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In Reply.—I wish to thank Dr Charles Cummings for his thoughtful response to my commentary on fragmentation in general surgery. I agree that information about the distribution of head and neck surgical procedures among the involved specialties is very difficult, if not impossible, to obtain. Academicians see a certain practice pattern in teaching centers and this is reflected in the data from the boards and the residency review committees. However, these data cover only a fraction of the spectrum of the performance of these procedures on a national basis. Other specialties, such as oral surgery, neurosurgery, pediatric surgery, and plastic surgery, are also active in head and neck surgery, and these are not included in Dr Cummings' figures. In the absence of reliable and comprehensive data on this subject, I am not sure that further debate on the statistics would be fruitful. My basic point was not to deny
FRIEDMANN P. Fragmentation in General Surgery: The Case of Head and Neck Surgery-Reply. Arch Surg. 1990;125(5):679–680. doi:https://doi.org/10.1001/archsurg.1990.01410170127028
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