surgeons make a lot less than i thought!?

[Chronic Student]

I have to agree with you all here, although I'm not a doc (I'm a PA).

I am $160,000 in debt with student loans and thats not including credit cards, etc. I worked my way through the first two years of undergrad and used student loans for the second two, without any family support. My credit cards got a real work-out though.

I worked for a few years and took more classes and applied to PA school several times before I got in. Spent my 28 months busting my butt and lived in seedy apartments and finally graduated.

I moved across the state of Texas and started my job with literally 20 bucks in my pocket and now get to deal with ungrateful, non-compliant, jerks who tell me I make too much and the people in the OR ask me to buy them lunch, because I'm rolling in dough.

Did I mention working 60-70 hours a week when they don't even work (the deadbeat patients that is).

It frustrates the hell out of me because they act like I was handed everything on a silver platter and sleep on piles of 100's at night.

If they only knew about the $1500 a month I shell out on student loans or that I still have to watch my bank account and make sure I've got enough money for gas until the next paycheck.

Now not all patients are like this, nor all the people in the OR. However, the ones who are like this really piss me off.

OK, rant over. Thanks for letting me vent.

-Mike

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[supercut]

I think it's important to point out how getting paid works. As a surgeon, the amount you are paid for doing a specific operation is a "global fee". You get paid for your initial evaluation, doing the surgery, and all followup care for a specific period of time after the surgery. If the patient languishes on your service with a prolonged ileus, and then has to wait for nursing home placement, you get paid the exact same amount for rounding on the patient every day as you do for someone who sails through the postop period quickly. If the surgery takes twice as long as usual, for whatever reason, you get paid the same.

Medicine folks, on the other hand, get paid for every day of rounds.

Also realize that what you get paid can depend highly on how well you get your office staff to work the system. Insurance companies work very hard to come up with bogus reasons not to pay claims. Two docs can provide the same dollar value of services, but the one whose office staff can better negotiate the insurance quagimire gets paid more. (Same way the person with the better tax accountant pays less taxes)

Getting paid as a doctor can be a challange to say the least. Oh, and if you are on salary at an academic center, you better be generating enough business to cover your salary...or face a pay cut.

It's a jungle out there!

 

[mdjobexchange]

Making money in medicine, especially as a surgeon is getting harder everyday. Not only is it a jungle out there, but you have to work your butt off to make it through the jungle.

The global fee is an awful creation by Medicare. Unfortunately, most insurance companies have picked it up and pay similarly. Most cases now are a 90 day global fee, where the postop visit and any complications or take-backs are covered under the global fee...in other words, if your hernia patient is a 68 year old, diabetic, obese smoker and you do the best operation you can and they end up pussing out their mesh and you have to take them back to the OR 3 times for various wash-outs and the ever popular wound-vac, you get the same payment as the 40 year old health person that had no problems. Guess what, I bet many physicians are going to start cherry picking patients as this goes on.

Office overhead makes a huge difference in what you get paid. If your overhead is 70% vs 45% and your collections are $700,000 a year, that means the difference between a take home salary of $210,000 vs. $385,000. Not only is good management important, but you have to be sure your office staff is not stealing money. I personally know 3 physicians who have had over $500,000 each stolen from their practices by office managers. Most of the theft occurred over a period of years.

As far as socialized medicine goes, anybody who wants that should ask themselves whether they want FEMA in charge of their healthcare. Our Federal Government is a failure in progress. I thought all of those people carrying around the "Ron Paul for President" signs were part of some kind of cult. I finally checked out his website and was rather surprised. He actually has some good ideas, most of which involve limiting our Federal Government and letting free markets decide. Medicine could use some more free market ideas. I am not the only one who thinks that doctors border on being indentured servants or slaves.

There was just a case in the Northeast where a number of primary care docs decided to drop Medicaid because it reimbursed so poorly. Unfortunately, their group did not have the proper corporate structure and the Federal Labor board determined that what they did constituted "Racketeering" and required them to keep taking medicaid patients, as they were the only primary group in a large radius. They tried to defend their position by saying this constituted slavery, but of course, it didn't work.

 

[surgeon2b forev]

Hey mdjobexchange,

I appreciate your comments and thoughts... but, I can't help but wonder... what are your thoughts on how we should control medical costs, and the ridiculous hyperinflation that is american medicine?

Costs were skyrocketing before HMO's became popular in the 90's.... and while they continued to skyrocket, the rate of medical inflation was greatly reduced.

One way to control costs is to give incentives to hospitals and providers to get patients out. You can't simply reimburse doctors whatever they deem necessary whenever WHEN they have a financial incentive to do so.

 

[urge]

brup...

 

[Pilot Doc]

You can't simply reimburse doctors whatever they deem necessary whenever WHEN they have a financial incentive to do so.

That's the way the rest of the economy works

 

[Tenesma]

1) supply and demand - there are not enough nurses and therefore they can make good money - my wife was making 85k/year as a nurse working 3 12 hour shifts without evenings or weekends -- and since she was a travel rn we also got free housing -

2) general surgeons: got screwed with 90 day rule and bullying by insurance companies - they also screw themselves with the attitude that they need to manage everything (primarily because they believe that nobody can manage post-operative HTN better than they can, etc...) ---

3) general surgeons get screwed also because they tend to do a lot of crap cases on patients either without insurance or patients with medicaid who need the 10th revision of their toe amp - so even if they work hard, they get stuck with low paying procedures/patient populations

how do you fix this?

A) only work as a consultant - and all pre,peri and post-operative care to be delivered by hospitalists/internists - frees up more time for you to do other stuff

B) aggressively market yourself with PCPs as the go to guy for more lucrative procedures - that will require research on your part as well as figuring out how NOT to piss off potential referral sources

C) choose procedures that don't have 90 day globals

D) create a niche market for yourself to set yourself apart

(example: a local gen surgeon does all the pacemaker implants for the huge cardiology group that doesn't have an EP guy, another local gen surgeon only does hemorrhoid management)

academia pays lousy - so don't go academic unless you are nuts... i find that most people who do stay academic either do it for perceived benefits, job-security, prestige - but frequently it is because they couldn't hack it in a private practice environment (ie: able to see 30 patients in 3.5 hours and then do 5 cases in 3-4 hours)...

most private practice guys i know can do chole's in under 30 minutes and partial hepatectomies in 45 minutes - so you can imagine the difference with academia where the residents are on their 5th hour of the chole - the revenue just won' tbe the same

 

[SLUser11]

A) only work as a consultant - and all pre,peri and post-operative care to be delivered by hospitalists/internists - frees up more time for you to do other stuff

This is the part that's the hardest to accept. We train in general surgery to become complete physicians and we develop patient ownership, and then we discover that we need to sacrifice many aspects of patient management in order to have a lucrative practice.

This is one of the many reasons that I'm very interested in being involved in teaching. At this point (and I'm very early in my training), I can't imagine making a hospitalist take all the calls on my patients. I'd rather continue to be involved by supervising resident management of these patients.

 

[Winged Scapula]

Agreed....there is a sense of pride in being able to do most things for your patient and not consulting out. Of course, sometimes it gets taken to extreme but I think most surgeons would be loathe to have others manage their pre/peri/post op patients, but it does seem to be done more regularly in the community setting.

If I can offer a piece of advice to the junior residents here: the more in office procedures you can become facile with, including biposies, especially image guided ones, the more income you can make. Breast is not the only arena for this...you will be suprised to find that you can make more money biopsying something in the office than going to the OR (which takes longer, is more hassle generally, etc.) Obviously in academics, this may not make a difference or there may be turf wars, but so few of us are taught these skills and what they pay.

 

[Faebinder]

With respect to giving hospitalist the management of postop patients... I dont think they want them. Truly. Likely those patients wont need a procedure post op (so less money involved) and the dressing changes... well we know how medicine will not touch a dressing. Heck as soon as a patient comes postop back to he ER, the ER proceeds to call the surgeon to admit.. not a medical admitting attending, even if the patient is a month post op with a semi related problem. Medicine doesn't appreciate "Surgical Dumping" even though they make money from it and surgery doesnt.

 

[Pilot Doc]

Medicine doesn't appreciate "Surgical Dumping" even though they make money from it and surgery doesnt.

If medicine dumping allows you to double your operative volume, the CEO who subsidizes the hospitalist contract will tell them to shut up and write your sliding scales.

 

[gida]

I think you guys (and gals) should take a look at referral patterns.
I will just tell you an example as I have found it now in a GI private practice....we have 6 general surgeons...5 of the 6 do a few egds and once in a while a colon. We have a group of 6 gastroenterologists....and we all 'tend to' refer almost all our patients to the 1 general surgeon who doesn't scope (unless we need a weekend consult when we just call the guy on call). The funny thing is that these guys still do their few scopes per week, and wonder why they don't get any of our business!! In fact, we just got a letter from one of the surgeons saying he isn't gonna scope anymore. Funny, you take some scopes away, we will refer to someone else, or refer out. And I know GIs in other states even, who do this as well. I have no qualms about referring my insured patients to a guy who doesn't dabble in endoscopy.
New colonic lesion....guy who doesn't scope is outta town...the patient should probably go to an academic center and have an expert do his colectomy...

 

[sleeping]

"stop scoping to get referrals"

I have seen this in the community hospitals I have been at. Too bad we always have to bow to medicine for referrals. Wish there was another way besides the ER for business.

 

[Faebinder]

I think you guys (and gals) should take a look at referral patterns.
I will just tell you an example as I have found it now in a GI private practice....we have 6 general surgeons...5 of the 6 do a few egds and once in a while a colon. We have a group of 6 gastroenterologists....and we all 'tend to' refer almost all our patients to the 1 general surgeon who doesn't scope (unless we need a weekend consult when we just call the guy on call). The funny thing is that these guys still do their few scopes per week, and wonder why they don't get any of our business!! In fact, we just got a letter from one of the surgeons saying he isn't gonna scope anymore. Funny, you take some scopes away, we will refer to someone else, or refer out. And I know GIs in other states even, who do this as well. I have no qualms about referring my insured patients to a guy who doesn't dabble in endoscopy.
New colonic lesion....guy who doesn't scope is outta town...the patient should probably go to an academic center and have an expert do his colectomy...

I disagree with your strategy. One, you refer out and guess who is doing the following colonoscopy? Not you, surgeons certainly don't have the time to screen every single colectomy and gastroectomy they do every single year and 3 years there after. Two, you refer out more, they do less surgeries and end up needing to screen more for business. So you are defeating your own purpose.

I advise you openly speak with the surgeons, sometimes they just dont have a clue. You can benefit from the followups they send to you.

 

[gida]

I disagree with your strategy. One, you refer out and guess who is doing the following colonoscopy? Not you, surgeons certainly don't have the time to screen every single colectomy and gastroectomy they do every single year and 3 years there after. Two, you refer out more, they do less surgeries and end up needing to screen more for business. So you are defeating your own purpose.

Not really
1) We refer out to an academic center, and the academic surgeons refer them back to us for their surveillance colons---why? they want to keep their referrals from us. And like you said, a good surgeon doesn't have the time and would rather be in the OR. Also a patient is much more likely to travel to an academic center for surgery, than travel there for a 20 minute colonoscopy.
2) Our local surgeons may be in the OR less, but they don't have the referral base to increase their endoscopies...most competent primaries (where we live) send the gastroenterologists the screening colons.

I agree, GI and surgeons should work as a team and not against one another...but I'm sorry, if you scope I'm not sending you business.
Trust me, their salaries are much more affected than mine!

 

[greater_omentum]

I have to respectfully wave the challenge flag on some of the numbers thrown out here for salary figures. I go to school up in new england, and was talking with one of the more senior surgeons in our department (has been a figure in our faculty for >25 years) between cases. He told me that he can hire general surgeons- depending on experience- for between 200K and 225K per year. Breast surgeons, he admitted, could be had for the bargain basement rate of 180K...but when you throw in the sweet hours our breast surgeons work, that doesn't really sound that bad. I would imagine our compensation is on the low end of things- academics in the northeast is not a known money maker...

bottom line, none of us are going to starve. another take home- the very same surgeon told me "if you're going into surgery, you have to learn how to whine." d

 

[Winged Scapula]

I have to respectfully wave the challenge flag on some of the numbers thrown out here for salary figures. I go to school up in new england, and was talking with one of the more senior surgeons in our department (has been a figure in our faculty for >25 years) between cases. He told me that he can hire general surgeons- depending on experience- for between 200K and 225K per year. Breast surgeons, he admitted, could be had for the bargain basement rate of 180K...but when you throw in the sweet hours our breast surgeons work, that doesn't really sound that bad. I would imagine our compensation is on the low end of things- academics in the northeast is not a known money maker...

bottom line, none of us are going to starve. another take home- the very same surgeon told me "if you're going into surgery, you have to learn how to whine." d

That's the difference. Academics in the northeast is amongst the lowest paying in the country. When you factor in COL, it hardly seems worth it. I meet a breast surgeon from Boston a couple of years ago and she claimed she was only making $90K. I have no reason to doubt her except to think there has to be some reason other than working part-time. At any rate, all you have to do is look at the AAMC average faculty salaries and see that a fellowship trained surgeon in the area generally only makes between $150 and $175K/year. I know some breast fellowship trained surgeons who did take jobs under $200K (despite an agreement by all of us not to...we knew someone would crumble). I also know a couple making > $300K. I am not as in touch with general surgery salaries since I barely know anyone in PP doing that.

The point is that rather than waive the challenge flag, accept that salaries have a very wide range depending on locale, market value, practice environment and other such things. Salaries are highly negotiable...friends and I interviewed for the same jobs and compared salary offers and they were always different. Obviously a fluid number based on what they presumed your marketability was (or whatever other factors they deemed important).

Short of showing you MY paystub, I'll tell you that your senior surgeon would not be able to get THIS breast surgeon for $180K or anywhere near that, and I'm not the highest paid of my colleagues across the country.

 

[H_Caulfield]

Most salary surveys don't seem to make the distinction between academic and private practice. For someone thinking about going into private practice, I wonder whether this would mean that he/she could expect to make significantly more than those survey figures, or whether the number of academic physicians is comparably so small as to not really affect it.

Ex., if general surgeons are listed as making 249k on average, would it mean that the private practice guys are averaging more like 280k? Or are the academics sparse enough that it's not going to make any practical difference.

Just thinking out loud. Either way the difference wouldn't be enough to be any sort of deciding factor.

 

[Winged Scapula]

Most salary surveys don't seem to make the distinction between academic and private practice.

That is true...that's why you have to look at things like AAMC surveys and take into account appointment percentage and professor level. They also don't take into account income from ownershop of ASCs, resident education (those in PP who have residents rotate with them will get some $$ frm the program), etc.

Some of the surveys include benefits (which can be worth $50K) but don't make that particularly clear.

 

[wanabdoc]

Does anyone know the percentage of physicians who are in private practice versus academics?

 

[TheMightyAngus]

That's the difference. Academics in the northeast is amongst the lowest paying in the country. When you factor in COL, it hardly seems worth it. I meet a breast surgeon from Boston a couple of years ago and she claimed she was only making $90K. I have no reason to doubt her except to think there has to be some reason other than working part-time. At any rate, all you have to do is look at the AAMC average faculty salaries and see that a fellowship trained surgeon in the area generally only makes between $150 and $175K/year. I know some breast fellowship trained surgeons who did take jobs under $200K (despite an agreement by all of us not to...we knew someone would crumble). I also know a couple making > $300K. I am not as in touch with general surgery salaries since I barely know anyone in PP doing that.

The point is that rather than waive the challenge flag, accept that salaries have a very wide range depending on locale, market value, practice environment and other such things. Salaries are highly negotiable...friends and I interviewed for the same jobs and compared salary offers and they were always different. Obviously a fluid number based on what they presumed your marketability was (or whatever other factors they deemed important).

Short of showing you MY paystub, I'll tell you that your senior surgeon would not be able to get THIS breast surgeon for $180K or anywhere near that, and I'm not the highest paid of my colleagues across the country.

Do breast surgeons do augmentations and other cosmetic procedures? Seems like they could make a killing off of cash paying patients if they do. If they don't, why aren't they?

 

[Winged Scapula]

Do breast surgeons do augmentations and other cosmetic procedures? Seems like they could make a killing off of cash paying patients if they do. If they don't, why aren't they?

It depends on what you can get credentialed for and what the environment allows. Most breast fellowships do not have adequate training in advanced tissue flaps so unless you could show that you had done these in training, it would probably be hard to get privileges to do TRAMs, Lats and other less common flaps.

However, augmentation with tissue expanders and implants are not technically difficult and you could probably get privileges for those without too much difficulty. The problem becomes more complicated however because if you have a group of PRS guys that wield a fair bit of power, they may be unwilling to want to teach you and will probably block attempts by you to do them. In addition, augmentation or reconstruction for oncologic reasons are not cash payors but rather paid for (by law) by insurance, so its not the big money you would think it would be (ie, as compared to augs for non-reconstructive purposes).

You do not want to get involved in turf wars...PRS depends on breast surgical oncologists for referrals and vice versa. If you piss off the local PRS guys, you won't have people to refer your patients to.

Finally, many breast surgeons are not interested in doing aesthetic procedures because we are trained at doing oncologic operations which can be at odds with the aesthetic goals. If it were up to me, I'd take nearly every last piece of breast tissue during a mastectomy, leaving extremely thin flaps. The PRS guys prefer you leave a little more because it ends up looking better, especially when using medical devices for reconstruction rather than tissue transfers.

Locally, we have found that many of the PRS guys have enough business and do not make much money on reconstruction with implants so are willing to turn some of that business our way. Your experience may vary wildly.

Hope that answers your question.

 

[FliteSurgn]

I think you guys (and gals) should take a look at referral patterns.
I will just tell you an example as I have found it now in a GI private practice....we have 6 general surgeons...5 of the 6 do a few egds and once in a while a colon. We have a group of 6 gastroenterologists....and we all 'tend to' refer almost all our patients to the 1 general surgeon who doesn't scope (unless we need a weekend consult when we just call the guy on call). The funny thing is that these guys still do their few scopes per week, and wonder why they don't get any of our business!! In fact, we just got a letter from one of the surgeons saying he isn't gonna scope anymore. Funny, you take some scopes away, we will refer to someone else, or refer out. And I know GIs in other states even, who do this as well. I have no qualms about referring my insured patients to a guy who doesn't dabble in endoscopy.
New colonic lesion....guy who doesn't scope is outta town...the patient should probably go to an academic center and have an expert do his colectomy...

Wow, the surgeons take a few scopes away and your group becomes a bunch of jealous and vindictive souls. Why does it have to be like that? Are you that threatened by the few meager endoscopies that those guys are doing? Despite having (assumingly) capable surgeons, you're refering cases away from your own institution out of spite? Who benefits in this scenario?

The other day, I wrote for a sliding scale, by your group's logic I can now write off all referrals from that PCP. Dang.

As a general surgeon, I still perform some endoscopy and I think it's very important to continue. I don't perform routine screening, but there are certain times that I need information that usually isn't conveyed from a non-surgeon performing the endoscopy. I've been burned (and subsequently the patient) by the description of colon cancer locations and especially rectal cancer measurements from the anal verge. As a surgeon that performs my colon resections almost exclusively via the laparoscope, I need to have very accurate information. When it's my reputation (and the patient's oncologic outcome) on the line, I'd prefer that I get my info first hand. Or how about that intra-operative EGD on a patient undergoing a Heller myotomy? You think it's in the patient's best interest to wait for a gastroenterologist to come do that too? (And realize that I get paid the grand sum of $0 for doing this)

It doesn't sound like you're hurting for income and by your own admission, the scopes these guys are doing is a pittance...so why not do the best thing for the patient, your facility, and the surgeons that you'd rely on in an emergency...get off your high horse and quit referring these things out of house.

Do a scope, find a cancer, immediately refer to LOCAL surgeon, get resection the next day without a new bowel prep vs. find cancer, refer to "expert" that doesn't dabble in endoscopy, let the patient wait, let them have another prep, you chuckle all the way to the bank. Next time, take a deep breath and think what would be best for the patient instead of what's best for your bottomline.

 

[Faebinder]

Wow, the surgeons take a few scopes away and your group becomes a bunch of jealous and vindictive souls. Why does it have to be like that? Are you that threatened by the few meager endoscopies that those guys are doing? Despite having (assumingly) capable surgeons, you're refering cases away from your own institution out of spite? Who benefits in this scenario?

The other day, I wrote for a sliding scale, by your group's logic I can now write off all referrals from that PCP. Dang.

As a general surgeon, I still perform some endoscopy and I think it's very important to continue. I don't perform routine screening, but there are certain times that I need information that usually isn't conveyed from a non-surgeon performing the endoscopy. I've been burned (and subsequently the patient) by the description of colon cancer locations and especially rectal cancer measurements from the anal verge. As a surgeon that performs my colon resections almost exclusively via the laparoscope, I need to have very accurate information. When it's my reputation (and the patient's oncologic outcome) on the line, I'd prefer that I get my info first hand. Or how about that intra-operative EGD on a patient undergoing a Heller myotomy? You think it's in the patient's best interest to wait for a gastroenterologist to come do that too? (And realize that I get paid the grand sum of $0 for doing this)

It doesn't sound like you're hurting for income and by your own admission, the scopes these guys are doing is a pittance...so why not do the best thing for the patient, your facility, and the surgeons that you'd rely on in an emergency...get off your high horse and quit referring these things out of house.

Do a scope, find a cancer, immediately refer to LOCAL surgeon, get resection the next day without a new bowel prep vs. find cancer, refer to "expert" that doesn't dabble in endoscopy, let the patient wait, let them have another prep, you chuckle all the way to the bank. Next time, take a deep breath and think what would be best for the patient instead of what's best for your bottomline.

And there ya go.. the voice of reason speaks. The anal verge comment is sooo true. Got burnt several times with the tattoo being far away from the tumor. Still at our institution, the colorectal surgeon will never scope as a screen unless it's a special request. Meanwhile, all the 1 year followup scopes get tossed back to the gastroenterologist. The relationship is solid like that. We consult them, they consult us. All is well. Tossing patients out to a different institution might result with that patient continuing with that institution for followup scopes and everything else.

I would suggest a meeting between both parties. Sir please don't screen scope here in this hospital and we will make sure you get some of the cancer patients by not refering them to the outside. It's really that simple. I doubt the message wont go across.

Likewise for the EGD, a promise to call the gastroenterologist to come scope during a heller will add extra benefits to both sides. (At our institution, we let the gastroenterologists come EGD scope the hellers and that makes em happy.)

 

[gida]

1) Our surgeons are not that competent (endoscopically or sugically).

2) We are a PC and own an ASC...in doing so we took over 3,000 scopes per year away from the hospital. Our surgical group sold their practice to the hospital. The hospital is our competition, and thus now business is business...we also send the path from all our ASC patients out away from the hospital, and now boo hoo hoo the pathologists are pissed.

3) I just want to learn simple lab choles. How many do I need to scrub in on to "just get my numbers."??? I'll do that, then go out in the community and start performing them. If I get any complications, I'll call the gen surg guy on call to back me up. Any post op complications, I'll consult the gen surg guys/gals. Since I'm GI I can do my own pre or post op ERCPs anyway.
UH, do you see anything wrong with this mentality? 50 colonoscopies during a 5 year surgical residency does not make someone close to competent.

Perhaps, you guys hold yourself to a higher standard. But I wouldn't let any of our surgeons do anything but hernias, choles, and appys.

I have only been in practice 3 months and already have horror stories....weekend, obstructive jaundice, ERCP shows Mirizi....call the surgeon, 2 weeks later I'm on call again and same patient with same smx...ERCP shows the same F.....G stone in the cytic duct...the surgeon did a chole and never addressed the stone in the cystic duct!! What a freaking *****. Read the GI ERCP findings or listen to the report, or don't you even know what Mirizi when I tell you over the phone!! Just Busch League.

 

[gasnewby]

It's Mirizzi's, actually.

 

[gasnewby]

And "lap" choles. Stands for laparoscopic.

 

[gida]

You would make a great transcriptionist if this doctor thing doesn't work out.

 

[gasnewby]

thanks. but it's really my superior knowledge base of GI disorders. keep studying though, you may catch up eventually.

 

[gasnewby]

Just Busch League.

are you talking about Nascar?

 

[FliteSurgn]

1) Our surgeons are not that competent (endoscopically or sugically).

If that's true, then I don't blame you for referring out. Referring out for competent care is different than referring out from spite.

3) I just want to learn simple lab choles. How many do I need to scrub in on to "just get my numbers."??? I'll do that, then go out in the community and start performing them. If I get any complications, I'll call the gen surg guy on call to back me up. Any post op complications, I'll consult the gen surg guys/gals. Since I'm GI I can do my own pre or post op ERCPs anyway.
UH, do you see anything wrong with this mentality? 50 colonoscopies during a 5 year surgical residency does not make someone close to competent.

I know family practice docs that used to perform their own open choles and appys. As you acknowledge, this is probably not the best case scenario when the **** hits the fan. Thus, the practice has been mostly abandoned. Skills in any specialty seem to be distributed in a bell shaped curve. Some surgeons are better than others just like some endoscopists are better than others. In this instance those skill sets may overlap.

As to endoscopic competence, I'll use myself as an example. I'd put my skills against anyone. The endo nurses routinely let me know that I am better than any of the GI docs here. I've never asked for GI assistance due to a complication from endoscopy, but the reverse certainly isn't true. For example I've never put a PEG through the colon, but I've fixed several from the GI guys.

As to numbers, I did more than 250 endoscopies during my residency. Lets be honest, and no offense meant, but endoscopy certainly isn't rocket science. I did not feel I needed anywhere near that number to be competent, but I did more than most of my counterparts because I like endoscopy. While I was a surgeon in the Air Force, about 80% of my practice was endoscopy because that's what was needed and we didn't have any active duty GI docs...they were all out in private practice stealing cases to their ASCs away from the community hospital so they could make more green.

Perhaps, you guys hold yourself to a higher standard. But I wouldn't let any of our surgeons do anything but hernias, choles, and appys.

See above. Skills vary widely in all disciplines. My partners and I all perform advanced laparoscopic surgery, bariatrics, pancreatic surgery, colorectal/GI resections, etc. I am the only one that "dabbles" in endoscopy though.

And, sorry to highjack this thread!