Once upon a time, all surgeons were general surgeons who performed operations from head to toe. Surgical training was by definition “general” because surgical practice required it. Since then, the number and complexity of surgical procedures have multiplied, and the expertise to perform them has been organized into dozens of subspecialties. Is the philosophy that all surgeons should first be general surgeons still a fact or just a fairy tale?
In an era when surgical trainees report record-high rates of professional burnout and the majority go onto subspecialty fellowships, early specialization has the potential to reduce the number of years in training, focus trainees’ time on achieving expertise in practice-relevant procedures, and accelerate the supply of surgeons to meet a widening workforce shortage.
But the potential disadvantages are not trivial. As critical access hospitals consolidate or close, a lack of general surgical care for rural patients could worsen the urban–rural outcome divide. Early specialization would necessitate medical students to commit to a specialty, sometimes before exposure to or experience in the breadth of surgical care. And as health care shifts toward a value-based model of reimbursement and rewards coordination, subspecialization could contribute to more fractured care pathways.
This year’s Resident and Associate Society (RAS) Symposium at the ACS Clinical Congress will feature a debate on early specialization and integrated subspecialty training as the default model for all surgeons—from trauma to thoracic, from critical care to colon and rectal, from plastics to “primary care” surgery. What is the future of surgical practice, and how should the structure of surgical training reflect the personal and professional needs of trainees to ensure clinical competency and career longevity? We invite RAS members to weigh the benefits and drawbacks of early specialization, identify potential impacts on trainees, training programs, and surgical patients, and make a compelling case that reflects the needs and demands of contemporary surgical training in the 21st century.
To participate in this competition, submit a 1,000-word essay by April 14, 2023, at 11:59 pm Central Time (UTC -6:00). Participants are encouraged to take and support a position rather than review the training landscape. Essays will be judged on the clarity, structure, and effectiveness of the argument. Two first-place winners will be invited to present their perspectives at the RAS Symposium. Two runners-up will have their submissions published in the Bulletin of the American College of Surgeons. This contest is open only to current Resident Members and Associate Fellows of the ACS.
