HEALTH REFORM: Have Scalpel-- Will Travel

We've written a lot about the shortage of primary care physicians, but recently we've also seen several articles about the shortage of general surgeons, particularly in rural areas and smaller communities. Today's Wall Street Journal takes a look at the problem, and the imperfect solution—the surgical equivalent of circuit riding judges.

General surgery is on the decline because of "increasingly grueling schedules, shrinking payments and the temptation of more profitable surgical niches," the subspecialties like cardiovascular surgery or neurosurgery. Odd as it may sound to readers, some general surgeons just can't pay the bills (including big med school loans) So they become traveling surgeons, spending a week here, a week there, removing gall bladders, spleens and the like. An estimated five percent of the 17,000 US surgeons spend at least some of the time in temporary practice.

It may make sense for the surgeons, who don't have as many on-call hours, administrative headaches, overhead costs, or patients they can't collect from. Although they are spending part of their time on the road, they also can control their schedules and on-call hours more. But it can be costly for hospitals. The cost for a temporary surgeon (arranged through a staffing agency, which gets a cut) is about $1,500/day plus travel and lodgings. Critics also worry about safety lapses when surgeons operate in unfamiliar settings, or when there are more handoffs for follow-up care.

As we've noted before, all this underscores the need for health care reformers to take a good hard look at how we rebalance the health care workforce between generalists and specialists, and a payment system that shifts away from the procedure-oriented specialists toward a system of more coordinated primary care.