Top

Langenbeck's Archives of Surgery

Published in:

01-01-2009 | Ethics and Health Care in Surgery

Working conditions and trainee shortage in operative disciplines—is our profession ready for the next decade?

Authors: Herwig Cerwenka, Heinz Bacher, Georg Werkgartner, Hans-Jörg Mischinger

Published in: Langenbeck's Archives of Surgery | Issue 1/2009

Abstract

Background

Increasing concern has been expressed worldwide on the problem of finding young doctors to enter a training programme in an operative speciality.

Materials and methods

A survey comprising 22 questions on working conditions and job satisfaction was placed on the homepage of the Austrian Society of Surgery; 667 questionnaires were completed.

Results

The question whether surgery is threatened by a trainee shortage was answered with “yes” by 68%. Only 37% were satisfied with their working conditions. The majority (61%) specified documentation as making up between 20% and 40% of their workload, 22.5% estimated an even higher percentage. Only 17.7% were satisfied with payment. A clear majority works 60 to 80 h per week or more. Only 32.5% stated that they can leave the hospital in the morning after weekend duty; for night duty during the week, this percentage decreased to just 4.2%. As for surgical training, 33.3% were satisfied. Regular assessments between the trainees and their department heads were confirmed by only 34%. A clear majority (96%) is in favour of rotations in other hospitals during residency for the sake of broader experience.

Conclusion

Working hour restrictions are essential, but not enough: Substantial improvements in the professional profile and in training are required.

Büchler P, Kraus TW, Friess H, Büchler MW (2003) Labor legislation in the European Union has impact on workforce management in surgical centers. Surgery 134:4–10

Dodson TF, Webb AL (2005) Why do residents leave general surgery? The hidden problem in today's programs. Curr Surg 62:128–131 doi:10.1016/j.cursur.2004.07.009 PubMedCrossRef

West D, Codispoti M, Graham T, Specialty Advisory Board in Cardiothoracic Surgery of the Royal College of Surgeons of Edinburgh (2007) The European Working Time Directive and training in cardiothoracic surgery in the United Kingdom. Surgeon 5:81–85PubMedCrossRef

Currie S, Coughlin PA, Bhasker S, Hossain J, Irvine CD, Curley PJ (2007) Vascular surgery is an unattractive career option for current basic surgical trainees: a regional perspective. Ann R Coll Surg Engl 89:792–795 doi:10.1308/003588407X232053 PubMedCrossRef

Beger HG, Arbogast R (2006) The art of surgery in the 21st century: based on natural sciences and new ethical dimensions. Langenbecks Arch Surg 391:143–148 doi:10.1007/s00423-006-0039-3 PubMedCrossRef

Carpenter RO, Spooner J, Arbogast PG, Tarpley JL, Griffin MR, Lomis KD (2006) Work hour restrictions as an ethical dilemma for residents: a descriptive survey of violation types and frequency. Curr Surg 63:448–455 doi:10.1016/j.cursur.2006.06.003 PubMedCrossRef

Schrem H, Machtens S, Kleine M, Mahlke L, Hagl C, Herrmann H, Bauer H (2003) Erste Ergebnisse der Umfrage zur aktuellen Arbeitssituation in den operativen Fächern im Zeitalter des Arbeitszeitgesetzes. Deutsche Gesellschaft für Chirurgie – Mitteilungen 4:377–82

Schröder W, Bollschweiler E, Leers J, Vivaldi C, Hölscher AH (2005) Wo drückt der Schuh?—Umfrage zu aktuellen Problemen junger Chirurg(inn)en in Nordrhein-Westfalen. Deutsche Gesellschaft für Chirurgie – Mitteilungen 1:44–47

Jones AM, Jones KB (2007) The 88-hour family: effects of the 80-hour work week on marriage and childbirth in a surgical residency. Iowa Orthop J 27:128–133PubMed

10.

Hutter MM, Kellogg KC, Ferguson CM, Abbott WM, Warshaw AL (2006) The impact of the 80-hour resident workweek on surgical residents and attending surgeons. Ann Surg 243:864–871 doi:10.1097/01.sla.0000220042.48310.66 PubMedCrossRef

11.

McGrath JS, Shehata M (1999) Attitudes of surgical trainees towards transplantation surgery as a career. Transpl Int 12:303–306 doi:10.1007/s001470050232 PubMedCrossRef

12.

Janssen C, Ommen O, Neugebauer E, Lefering R, Pfaff H (2007) How to improve satisfaction with hospital stay of severely injured patients. Langenbecks Arch Surg 392:747–760 doi:10.1007/s00423-007-0186-1 PubMedCrossRef

13.

McKee M, Priest P, Ginzler M, Black N (1991) Which general surgical operations must be done at night? Ann R Coll Surg Engl 73:295–301PubMed

14.

Faiz O, Banerjee S, Tekkis P, Papagrigoriadis S, Rennie J, Leather A (2007) We still need to operate at night!. World J Emerg Surg 2:29 doi:10.1186/1749-7922-2-29 PubMedCrossRef

15.

Everett CB, Helmer SD, Osland JS, Smith RS (2007) General surgery resident attrition and the 80-hour workweek. Am J Surg 194:751–756 doi:10.1016/j.amjsurg.2007.08.033 PubMedCrossRef

16.

Moschos E, Beyer MJ (2004) Resident attrition: is gender a factor? Am J Obstet Gynecol 191:387–391 doi:10.1016/j.ajog.2004.04.017 PubMedCrossRef

17.

Manriquez Gilpin M (2005) Residency attrition rate in obstetrics and gynecology: are we losing more postgraduates today? Am J Obstet Gynecol 193:1804–1806 doi:10.1016/j.ajog.2005.07.083 PubMedCrossRef

18.

Kusuma SK, Mehta S, Sirkin M, Yates AJ, Miclau T, Templeton KJ et al (2007) Measuring the attitudes and impact of the eighty-hour workweek rules on orthopaedic surgery residents. J Bone Joint Surg Am 89:679–685 doi:10.2106/JBJS.F.00526 PubMedCrossRef

19.

Carlin AM, Gasevic E, Shepard AD (2007) Effect of the 80-hour work week on resident operative experience in general surgery. Am J Surg 193:326–329 doi:10.1016/j.amjsurg.2006.09.014 PubMedCrossRef

20.

Walter AJ (2006) Surgical education for the twenty-first century: beyond the apprentice model. Obstet Gynecol Clin North Am 33:233–236 doi:10.1016/j.ogc.2006.01.003 PubMedCrossRef

21.

Franzese CB, Stringer SP (2007) The evolution of surgical training: perspectives on educational models from the past to the future. Otolaryngol Clin North Am 40:1227–1235 doi:10.1016/j.otc.2007.07.004 PubMedCrossRef

22.

Tan TC, Tan KT, Tee JC (2007) An end to “See one, do one and teach one” residency training programme—impact of the training, education, surgical accreditation and assessment (TESA) programme on medical care and patients’ safety. Ann Acad Med Singap 36:756–759PubMed

23.

Ibrahim S, Tay KH, Lim SH, Ravintharan T, Tan NC (2008) Analysis of a structured training programme in laparoscopic cholecystectomy. Langenbecks Arch Surg 2008, Jan 10. doi:10.1007/s00423-007-0269-z

24.

Hassan I, Koller M, Kluge C, Hoffmann S, Zielke A, Rothmund M (2006) Supervised surgical trainees perform thyroid surgery for Graves’ disease safely. Langenbecks Arch Surg 391:597–602 doi:10.1007/s00423-006-0077-x PubMedCrossRef

25.

Jurgaitis J, Paskonis M, Mehrabi A, Kashfi A, Gragert S, Hinz U et al (2006) Controlled-surgical education in clinical liver transplantation is not associated with increased patient risks. Clin Transplant 20(Suppl 17):69–74 doi:10.1111/j.1399-0012.2006.00603.x PubMedCrossRef

26.

Krones CJ, Schröder W, Ansong J (2006) The surgery assistant in graduate education. Personal requirements and expectations of graduate education faculty and graduate education schools. Chirurg Suppl, pp 303–305

27.

Büchler P, Martin D, Knaebel HP, Büchler MW (2006) Leadership characteristics and business management in modern academic surgery. Langenbecks Arch Surg 391:149–156 doi:10.1007/s00423-006-0040-x PubMedCrossRef

28.

Schürer S, Schellberg D, Schmidt J, Kallinowski F, Mehrabi A, Herfarth C et al (2006) Evaluation of traditional German undergraduate surgical training. An analysis at Heidelberg University. Chirurg 77:352–359 doi:10.1007/s00104-005-1123-x PubMedCrossRef

29.

Somaseker K, Shankar J, Conway KP, Foster ME, Lewis MH (2003) Assessment of basic surgical trainees: can we do more? Postgrad Med J 79:289–291 doi:10.1136/pmj.79.931.289 PubMedCrossRef

30.

Ansorg J, Hassan I, Fendrich V, Polonius MJ, Rothmund M, Langer P (2005) Qualität der Chirurgischen Weiterbidung in Deutschland. Dtsch Med Wochenschr 130:508–513 doi:10.1055/s-2005-863084 PubMedCrossRef

31.

v. Frankenberg M, Schmitz-Winnenthal H, Bornemann T, Köninger J, Büchler MW (2007) Project “Partnership”—university surgical departments and hospitals for basic and regular medical care. Directing cooperation for the future. Chirurg 78:368–73PubMedCrossRef

Title: Working conditions and trainee shortage in operative disciplines—is our profession ready for the next decade?
Authors: Herwig Cerwenka
Heinz Bacher
Georg Werkgartner
Hans-Jörg Mischinger
Publication date: 01-01-2009
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 1/2009
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-008-0356-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Working conditions and trainee shortage in operative disciplines—is our profession ready for the next decade?

Abstract

Background

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2009

Renal transplantation today

Hypothermic in situ perfusion of the porcine liver using Celsior or Ringer-lactate solution

Probiotics and acute pancreatitis need a long way to go

Gastric remnant cancer: an old problem with novel concerns

Analysis of POSSUM score and postoperative morbidity in patients with rectal cancer undergoing surgery

Tyrosine phosphorylation of insulin receptor substrates during ischemia/reperfusion-induced apoptosis in rat liver