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Studnicki J, Fisher JW, Tsulukidze MM, Taylor YJ, Salandy S, Laditka JN. Career Phase of Board-Certified General Surgeons: Workload Composition and Outcomes. Arch Surg. 2011;146(11):1307–1313. doi:10.1001/archsurg.2011.265
Author Affiliations: Department of Public Health Sciences (Drs Studnicki, Fisher, and Laditka) and Doctoral Program in Health Services Research (Dr Tsulukidze and Mss Taylor and Salandy), College of Health and Human Services, University of North Carolina, Charlotte.
Objective To examine surgeon career phase and its association with surgical workload composition and outcomes of surgery.
Design Cross-sectional study.
Setting The study used data from calendar years 2004 through 2006 from 4 Florida general surgeon (GS) cohorts determined by years since board certification.
Participants American Board of Surgery–certified GSs regardless of subspecialty (n = 1187) performing 460 881 operations on adults 18 years or older.
Main Outcome Measures Workload composition based on the Clinical Classification System, complications identified by patient safety indicators, and in-hospital mortality. Poisson regression with robust error variance estimated adjusted rate ratios (RRs) for complications and mortality.
Results Compared with late-career surgeons, the rate of complications from cardiovascular procedures was higher for surgeons in the early-career phase (RR, 1.23; 95% CI, 1.06-1.44) and the late middle–career phase (1.18; 1.02-1.37). The mortality rate for cardiovascular procedures also was higher for early-career surgeons (RR, 1.23; 95% CI, 1.04-1.46). For digestive procedures, early-career surgeons had lower complication rates than late-career surgeons (RR, 0.86; 95% CI, 0.75-0.99).
Conclusion Late-career GSs perform both better and worse compared with early-career GSs, relative to their workload composition and proportional surgical volume. Factors such as training and case complexity may contribute to these career-phase differences.
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