Christopher DuCoin

Is it All About the Money? Not All Surgical Subspecialization Leads to Higher Lifetime Revenue when Compared to General Surgery

OBJECTIVE It is believed that spending additional years gaining expertise in surgical subspecialization leads to higher lifetime revenue. Literature shows that more surgeons are pursuing fellowship training and dedicated research years; however, there are no data looking at the aggregate economic impact when training time is accounted for. It is hypothesized that there will be a discrepancy in lifetime income when delay to practice is considered. DESIGN Data were collected from the Medical Group Management Associations 2015 report of average annual salaries. Fixed time of practice was set at 30 years, and total adjusted revenue was calculated based on variable years spent in research and fellowship. All total revenue outcomes were compared to general surgery and calculated in US dollars. PARTICIPANTS The financial data on general surgeons and 9 surgical specialties (vascular, pediatric, plastic, breast, surgical oncology, cardiothoracic, thoracic primary, transplant, and trauma) were examined. RESULTS With fellowship and no research, breast and surgical oncology made significantly less than general surgery (-

Buckle of the bariatric surgery belt: an analysis of regional disparities in bariatric surgery

1,561,441, -

Post-Operative Infections: Trends in Distribution, Risk Factors, and Clinical and Economic Burdens

1,704,958), with a difference in opportunity cost equivalent to approximately 4 years of work. Pediatric and cardiothoracic surgeons made significantly more than general surgeons, with an increase of opportunity cost equivalent to

Update regarding the society of American Gastrointestinal and Endoscopic Surgeons (SAGES) grant distribution and impact on recipient’s academic career

5,301,985 and

Time crunch: increasing the efficiency of assessment of technical surgical skill via brief video clips

3,718,632, respectively. With 1 research year, trauma surgeons ended up netting less than a general surgeon by

A Surgeon Led Clinically Focused Anatomy Course Increases Student Selection of General Surgery As a Career

325,665. With 2 research years, plastic and transplant surgeons had total lifetime revenues approximately equivalent to that of a general surgeon. CONCLUSIONS Significant disparities exist in lifetime total revenue between surgical subspecialties and in comparison, to general surgery. Although most specialists do gross more than general surgeons, breast and surgical oncologists end up netting significantly less over their lifetime as well as trauma surgeons if they do 1 year of research. Thus, the economic advantage of completing additional training is dependent on surgical field and duration of research.

Thyroid Surgery and Obesity: Cohort Study of Surgical Outcomes and Local Specific Complications

BACKGROUND Surgical options have emerged as effective treatments to mitigate obesity-associated co-morbidities leading to reduced mortality risk. Despite the benefits of bariatric surgery, a low portion of the eligible population undergoes weight loss procedures. OBJECTIVES To determine if regional disparities exist among bariatric patients in the United States and potential effects of any difference SETTING: National Inpatient Sample (NIS). METHODS We performed a retrospective, cross-sectional analysis of the NIS database from 2003-2010. We identified 4 regions of the United States; Northeast, Midwest, West, and South. Endpoints included race, payor status, co-morbidities, urban/rural areas, institutional academic status, surgeon, and institutional volume. The sample was analyzed using χ2 tests, linear regression, and multivariate logistical regression analysis. RESULTS A total of 132,342 cases and 636,320 controls were studied. A majority of the study population was female (62.5%) and white (70.0%) with private insurance (42.0%). The highest prevalence of obesity was identified in the South (39.7%) and the lowest in the Midwest (17.1%). The greatest numbers of bariatric procedures are performed in the Northeast (24.4%) compared with the South (13.9%) and Midwest (13%). After controlling for demographic characteristics, the proportion of procedures performed in the Northeast compared with the South (odds ratio .52, confidence interval .40-.66; P<.001) and Midwest (odds ratio .50, confidence interval .33-.75; P<.005) was significant. CONCLUSION Significant disparities in bariatric procedures performed were identified in the South and Midwest regions compared with the Northeast. Although the South has a higher prevalence of obesity, thus it could be suggested by outreach programs.

Developing a robust suturing assessment: validity evidence for the intracorporeal suturing assessment tool

BACKGROUND Post-operative infection (POI) is a serious complication in all surgical disciplines and can derail a patients treatment and recovery course. In this analysis, we examine national trends, risk factors, and costs associated with POI. METHODS Using the Nationwide Inpatient Sample (NIS) for the years available for data analysis at the time of this study (2003-2010), we performed a cross-sectional study of adult (≥18 years) inpatients with POI and designated Clinical Classification Software (CCS) procedural class codes for the operations performed. A comparison group was selected randomly from patients with the same CCS codes who underwent the same procedures but did not experience POI. As the NIS represents 20% of U.S. hospital admissions, excess cost and stay were calculated on the basis of the average difference between cost and duration of stay for POI cases and the cost and duration of stay for the comparison group, then extrapolated to estimate the national burden for the remaining 80% of stays nationwide. RESULTS Sample admissions included 139,652 cases of POI and 941,670 comparison subjects. The POIs were most common in procedures involving the digestive tract (46.5%), cardiovascular system (16.3%), or musculoskeletal system (11.2%). Older age, male gender, high Charlson Comorbidity Index Score (CCIS), and teaching, urban, or large hospitals were independent risk factors for POI in the multivariable model (p < 0.05). A POI was associated with a higher risk of death (odds ratio 2.93; 95% confidence interval 2.82-3.04, p < 0.001). Nationally, we estimate that POI resulted in an annual average of 1.04 million days of excess hospital stay and

The Economics of Academic Advancement Within Surgery

2.72 billion excess cost. CONCLUSIONS Identification of independent risk factors suggests areas for quality improvement initiatives. Post-operative infection carries substantial clinical and financial burdens in the United States, and further analysis of the associated costs is needed to identify areas for intervention to reduce this burden.

No more broken hearts: weight loss after bariatric surgery returns patients’ postoperative risk to baseline following coronary surgery

BackgroundSmall seed grants strongly impact academic careers, result in future funding, and lead to increased involvement in surgical societies. We hypothesize that, in accordance with the SAGES Research and Career Development committee mission, there has been a shift in grant support from senior faculty to residents and junior faculty. We hypothesize that these junior physician-researchers are subsequently remaining involved with SAGES and advancing within their academic institutions.MethodsAll current and previous SAGES grant recipients were surveyed through Survey Monkey™. Questions included current academic status and status at time of grant, ensuing funding, publication and presentation of grant, and impact on career. Results were verified through a Medline query. SAGES database was examined for involvement within the society. Respondent data were compared to 2009 data.ResultsOne hundred and ninety four grants were awarded to 167 recipients. Of those, 75 investigators responded for a response rate 44.9%. 32% were trainees, 43% assistant professors, 16% associate professors, 3% full professors, 3% professors with tenure, and 3% in private practice. This is a shift from 2009 data with a considerable increase in funding of trainees by 19% and assistant professors by 10% and a decrease in funding of associate professors by 5% and professors by 10%. 41% of responders who were awarded the grant as assistant or associate professors had advanced to full professor and 99% were currently in academic medicine. Eighty-two percent indicated that they had completed their project and 93% believed that the award helped their career. All responders remained active in SAGES.ConclusionSAGES has chosen to reallocate an increased percentage of grant money to more junior faculty members and residents. It appears that these grants may play a role in keeping recipients interested in the academic surgical realm and involved in the society while simultaneously helping them advance in faculty rank.