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March 5, 2008

The Future of General Surgery

JAMA. 2008;299(9):1014-1016. doi:10.1001/jama.299.9.1015-a

To the Editor: In his Commentary about the imminent disappearance of the general surgeon, Dr Fischer1 notes several causes and implications of the general surgeon shortage. We believe that a surgical hospitalist program may be an important remedy.

We introduced a surgical hospitalist program in 2005 at the University of California, San Francisco, to address the challenges of caring for patients with surgical emergencies and to transform the role of the general surgeon. This program was modeled after the medical hospitalist, pioneered at the University of California, San Francisco, in the 1990s.2 Under the surgical hospitalist model, board-certified general surgeons provide coverage for an entire week, dedicating all of their time to being available for emergency department and inpatient consultations, with a goal of providing a consultation within 30 minutes. Elective procedures and clinics are minimized during the on-call week. Surgical hospitalists lead rounds to promote continuity of care and to educate residents and medical students. For patients requiring complex surgical intervention, the surgical hospitalist first assesses and stabilizes the patient and, if needed, consults an appropriate specialist surgeon.