The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Advantages to patients of a single anaesthetic for more than one operation are obvious; attracting generalist surgeons, training them and ensuring they have adequate credentials remain hurdles.Martin H Bruening and Guy J Madder

Bruening, M.

Maddern, G.

The Medical Journal of Australia

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Adelaide Research & Scholarship

PUBLISHED VERSION   Bruening, Martin Hermann; Maddern, Guy John  Who will do general surgery? Medical Journal of Australia, 2005; 182(7):317  This article is available from the Medical Journal of Australia at:    http://www.mja.com.au/public/issues/182_07_040405/bru10859_fm.html    PERMISSIONS   This document has been archived with permission from the editor of the Medical Journal of Australia, 26 April 2007.         http://hdl.handle.net/2440/33345 MJA • Volume 182 Number 7 • 4 April 2005 317EDITORIALSThe Medical Journal of Australia ISSN:0025-729X 4 April 2005 182 7 317-317©The Medical Journal of Australia 2005www.mja.com.auEditorialsith the inexorable increase in specialised surgery, theconcept of “general” surgeons, what they do, andwhat they represent, is difficult to categorise. Indeed,is there a need for a generalist surgeon when it seems that mostareas of our bodies have a designated subspecialist?In this issue of the Journal (page 337), Wilson, a generalpractitioner–surgeon makes a compelling case for the continuingexistence of the general surgeon.1 He presents an affirmativeargument through the details of his experi-ence in performing multiple elective surgicalprocedures on individual patients. Most ofthe procedures were relatively minor, yettraversed a wide range of subspecialties. Thecomplication rates were low, and there canbe no doubt that the patients benefited froma single visit to an operating theatre to havemultiple problems treated.Where can a trainee gain experience in many of the minorprocedures described by Wilson? Emphasis in tertiary hospitalshas traditionally been on major caseloads, yet a veritable gold-mine of minor operative cases are present in day-surgical units.With a little imagination and cross-specialty cooperation, a6-month term exclusively in a day-surgical unit would providea trainee with a solid grounding in minor operative surgery.Rotations through regional surgical centres, where generalsurgical operative lists continue to remain varied,2 wouldprovide another significant learning opportunity for trainees.However, the role of the GP–surgeon in major populationcentres seems limited, especially in view of credentialling require-ments imposed by health care authorities. The issues of credential-ling, clinical governance and continuing professional developmenthave been highlighted by the Royal Australasian College ofSurgeons (RACS) as being of critical importance for the practisingsurgeon, and much effort has been invested in formulating policiesto reflect this and, in turn, maintain a high standard in surgicalcare. Who is responsible for ensuring that practitioners who arenot fellows of the RACS comply with accepted surgical guidelines?While Wilson describes himself as a “GP–surgeon”, he is a fellow ofboth the Royal Australasian and Edinburgh Colleges of Surgeons, afactor that would certainly ease the path of credentialling in hiscase. The ongoing need for GP proceduralists in rural regions isunquestionable, and the various support and training mechanismshave been described at length in the Journal.3 The RACS hasclearly outlined the general surgical curriculum.4 It states, “traineesshould gain sufficient experience in operative surgery to achievecompetency in managing common surgical conditions and emer-gencies as outlined”, and subsequently lists a comprehensive rangeof surgical conditions. Currently, most advanced trainees seem toattain competency in a core group of the listed procedures andthen move into subspecialty regions, rarely to venture outside theirchosen field. The lack of young, qualified surgeons to serve thecommunity in a range of generalist procedures will becomemagnified by the ageing and eventual retirement of a substantialproportion of the Australian surgical community.5 It is preciselythis group of surgeons who, by virtue of previous training andexperience, remain adept at a wide range of general surgicalprocedures. There appears to be an opportunity for senior sur-geons, perhaps wishing to step back from on-call emergency work,to become “day surgery specialists” and impart invaluable know-ledge and skill to junior colleagues.The concept of a general surgeon able to perform a range ofprocedures on a single patient under asingle general anaesthetic is worthy. Whilethere is no rigorous evidence to prove it,anecdotally, at least, there is a definite needfor such individuals within the medicalcommunity. The importance of performingminor surgical procedures well needs to bere-emphasised, and while the major casesmay have more “lustre” for trainees, it soonbecomes apparent during surgical practice that much patientsatisfaction can be derived from successfully curing ingrowntoenails, carpal tunnel syndrome or anal fissure.Martin H BrueningSenior LecturerMartin.bruening@adelaide.edu.auGuy J MaddernProfessorUniversity of Adelaide, Department of SurgeryThe Queen Elizabeth Hospital, Adelaide, SA.1 Wilson RE. Multispecialty surgical pathology in general practice. Med JAust 2005; 182: 337-339.2 Tulloh B, Clifforth S, Miller I. Caseload in rural general surgical practiceand implications for training. ANZ J Surg 2001; 71: 215-217.3 Green AJ. Surgical services and remote referrals in rural and remoteAustralia. Med J Aust 2002; 177: 110-111.4 Royal Australasian College of Surgeons. Surgical education and traininghandbook. Available at: http://www.racs.edu.au/edu/training/seth/seth_11.pdf (accessed Feb 2005).5 Australian Medical Workforce Advisory Committee. The general surgeryworkforce in Australia. Sydney: AMWAC, May 1997. (AMWAC Report1997.2.) ❏Who will do general surgery?WAdvantages to patients of a single anaesthetic for more than one operation are obvious; attracting generalist surgeons, training them and ensuring they have adequate credentials remain hurdles...credentialling, clinical governance and continuing professional development are of critical importance for the practising surgeon.

Who will do general surgery?

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Who will do general surgery?

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