Surgical work loads in a community practice

The article examined alleged underutilization of surgeons by quantifying the in hospital surgical work load of a population of general surgeons. A methodology for aggregating different types of surgical procedures was developed and applied to a population of 19 general surgeons in private practice in New York. The methodology involved the calculation of a summary index through the development of a set of weights. This was based on a relative fee value scale and correlated with operating room time. Results showed variations in work loads and classified the variations by accreditation, number of affiliations, age and by complexity of operation. A discussion examined results, suggested a desirable work load, and noted possible geographic variations. Five questions were raised for further study: Might there be a widespread underutilization of surgeons?; Does underutilization of surgeons jeopardize quality of care through atrophy of skills?; Is a surgeon with a low work load of surgery likely to be encouraged to do unnecessary surgery?; Might residency programs be training too many general surgeons?; Might complex surgery be scattered among too many general surgeons, and, if so, might it be better to have a pattern of regional organization in which all complex surgery would be referred to one hospital to be performed by highly trained full-time surgeons?