By Lynette A. Scherer

Where have all the surgeons gone? Chances are your hospital is feeling the effects of today’s shortage of general surgeons – and if not, it will soon. Recent Health Resources and Services Administration studies have reported uneven geographic distribution of general surgeons, with the most severe shortages at rural hospitals. American Association of Medical Colleges research also anticipates the surgeon shortage will worsen over the coming decade as many in the surgical workforce reach retirement age. Additionally, Americans are living longer and the population of adults requiring more surgical care is growing, exacerbating the shortage.

In particular, general surgeons with a broad acute care skillset are becoming increasingly rare. Hospitals of all sizes require surgeons capable of performing common procedures such as appendectomies or trauma surgery after severe injuries, but the traditional lifestyle of a general surgeon is demanding. Often they work full-time during the day at their own private practice yet must also remain on call at all hours of the night to treat hospital patients. Surgeons who help to cover the ER feel the schedule strain most acutely. For quality of work and life, it’s not ideal to be on call 24/7, wake up early for elective surgery, have the day’s patient schedule disrupted for yet another emergency case and then potentially be responsible for treating patients at night. Given the choice, many surgeons will opt for more lucrative specialty practices or opt out of surgery in general to achieve better control over their schedules.

While personnel shortages place strain on all facets of hospital care, a general surgeon deficit in the ER has an immediate impact on patient outcomes. Waiting for an on-call surgeon to arrive can cause delays in procedures where timing often matters. Patients may “walk” from the ER to seek care in another hospital. When a hospital cannot provide timely emergency and acute care, its case mix, financial health and reputation – and much more important, the health of its community—suffer. Quality measures decline and rural hospitals that lack reliable access to surgeons may even be forced to shut down due to inadequate staffing, leaving the community with a gap in care.

A solution for the future
Over the past several years, workers of all sorts have become more focused on quality of life than ever before. Awareness of burnout and its mental health effects has increased, and the pandemic prompted an even greater shift in priorities and a desire for work-life balance. How can today’s hospital reconcile the demand for general surgeons with the turn away from the unpredictable lifestyle? Enter the surgicalist.

Surgicalists, perhaps best described as surgical hospitalists, are salaried hospital staff that provide full-time surgical coverage and ensure that quality surgical care is available as needed. With no private practices competing for their time and attention, surgicalists can focus on ER and acute care demands on a predictable set schedule. For example, a surgicalist might work every day for two weeks with pre-determined hours, then have two weeks off to rest and recharge. Existing private practice surgeons often continue to assist with on-call needs as desired but with a much more manageable schedule.

Surgicalists staffing a hospital are not only general surgeons but are also drawn from the emerging specialty of “acute care.” These surgeons combine surgery for traumatic injuries with general surgical skills, making them an excellent choice for the emergency surgical coverage.

Another advantage of the surgicalist model is that typically surgeons employed in surgicalist programs will integrate seamlessly into the hospital’s workflow – adopting its standardized procedures, communicating consistently and following a patient on their entire journey from admission through discharge for better care coordination. An onsite departmental medical director is often hired to ensure the program effects changes both in the department and hospital-wide. Patient “hand-offs” are smoother, quality measures improve, and with greater efficiencies and shorter length of stays, hospitals may even have more open beds to handle a greater number of surgical cases.

Starting up a surgicalist program
What’s the best place to start in recruiting surgicalists to your hospital? Rather than handling hiring and program management in-house, a surgicalist program management firm may save hospitals time and offer greater value. These firms deliver turn-key professionally developed, proven programs that help to simplify the process while attracting highly skilled, board-certified or -eligible surgeons. After all, that’s all they do, and they have their fingers on the pulse of the current marketplace.

This type of organization will:
-Analyze your hospital’s current emergency surgery program and patient population and compare with similar facilities across the nation to set realistic goals.
-Perform marketplace analysis, taking into account emergency surgery patient volume and current treatment locations to determine how to attract patients.
-Determine the staffing required, including numbers and types of surgeons, to meet the expected demand.
-Detail the experience required of incoming surgeons and set compensation, including salaries, bonuses, raise potential, based on marketplace and location.
-Screen candidates by accessing an established, wide-reaching talent pool to find candidates compatible for the position and location – plus quickly conduct interviews, reference checks and on-boarding.
-Set the right work-life balance for job satisfaction by structuring work schedules and minimizing administrative hassles for surgeons.
-Collaboratively develop evidence-based surgical protocols and best practice guidelines to ensure consistent communication and patient care coordination among hospital staff.

A reputable surgicalist program can attract more surgeons to a hospital in particular – and perhaps add to the ranks of general surgeons in the medical community overall thanks to its unique career and lifestyle benefits. In fact, this emerging medical specialty may help to curb the overall surgeon shortage if the concept becomes widespread. Rethinking the traditional surgical staffing model can go a long way toward practitioner health and happiness, which in turn creates better patient outcomes. It may just be the staffing solution that’s compatible with the future of healthcare.

Lynette A. Scherer, MD, FACS, is an internationally recognized, fellowship-trained trauma surgeon certified by the American Board of Surgery in general surgery and trauma/critical care. She is currently the chief executive officer for Surgical Affiliates Management Group (SAMGI), the first company to specialize in providing surgical hospitalists.