Surgical residencies: To shorten or to shrivel?

Let us shorten surgical education but not at the expense of the residency. Let us decrease the number of residencies where advisable to do so, but not their educational content. Extreme pressures to maintain the total number of residents in any hospital come from the attending staff, from the administration, and from a society that desires a maximum surgical capability. Given these pressures, any shortening of the residency will only result in an increased production of young surgeons looking for jobs. Although the total number of Board-certified surgeons in this country is probably not excessive, and granting a maldistribution of surgeons and surgical care, which must be rectified, we cannot endorse a program that will grossly increase the number of surgeons entering practice each year. Control of specialty residencies seems inevitable. But we must beware of any system of national control of surgical residencies that is not accompanied by a national control of those who perform surgery in the hospitals of this country. If we limit the number of qualified residents being trained, without limiting the surgical act to those who have been surgically trained, it will limit the quality factors in American surgery, while encouraging the proliferation of mere quantity. The excess of poor surgery, unnecessary surgery, and unmerited surgical disasters, so emphasized by social planners looking at American surgery, will only be exaggerated and intensified. Control of production mandates control of performance.