Surgeon Census and Stats

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Recently the Royal Australasian College of Surgeons published the results of their 5 yearly census. I love a good census as much as I love taking a picture of myself! Here are some fascinating stats:

70% of surgeons reported inadequate Wi-Fi in their principal hospital practice. How can we tweet our operations if there’s no Wi-Fi?

When establishing surgical practice, family ties were rated as most important factor followed by lifestyle factors. Not money!

Surgeons aged 70 and over form 9% of Aussie and 6% of Kiwi surgical workforce. Old dogs still learn new tricks in surgery.

Next generation: 70% of surgeons are actively engaged in training future surgeons. Proud to be part of this family.

1 in 6 surgeons spend more than 10hrs per week engaged in supervising and training future surgeons. We are serious about producing great surgeons.

Passing the baton: More than 50% of surgeons are planning for their replacement as part of retirement plan.

We work rural! 53% of Australian & 84% of Kiwi surgeons worked either full or part time in a rural or regional area.

Contrary to public perception that surgeons attempt to limit numbers, 70% believe that more surgeons required to meet demand.

50% of surgeons report inadequate teaching recognition and administrative support. We love our work and we love teaching. Don’t stress us up with paperwork.

1 in 6 surgeons under 40 reported having taken no leave or less than 1 week in the last 12months. Is that why we’re angry all the time?

Surgeons work 51hr per week. 11hr more than the average Australian working week of 39.9hr. Is that why we’re always tired?

More than 20% of surgeons are working more than the recommended emergency oncall period of 1:4. There’s just not enough of us around.

Where does our stress come from? 1 in 4 surgeons aged 30-60 reported experiencing high or extreme stress due to administrative interference.

The main source of workplace stress for surgeons is administrative interference. That’s right! Not clinical duties or difficult cases. It’s admin that stresses us up!

And confirming what we already know: Administrative interference was ranked by surgeons as more stressful than litigation!

Interesting findings. If you did a census of your own specialty, what would you find?


7 thoughts on “Surgeon Census and Stats

  1. Interesting report. Why is it then that there is a > 3+ year wait list in public hospitals vs a few weeks in private? Whilst there may be enough ENTs, they finish their training and immediately spend 80%+ of their time in private hospitals. They should be required to spend at least 1/2 their time publicly and not explode the list to force Australians to go private. We did pay for your training, which by RACS estimates are nearly $1M to train one surgeon – all of which are paid for by PUBLIC tax dollars. I don’t believe that private hospitals, nor any of the private system paid for any of it.

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    1. Thank you for your comment. My surgical training costs me about $200,000.00 and a total of 15 years, plus additional overseas fellowships of about $500,000.00 from my own income. By the end of my training, I probably would have spent 1million dollars. I’m not sure where you get your data, but the 2011 census tells me that the average surgeon spends 45% in public and 55% in private, as you correctly expect, approximately half their time in public. Australia is one of the few countries where you get universal health care. By sheer volume of population numbers alone, there’s no way the public system will ever match the short waitlist of the private system. Down in the trenches, it is not as simple as ‘seeing a surgeon’. We need operating lists with anesthetists, nurses, ward beds staffed by nurses, etc. We work hard, and dangerous hours, but we will still not meet demand in the public because there are no beds, no nurses, no anesthetists, theatre techs, equipments, etc etc. It’s a rather complex issue that not any one surgeon can ever fix. It’s political as well,which is where most of the public health challenges are. Your questions and concerns are of a public health nature, which involve dimensions of policies, resource allocations, etc. RACS is always pushing hard to advocate for better surgical care in Australia. Australia is a lucky country by many standards, including health. We can always do better, but resources and policies are our limitations.

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  2. Thank you for your response, though I disagree with your numbers. Are you suggesting that the 45% of ENTs of an FRACS qualified surgeons time is in the public system? That is, FRACS qualified (not trainees) surgeons? We should also take out IMG surgeons. What percentage of Aussie trained FRACS surgeons work full time in the public system? The number is extremely small, no doubt.

    Indeed, from the report that you cite, please note the following on page 8:
    http://www.surgeons.org/media/18789488/rpt_2012-09-10_2011_surgical_workforce_census_report.pdf

    OTO:
    Average hours public consulting: 6.9
    Average hours public procedures: 7.2
    Total = 14.1 Hours

    That is for the FRACS qualified ENTs, who work publicly, the average time spent is 14.1 hours per week. This time does not include those who only work privately.

    As far as the cost of education to fellowship, here are my estimates – Please let me know where the other $850k plus in education related expenses comes from?:

    Per Year Years Total
    Melbourne MBBS 9792 6 58752
    SET Fee 5800 5 29000
    Clinical Exam Fee 1800 1 1800
    Specialty surgical science 1570 1 1570
    Selection Reg Fee 440 1 440
    Selection Processing Fee 649 1 649
    Fellowship exm fee 6525 1 6525
    Books 1000 10 10000
    Courses in Training 3000 8 24000
    Registration 700 8 5600

    Total 138336

    Sources:
    http://medicine.unimelb.edu.au/study-here/md/course_information/places_fees_scholarships
    http://www.surgeons.org/media/302840/spr_2012-01-01_college_fees_2012.pdf
    AHPRA

    Of course, the vast majority of these expenses are tax deductible, further reducing the burden.

    As far as fellowship after training – only 1/2 of ENT FRACS will pursue this (page 49 of the RACS report):
    http://www.surgeons.org/media/18789488/rpt_2012-09-10_2011_surgical_workforce_census_report.pdf

    They will be paid for their training in the country that they choose, and will incur little cost, aside from airfare and registration – but, mind you, this is not compulsory, but a choice.

    In addition, the reason why we are forced to employ IMG surgeons, is because FRACS surgeons will NOT take full time public appointments. While I agree with you that there is increased administration, headaches, etc – I also think that if the public pays for a surgeon’s training – that is, the costs of the training is shouldered by tax payers (salary, benefits, excess labs/CT, increased time in theatre, etc, etc) – that there should be a quid pro quo. Much like bonded spots in medical school. There should be a licensing requirement that a certain percentage of time is spent in the public system. Once the private systems bears the cost of training surgeons, then it can be reconsidered.

    Now, let me ask you – what happens when there is a major complication for a patient seen in the private system? They are transferred to the public system. Theatre lists are adjusted, if needed, and people who have made plans for their operations are either delayed or cancelled. It happens all the time – and I am sure you agree with this. If elective care starts in the private system, it should stay there. That was a choice that was made between the patient and their surgeon. Part of the reason why the public system is in trouble is that cash generating procedures are done in the private system, while the public system has to care for the mistakes. I am sure we can agree on this. How many tonsillectomies are done in the private system? How many that bleed at 2 am are taken care of in the private system, or do they present to a public hospital?

    I would also be happy to discuss clinics at the public hospitals. When a consultant is paid to be there – how much time are they actually there? Actually consulting with patients? Or are they simply in another room liaising only with registrars.

    Anyway – I do enjoy your blog – just am pointing a few things out from a regular person’s perspective.

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      1. Hi SnakeI thought that i shluod also mention that i was told that my surgeon had a death in the family so that is why someone else stepped in i dont know how true this is, it sounded very genuine at the time (just dont know) and i felt really sorry for the surgeon and didnt question him leaving me with someone else because if it was my family i would drop every thing at the last minute. I wish they cancelled the operation but i wasnt given that as an option.Nag Dear Nag,I don’t know either, it could be that your surgeon was genuinely not available on that day, even if I am sure that a study on death rates in families of surgeons working for some cosmetic surgery companies would show alarming results.Can you prove you were not given the option to cancel or postpone your operation? Again, it’s a nasty game, and sometimes patients sign papers without reading them, I am afraid.Snake

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      2. Be aware if your GP is counting on bilinlg your insurance for your rhinoplasty and if you do not need to be concerned with this practice let your cosmetic specialist know. While some view the price of rhinoplasty to be high, many others feel the pricetag is simply justified by their improved appearance.

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