The Ever-Changing Departments of Surgery: The New Paradigm—The Roadmap to a Modern Department of Surgery

Abstract

Surgical services, most frequently organized in departments of surgery, have been and continue to be an integral part of any healthcare-providing institution. Next in size only to departments of medicine, departments of surgery are most commonly considered the financial pacemakers of healthcare systems, generating substantial clinical revenue to hospitals and significant downstream revenue for other clinical departments. In general, the success of both academic and nonacademic institutions depends largely on the existence of viable and comprehensive departments of surgery. Like all other elements of modern healthcare, departments of surgery have undergone significant changes over the decades as they have developed into complex, multi-matrix embedded and constantly changing entities that continue to evolve and adapt to the needs and demands of their institutions and to our ever-changing healthcare system. The modern department of surgery requires a chair who is not only a respected clinician, an established (and funded) researcher, and a dedicated educator but also someone with an outgoing personality who can motivate and lead with a vision. Further attributes are business acumen and the ability to compromise specifically when dealing with hospital or medical schools matters. This chapter provides an overview of the changes that departments of surgery have undergone over time and how they relate to the introduction of new technologies and the complex relationships between clinical and administrative leadership. The chapter focuses predominantly on the evolution of, and new paradigms for, academic surgery departments and their quest to train the next generation of surgeon leaders.