how to make it more attractive?
Prusowska has no illusions that being a general surgeon will not return to the state from 30 years ago, when the choice of this specialization was extremely prestigious. However, it cannot be allowed to neglect general surgery to the extent that there will be no one to operate.
— Being a general surgeon is very hard physical and intellectual work. Doctors are on duty day and night, in difficult conditions, inconsistent with the realities of surgery, e.g. in the Czech Republic. This is discouraging, but not as much as, for example, an unattractive form of specialized training. A young person who is faced with the choice of specialization must see the sense of learning this specialization. He must see that he will learn in a modern way, on modern material, with access to the best methods. We do not have it at the moment – explains the specialist.
In the Czech Republic mentioned by Prusowska, over 80 percent are satisfied with health care. citizens. GDP allocated to health care is 7,8%. There are also several payers who conclude contracts with hospitals and clinics, paying a certain lump sum. Competition between payers makes them monitor whether patients are treated in accordance with standards in centers. Officially, the waiting time for an appointment with a surgeon in the Czech Republic should not exceed 45 minutes. The basic salary of a specialist in a hospital is approximately CZK 60-70 gross (approximately PLN 000). Duty hours are paid additionally.
Interestingly, the specialization in general surgery is a priority specialization, and hence the surgical resident’s earnings are slightly higher than for other specializations. After six years, however, there is a collision with an unattractive, poorly paid position that comes with huge responsibilities.
– Young people know that these six years will pass quickly, they look ahead and see that at the moment general surgery is not the field that will bring them favorable working conditions.
What particularly worries our interlocutor is the fact that at some point general surgery may become a branch of medicine that will be practiced by people with the lowest LEK scores (medical final exam).
– It may turn out that people who would not get into anything else will start to be admitted to general surgery. This is very disturbing, because general surgery is not a job for everyone and cannot be treated as plan B. It must be the first choice – adds Prusowska.
The Alliance of Surgeons wants the Ministry of Health and the National Health Fund to see and respond to general surgery problems. Otherwise, it may turn out that in a few years the general surgeon will become a “scarce commodity”.
What does not having access to a general surgeon mean for a patient?
A general surgeon is a doctor who deals with the planned treatment of diseases of the abdominal cavity – cholelithiasis, abdominal hernias, spleen, treatment of diseases of the thyroid gland, varicose veins of the lower extremities. In addition, it heals acute and chronic wounds, ulcers and pressure ulcers.
– In the field of acute diseases, all acute conditions of the abdominal cavity are operated – appendicitis, inflammation of the bile ducts and gall bladder, gastrointestinal obstruction of any kind, perforation of the upper and lower gastrointestinal tract – Prusowska enumerates.
But it is not everything. The tasks of the general surgeon also include the treatment of tumors of the abdominal cavity, skin and soft tissues. In the absence of specialists in other fields, it is required to treat head, kidney, bladder and chest injuries.
Most of these procedures should be performed with the assistance of other general surgeons or resident surgeons. Now let’s imagine (it won’t be difficult, because it’s already happening) that there is only one general surgeon on duty in the entire hospital.
— There may be a situation where patients will be taken from hospital to hospital in search of a team that will operate on acute conditions.. One of the most severe, but also the most popular, are gastrointestinal perforations. Such a patient should be on the table in a very short time, he will have to wait, because there will be no one to operate on him, explains Prusowska.
All this can lead to the patient not being well and operated on time,
– Imagine a situation where at two in the morning an ambulance arrives for a patient in serious condition, with a hole in the stomach the size of five zlotys, very suffering. He goes to the hospital, where there is a surgeon who has already operated on five or seven people and is assisted by, for example, a resident of gynecology, because no one else is there. What’s happening? Firstly, the quality of this gynecologist’s education is declining, because he should be doing something completely different. Secondly, a tired physician is more likely to make mistakes and reduce the quality of the operation.
The lack of general surgeons is also a threat to patients undergoing elective surgery. They will have to wait longer as GPs will deal with emergencies. Unfortunately, not always as fast as it should be.
– Time is of the essence in emergency operations. A patient who was operated on three hours after perforation in the abdominal cavity has a different prognosis than if the operation is performed after nine or 12 hours – he adds.
If there are no general surgeons, there will be a problem with adequate provision of patients after injuries, e.g. as a result of accidents. A general surgeon removes a ruptured spleen. If there are no other specialists and the patient cannot be transported, the general surgeon will operate after a craniocerebral trauma.
– You should also bear in mind that most of these procedures cannot be performed alone. An eminent surgeon can handle only equipment, but the quality of this procedure will be worse. And let’s be honest, there are few outstanding surgeons, explains Prusowska.
At the hospital with which Bogna Prusowska cooperates, there is usually one general surgeon – a specialist or a resident – on duty. There should be more, but they’re just not there. The fewer general surgeons there are, the wider the range of procedures they perform.
The Surgeons Alliance wants general surgery to be recognized by the authorities and adequately funded. We feel the lack of doctors of this specialty now, and it will be even worse.
Commentary of the Supreme Medical Council on general surgery
We asked the president of the Supreme Medical Council, professor Andrzej Matyja, to comment on the problems of general surgery. He admits that we are currently dealing with a huge staff crisis in the medical profession.
– In the case of general and oncological surgery, we have over 9 doctors of these specializations in the Central Register of Doctors, but only half of this number is professionally active – says prof. Matya.
He adds that trainee medics complain that in some hospitals they are rarely admitted to the operating table, and that they complete their specialization with half the required skills.
– For many years we have been cultivating fiction in general surgery education. Both the heads of specialization and the residents themselves know this. I mean the number and type of compulsory surgery. If we counted the number of residents and the required treatments, we would conclude that the residency program is impossible to implement. In many places because of an overabundance of administrative work residents are treated as slaves to the system-imposed bureaucratic work. The curriculum requires immediate change and adaptation to the capabilities of individual departments, the number and types of treatments performed, of course not forgetting the quality – explains the President of the NRL.
Finally, he adds that the Supreme Medical Council from the very beginning has supported and will support all initiatives, including the education of residents, aimed at improving the situation in health care in Poland.
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