The circuitous route to surgery raises many questions in my mind about the program's overall efficacy to producing competent, compassionate physicians. During a surgery resident panel today, fourth year medical students expressed a mix of relief and exhilaration when talking about being free of the shackles of a strictly 'medicine' route and transitioning to a more results driven surgical environment. Moreover the advice that they gave to the younger generations reinforced the notion that surgery is an "old boy" institution with many barriers to entry.
Let's just say that I'm beginning to gain an appreciation for the stereotypes swirling around surgeons.
It's no surprise to me that students that matched in surgery would express overall relief about dodging the internal medicine bullet. Medical school today, specifically urban medical institutions, emphasize general practice-ish care throughout the curriculum and give little credence to the many alternative tracts in medicine. As a result surgery oriented students often have to forge their own track if they want to gain insight and experience about the field. But this isn't necessarily advantageous for the student.
From my perspective it immediately creates an "us vs. them" mentality amongst surgery kids and medicine kids. Surgery kids develop an ego because they feel like they've overcome so much to forge a place for themselves at school. Likewise, medicine kids label future surgeons as "gunners" with attitude problems that lack essential skills in patient-oriented medicine. It seems that surgeons fall right into this stereotype. But the thoughts of peers and colleagues aren't the only factors driving this mentality. Surgery, unlike many medicine tracts, demands high grades, higher board scores and often research experience. Surgery-minded students must, in essence, be superhuman and not only complete medical school, but get published and make it look easy. It's not surprising that they might cope with these enormous stressors by becoming somewhat egocentric.
Perhaps the most difficult thing to stomach is the social club behavior in sub specialties in surgery. Suddenly grades, skills, and experience take a back seat to letters of recommendation, hand shaking, back patting, and reputation. Surgery students rotate in hospitals because of a hospitals good name or star studded faculty. Too bad for honest hard work.
What bugs me is that all of this really just establishes a bizzare initiation that one must suffer through to practice in a life saving field of medicine. Surgeons are often on the cutting edge of clinical science but instead of working in a collaborative spirit they close themselves off to everyone that isn't part of their exclusive club that they worked so hard to be a part of. What are we teaching our nation's best and brightest? What examples are we setting for future generations of physicians?
Like most everything else in healthcare things need to change if outcomes are going to improve. Surgeons need to gain heart, and those in medicine need to shed stereotypes. In general, physicians need to take an honest look at an impact that their system of initiation has on patient's outcomes and decide if they're really keeping up with their oath to do no harm.
