Surgeon of the Modern Hospital

  • Allison G. McNickleEmail author
  • John J. Fildes


As part of the modern hospital, surgeons will face a changing landscape in their practice and training from cutting-edge new technologies to a diverse set of medical stakeholders. Their skills will be in demand as population growth outpaces workforce expansion. This gap is likely to be exaggerated in rural and underserved areas, which could potentially serve as a venue for additional training positions. Regardless of practice setting, the modern surgeon must be able to lead a high performance and frequently multidisciplinary team to optimize the care and outcomes of many disease states. A knowledgeable surgeon recognizes the different learning styles, technological skills, and interpersonal behaviors across generations and engages each of them effectively. They will find the modern patient better informed about diseases and recent technology. Accordingly, their patients will expect to be involved in shared decision-making and treatment planning. Surgeons will be exposed to technologic advancements and must champion the safe and ethical introduction into everyday practice. Surgical practitioners must be dedicated to lifelong learning and performance improvement – both for their own and for their group, practice, or institution. Changes in technology and care will occur within the span of their career; thus effectively learning, adopting, and evaluating innovations will be an important aspect of their practice. Overall, the surgeon of the modern hospital will practice in an era of innovation, changing interpersonal dynamics and team-based care.


Surgical workforce High-performance team Shared decision-making Surgeon-scientist Surgical innovation Surgical quality improvement Leadership in surgery Multidisciplinary team 


  1. 1.
    American College of Surgeons comments on introduction of ensuring access to general surgery act. American College of Surgeons. 15 June 2017,
  2. 2.
    Dill MJ. The state of the physician workforce. 4 Nov 2017, Presentation downloaded from
  3. 3.
    Ellison EC, Pawlik TM, Way DP, Satiani B, Williams TE. The impact of the aging population and incidence of cancer on future projections of general surgical workforce needs. Surgery. 2018;163:553–9.CrossRefGoogle Scholar
  4. 4.
    Etzioni DA, Finlayson SR, Ricketts TC, Lynge DC, Dimick JB. Getting the science right on the surgeon workforce issue. Arch Surg. 2011;146(4):381–4.CrossRefGoogle Scholar
  5. 5.
    Tierney J, Terhune K. Expanding the National Health Service Corps Scholarship Program to general surgery: a proposal to address the national shortage of general surgeons in the United States. JAMA Surg. 2017;152(4):315–6.CrossRefGoogle Scholar
  6. 6.
    Grover K, Agarwal P, Agarwal N, Tabakin MD, Swan KG. Students to surgeons: increasing matriculation into surgical specialties. Surg Innov. 2016;23(6):623–34.CrossRefGoogle Scholar
  7. 7.
    Mason BS, Ross W, Chambers MC, Grant R, Parks M. Pipeline program recruits and retains women and underrepresented minorities in procedure based specialties: a brief report. Am J Surg. 2017;213(4):662–5.CrossRefGoogle Scholar
  8. 8.
    2016 physician specialty data report. Association of American Medical Colleges. Accessed 1 Apr 2018.
  9. 9.
    Sirinek KR, Willis R, Stewart RM. Geographic maldistribution of general surgery PGY1 residents: another US surgical desert. Am J Surg. 2014;208(6):1023–8.CrossRefGoogle Scholar
  10. 10.
    Khoushhal Z, Hussain MA, Greco E, Mamdani M, Verma S, Rotstein O, Tricco AC, Al-Omran M. Prevalence and causes of attrition among surgical residents. JAMA Surg. 2017;152(3):265–72.CrossRefGoogle Scholar
  11. 11.
    Ableson JS, Sosa JA, Symer MM, Mao J, Michelassi F, Bell R, Sedrakyan A, Yeo HL. Association of expectations of training with attrition in general surgery residents. JAMA Surg. 2018;153:712; e-pub ahead of print.CrossRefGoogle Scholar
  12. 12.
    Lynge DC, Larson EH, Thompson MJ, Rosenblatt RA, Hart LG. A longitudinal analysis of the general surgery workforce in the United States, 1981–2005. Arch Surg. 2008;143(4):345–50.CrossRefGoogle Scholar
  13. 13.
    Khubchandani JA, Shen C, Ayturk D, Kiefe CI, Santry HP. Disparities in access to emergency general surgery care in the United States. Surgery. 2018;163:243–50.CrossRefGoogle Scholar
  14. 14.
    Maykel JA. Leadership in surgery. Clin Colon Rectal Surg. 2013;26:254–8.CrossRefGoogle Scholar
  15. 15.
    Statement on high-performance teams. American College of Surgeons. 1 Feb 2010,
  16. 16.
    Ford K, Menchine M, Burner E, Arora S, Inaba K, Demetriades D, Yersin B. Leadership and teamwork in trauma and resuscitation. West J Emerg Med. 2016;17(5):549–56.CrossRefGoogle Scholar
  17. 17.
    Stone JL, Aveling EL, Frean M, Shields MC, Wright C, Gino F, et al. Effective leadership of surgical teams: a mixed methods study of surgeon behaviors and functions. Ann Thorac Surg. 2017;104:530–7.CrossRefGoogle Scholar
  18. 18.
    Jaffe GA, Pradarelli JC, Lemak CH, Mulholland MW, Dimick JB. Designing a leadership development program for surgeons. J Surg Res. 2016;200:53–8.CrossRefGoogle Scholar
  19. 19.
    Hoyt DB, Ko CY. Optimal resources for surgical quality and safety. 1st ed. Chicago: American College of Surgeons; 2017.Google Scholar
  20. 20.
    Taylor K. Paternalism, participation and partnership – the evolution of patient centeredness in the consultation. Patient Educ Couns. 2009;74:150–5.CrossRefGoogle Scholar
  21. 21.
    Holmström I, Röing M. The relation between patient-centeredness and patient empowerment: a discussion on concepts. Patient Educ Couns. 2010;79:167–72.CrossRefGoogle Scholar
  22. 22.
    Kravitz RL, Melnikow J. Engaging patients in medical decision making. BMJ. 2001;323(7313):584–5.CrossRefGoogle Scholar
  23. 23.
    Healy JM, Davis KA, Pei KY. Comparison of internal medicine and general surgery residents’ assessments of risk of postsurgical complications in surgically complex patients. JAMA Surg. 2018;153(3):203–7.CrossRefGoogle Scholar
  24. 24.
    Evers BM. The evolving role of the surgeon scientist. J Am Coll Surg. 2015;220(4):387–95.CrossRefGoogle Scholar
  25. 25.
    Merani S, Switzer N, Kayssi A, Blitz M, Ahmed N, Shapiro AMJ. Research productivity of residents and surgeons with formal research training. J Surg Educ. 2014;71(6):865–70.CrossRefGoogle Scholar
  26. 26.
    Brochu A, Aggarwal R. Research during general surgery residency: a Web-based review of opportunities, structure and outputs. J Surg Res. 2018;223:149–54.CrossRefGoogle Scholar
  27. 27.
    Papasavas P, Filippa D, Reilly P, Chandawarkar R, Kirton O. Effect of a mandatory research requirement on categorical resident academic productivity in a university-based general surgery residency. J Surg Educ. 2013;70:715–9.CrossRefGoogle Scholar
  28. 28.
    Hsieh H, Paquette F, Fraser SA, Feldman LS, Meterissian S, Fried GM, Bergman S. Formal research training during surgical residency: scaffolding for academic success. Am J Surg. 2014;207:141–5.CrossRefGoogle Scholar
  29. 29.
    Grova MM, Yang AD, Humphries MD, Galante JM, Salcedo ES. Dedicated research time during surgery residency leads to a significant decline in self-assessed clinical aptitude and surgical skills. J Surg Educ. 2017;74:980–5.CrossRefGoogle Scholar
  30. 30.
    Suliburk JW, Kao LS, Kozar RA, Mercer DW. Training future surgical scientists. Ann Surg. 2008;247:741–9.CrossRefGoogle Scholar
  31. 31.
    Valsangkar NP, Kays JK, Feliciano DV, Martin PJ, Parett JS, Joshi MM, et al. The impact of members of the Society of University Surgeons on the scholarship of American surgery. Surgery. 2016;160:47–53.CrossRefGoogle Scholar
  32. 32.
    Valsangkar NP, Milgrom DP, Martin PJ, Parett JS, Joshi MM, Zimmers TA, Koniaris LG. The positive association of Association for Academic Surgery membership with academic productivity. J Surg Res. 2016;205:163–8.CrossRefGoogle Scholar
  33. 33.
    Mansukhani NA, Patti MG, Kibbe MR. Rebranding “the lab years” as “professional development” in order to redefine the modern surgeon scientist. Ann Surg. 2017;266:937–8.CrossRefGoogle Scholar
  34. 34.
    Riskin DJ, Longaker MT, Gertner M, Krummel TM. Innovation in surgery: a historical perspective. Ann Surg. 2006;244:686–93.CrossRefGoogle Scholar
  35. 35.
    Buschemeyer WC, Cunningham DK, Edwards MJ. Surgical training and implementation of emerging surgical technologies. Am J Surg. 2005;190:166–72.CrossRefGoogle Scholar
  36. 36.
    Pradarelli JC, Thornton JP, Dimick JB. Who is responsible for the safe introduction of new surgical technology? An important legal precedent from the da Vinci surgical system trials. JAMA Surg. 2017;152(8):717–8.CrossRefGoogle Scholar
  37. 37.
    Stefanidis D, Fanelli RD, Price R, Richardson W. SAGES guidelines for the introduction of new technology and techniques. Surg Endosc. 2014;28:2257–71.CrossRefGoogle Scholar
  38. 38.
    Gloviczki P. ESVS volodos lecture: innovations and the hippocratic oath. Eur J Vasc Endovasc Surg. 2018;55(5):605–13.CrossRefGoogle Scholar
  39. 39.
    Exam pass rates. American Board of Surgery. Accessed 1 Apr 2018.
  40. 40.
    Jones DB, Stefanidis D, Korndorffer JR, Dimick JB, Jacob BP, Schultz L, Scott DJ. SAGES University MASTERS Program: a structured curriculum for lifelong learning. Surg Endosc. 2017;31:3061–71.CrossRefGoogle Scholar
  41. 41.
    Greenberg CC, Ghousseini HN, Pavuluri Quamme SR, Beasley HL, Frasier LL, Brys NA, et al. A statewide surgical coaching program provides opportunity for continuous professional development. Ann Surg. 2018;267:868–73.CrossRefGoogle Scholar
  42. 42.
    Statement on diversity. American College of Surgeons. 1 Jan 2018,
  43. 43.
    French JC, O’Rourke C, Walsh RM. A current assessment of diversity characteristics and perceptions of their importance in the surgical workforce. J Gastrointest Surg. 2014;18:1936–43.CrossRefGoogle Scholar
  44. 44.
    Zhuge Y, Kaufman J, Simeone DM, Chen H, Velazquez OC. Is there still a glass ceiling for women in academic surgery? Ann Surg. 2011;253:637–43.CrossRefGoogle Scholar
  45. 45.
    Lillemoe KD. Surgical mentorship: a great tradition, but can we do better for the next generation. Ann Surg. 2017;266:401–10.CrossRefGoogle Scholar
  46. 46.
    Walsh RM, Jeyarajah DR, Matthews JB, Telem D, Hawn MT, Michelassi F, Reid-Lomardo KM. White Paper: SSAT commitment to workforce diversity and healthcare disparities. J Gastrointest Surg. 2016;20:79–84.Google Scholar
  47. 47.
    Waljee JF, Chopra V, Saint S. Mentoring millennials. JAMA. 2018;319(15):1547–8.CrossRefGoogle Scholar
  48. 48.
    Roberts DH, Newman LR, Schwartzstein RM. Twelve tips for facilitating Millennials’ learning. Med Teach. 2012;34:274–8.CrossRefGoogle Scholar
  49. 49.
    DiLullo C, McGee P, Kriebel RM. Demystifying the Millennial student: a reassessment in measure of character and engagement in professional education. Anat Sci Educ. 2011;4:214–26.CrossRefGoogle Scholar
  50. 50.
    Kibbe MR. JAMA surgery – the year in review, 2017. JAMA Surg. 2018;153:405–6. e-published March 21, 2018.CrossRefGoogle Scholar
  51. 51.
    Logghe HJ, Boeck MA, Gusani NJ, Hardaway JC, Hughes KA, Mouawad NJ, et al. Best practices for surgeons’ social media use: statement of the Resident and Associate Society of the American College of Surgeons. J Am Coll Surg. 2018;226(3):317–27.CrossRefGoogle Scholar
  52. 52.
    Lee TH. Turning doctors into leaders. Harv Bus Rev. 2010;88(4):50–8.PubMedGoogle Scholar
  53. 53.
    Jalil R, Soukup T, Akhter W, Sevdalis N, Green JSA. Quality of leadership in multidisciplinary cancer tumor boards: development and evaluation of a leadership assessment instrument (ATLAS). World J Urol. 2018;36(7):1031–8; E-pub ahead of print Mar 3, 2018.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.UNLV School of MedicineLas VegasUSA
  2. 2.Department of SurgeryUNLV School of MedicineLas VegasUSA

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