I am unsure that Dr Crane and I are really in disagreement. The point of the commentary was that properly supported surgical education at community hospitals is a valuable part of surgical education, and that the expenses of supporting surgical residency education are justified in that it is an asset to the community teaching hospital, not a liability. My underlying personal concern is that surgical educators and the surgical educational establishment have perhaps focused too much on the 17% of health care provided at university and major teaching hospitals, and underemphasized the 83% of American health care provided at community hospitals and community teaching hospitals. This may help to explain why the expertise of many of our organizations is underappreciated by policymakers concerned about the comprehensive delivery of health care—we are too little concerned about how our recommendations "will play in Peoria."
McMillen MA. The Value of Physician Assistants in the Modern Surgical Setting—Reply. Arch Surg. 1999;134(5):575-576. doi: