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Wednesday, July 6, 2022

General surgery. There are fewer and fewer surgeons in Poland. Data and appeals to change it

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Only 35 doctors in Poland have recently decided to start specialization training in general surgery. 62 residences remain vacant, and hospital directors are puzzled over how to fill their shifts. Within five years, the number of surgeons in Poland has dropped by half, and the average age of practicing this profession has increased to 59.5 years. Reason? – Hard work, low wages and underinvestment of departments that are on the verge of profitability for hospitals – the doctors are explaining. In order to be able to save lives under the National Health Fund, they inject wrinkles and enlarge the lips in private clinics.

According to the data of the Supreme Medical Chamber, on June 1, 2022, there were 9,535 general surgeons in Poland, of which 8,910 practiced.

Of these 8910 “full” specialists, with a second degree of specialization or a completed unified specialization, there are 6416 people. However, general surgery procedures are probably performed by even fewer doctors. – This data concerns all doctors who have specialized in general surgery, including those who chose oncological, thoracic or vascular surgery as their next specialization. In the past, it was impossible to become a thoracic or vascular surgeon without completing a specialization in general surgery, and people who perform only procedures such as vascular surgery today are included in our statistics as general surgeons – explains Renata Jeziółkowska, spokesman of the Supreme Medical Chamber.

These several thousand general surgeons are not enough, which is felt acutely by hospital managers and patients. And there is no solution to this situation, because the once prestigious surgery attracts fewer and fewer doctors every year.

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According to the Agreement of Surgeons “Skalpel”, in the spring session of 2022, only 35 doctors chose the specialization in general surgery, and 62 residences were not filled. This means that only every third specialization place was filled, despite the fact that general surgery is one of the priority specializations, and its residents can count on salaries higher than e.g. dermatologists, cardiologists or gynecologists.

They have been appealing for three years

“The average age of a surgeon a year ago was 58.5 years, and the total number of general surgeons in Poland is approx. 9 thousand, which in crisis situations poses a direct threat to the life and health of citizens” – wrote in December 2019 in their manifesto Agreement of Surgeons “Skalpel”.

Krzysztof Hałabuz – co-founder of the Association of Residents (PR) and resident of general surgery, Katarzyna Pikulska – PR activist after residency in orthopedics and a marriage of specialists: general and vascular surgeon Renata Florek-Szymańska and neurosurgeon Tomasz Szymański concluded that no changes in education and earnings surgeons, in a few years there will be no one to operate on Poles.

For three years they have been alarming in the Ministry of Health and in the media that the condition of Polish surgery is catastrophic. They write to national ministers and consultants and fight for the so-called a no-fault system, which will result in doctors not being criminally liable for adverse events beyond their control. Already three years ago, they pointed out that the specialization program is outdated, and that future surgeons must perform, inter alia, vagotomy, i.e. excision of the vagus nerve at the stomach, which is currently treated pharmacologically, or several esophageal surgeries performed in only a few centers in the country. To complete specialization training, residents travel all over the country, often just to look over someone’s shoulder. This is discouraging.

Average age of the surgeon: 59 years

– Three years after our manifesto, the situation in surgery has even worsened, as evidenced by an increase in the average age of the surgeon by one year to 59.5 years. You can blame it on the pandemic that delayed all corrective actions, but the truth is that surgery is not a priority for this government, says Krzysztof Hałabuz, president of the Alliance of Surgeons “Skalpel”. And the president of “Skalpela”, general and vascular surgeon Renata Florek-Szymańska notes that the times when every candidate for medicine wanted to become a surgeon are over, and the best candidates applied for this specialization.

– When I chose surgery 20 years ago, first I had to wait a few years for the opening of the specialization, because the places were blocked, and then I regularly heard that the woman’s place is in the kitchen, not in the operating room. I did it because I wanted to learn and I was tough. Today, the resident of surgery is taken care of, because young people in this specialization are like medicine – explains Renata Florek-Szymańska.

Piotr Pisula, former chairman of the Alliance of Residents and a resident of general surgery for a year, admits that it is very difficult to find people like him today: – Surgical departments, especially in district hospitals, have huge staff problems. It happens that they work “overlap”, because the entire medical staff consists of three surgeons who exchange on duty every third day, if they do not find external ones. When a resident comes to see them, the staff of the branch increases by 30%. – says.

He chose the poviat hospital – first in Wolsztyn (Greater Poland Voivodeship), and now in Oborniki Wielkopolskie, wisely. – There may be five or even ten residents on the ward in Poznań, so it is more difficult for them to get to the operating table. There are places where they stand for months as third or fourth assist. In a poviat where there is a dramatic shortage of people, independence is quickly achieved. Senior doctors want you to start on duty yourself as soon as possible, so they teach you everything – says Piotr Pisula.

As early as his studies, Pisula was on duty in general and vascular surgery departments, he was given an opportunity to study. He started his residency with experience and the conviction that he knew what he wanted to do. – I have this character, I like to make decisions quickly and act. Already during the studies, my colleagues and lecturers said: “This one will become a surgeon”. But I know that there are not many people like me – he admits. A former scout, a graduate of biological chemistry and the Medical University in Poznań, he is a born activist and taskman. Therefore, he withstands the pressure and the pace.

The carpenter does not take the emotions home

He adds that surgery may be discouraged by the fact that it is difficult to find a healthy “work-life balance”. – It is a job under constant stress, keeping you awake at night, full of emergency situations, where you have to make quick decisions that determine human life – here and now, not on paper. When going to college and having no idea of ​​the system, many people are imprinted with the magic myth from the olden days that surgery is the most prestigious. But when they stand at the table and have to hold “hooks” for three hours, many people realize that such a lifestyle is not for them, he explains.

Former Alliance of Residents chairman and orthopedic resident Filip Płużański agrees that the surgeon’s job is both physically and emotionally demanding. – Although during the procedure we limit ourselves to the operating field, not thinking that this patient has four children and a wife who are waiting for him, but if it turns out that we cannot help him, because, for example, he has an inoperable cancer, we take this helplessness home, along with physical fatigue. That is why so many surgeons are among highly functioning gamblers and alcoholics – says Płużański.

He is angry at the vicious comparison of surgeons to butchers, and orthopedists to builders or carpenters. – After finishing the plaster, the worker closes the door and goes home calmly, not worrying that if he does not close the bucket with the paint, someone will die – he explains.

To save as part of the National Health Fund, she privately enlarges her lips

And all this for PLN 6769 gross per month – this is the minimum amount base salary a specialist employed full-time in public health care. And from July, in accordance with the law on the method of determining the lowest basic salary in health care, adopted on Thursday by the Sejm, gross PLN 8210, which, as doctors emphasize, will not equal the double-digit inflation.

For most general or vascular surgeons, the public hospital remains their primary place of work. There, they excise diffuse appendages, remove gallbladders, and perform extensive oncological operations. – In public hospitals, they are performed by specialists with great work experience and unique skills who are unable to pay off loans or support their families for their work. In order to save people’s lives in a public hospital, they have to earn extra money in private institutions, for example in aesthetic medicine offices, says Renata Florek-Szymańska.

Without lip augmentation, wrinkle injections, or the implantation of lifting threads, she would not be able to afford saving aneurysm victims. – Young people see it and choose specializations that will allow them to survive in the future – he emphasizes.

Surgery unprofitable for the hospital

According to Krzysztof Hałabuz, graduates of medical faculties are also deterred by the outdated training system: the lack of modern treatments, the inability to exercise in simulation centers and queues to the operating table. – Many procedures must be performed as an operator or first assistant to complete the specialization training. And many residents over the years are the second or third assist. This should not be the case, says the president of the Alliance of Surgeons “Skalpel”.

Renata Florek-Szymańska is one of the few specialists who train younger colleagues. When she left the previous hospital, the youngest resident came to thank her that he could always count on her, ask about something and that she let him learn, which was not the norm in the ward.

One more thing discourages the young – the surgical wards are the most neglected part of the hospital. It is not about beds or patient rooms – these are often renovated with funds from the local government or the EU. We are talking about equipment – even 15 years old, perishable, not always working as it should, no threads or specialized dressings. The surgical department, apart from paediatrics, internal medicine and gynecology, required even in basic level hospitals, is one of the least profitable. For surgical procedures National health Fund pays much less than they cost the hospital.

– Let us assume that an hour of operation of the operating theater, taking into account drugs, surgical materials and the costs of work of surgeons, anaesthesiologists and the rest of the staff, amounts to PLN 30,000. It is more profitable for the management to let in orthopedists who will perform, for example, arthroplasty for PLN 34 during this hour, than for general surgeons who will operate on varicose veins. In the first case, the hospital will lose PLN 28,000, in the second case it will earn PLN 4,000. Unfortunately, the most necessary and most frequently performed surgeries, such as hernias, gallbladders or varicose veins, generate losses – says Filip Płużański, who was the medical director of the hospital in Łowicz for over a year.

– And it shouldn’t be so! It’s just unfair to everyone, especially patients. Procedures should be priced adequately, fairly. Except that health ministry for at least four years there has been no time to make the valuations real – emphasizes Krzysztof Hałabuz.

What’s next, surgery?

Renata Florek-Szymańska looks to revise the valuation of procedures and training path. She also quietly hopes that it will be before she and the thousands of surgeons of her generation are of an age when they are no longer able to work. There is no doubt that today the system is based on people like her and her husband with a sense of mission, taking the duty of sick colleagues and thinking mainly about patients. Because – she is sure – the young generation will not make their mistakes, which is reflected in the staffing of specialization places.

Krzysztof Hałabuz believes that the Ministry of Health will understand that surgery is centimeters away from drama. Therefore, he recruits surgeons to the association and encourages them to fight for patients.

Filip Płużański sees hope in doctors from Ukraine. – They are still living with the prestige of this specialization, which for them remained St. The grail of medicine. I am not worried about their skills, because no one will let a doctor come to the table without specialization and recognition. Personally, I would be glad if I could learn from an experienced orthopedist from Ukraine – emphasizes Płużański.

Main photo source: Shutterstock

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