Inserción laboral del cirujano joven en la Ciudad de Buenos Aires. Necesidad de reestructuración del sistema de formación del cirujano general / Young surgeons entering the workforce in the City of Buenos Aires. Need for restructuring of the general surgery training system

RESUMEN Antecedentes: la formación en cirugía se mantuvo uniforme desde la instauración del modelo de re sidencias. El avance de la ciencia ha llevado a la superespecialización y un 70% de los cirujanos conti núan en formación con una especialidad posbásica. Objetivos: identificar la proporción de cirujanos que derivan horas a otra actividad y analizar la inser ción laboral del cirujano. Material y métodos: estudio prospectivo, descriptivo, de corte transversal. 1) Encuesta, 2) Registros de la Dirección General de Docencia e Investigación, 3) Concursos y Perfiles profesionales de acceso público. Resultados: sobre 435 encuestados, al finalizar la residencia, un 73,3% continuó su formación en una posbásica. Solamente un 24,7% se insertó inmediatamente en el mercado como cirujano general. En cuanto a la inserción laboral actual de aquellos que finalizaron la formación como cirujano general, apenas un 17,4% se desempeña de manera exclusiva como cirujano general. Conclusiones: la falta de confianza para actuar de manera independiente y la necesidad de completar 4 años de formación para ingresar en el campo de interés aparecen como las problemáticas para resol ver. Se propone un programa de 5 años con formato 2+3. El período de formación básica abordará en 24 meses las generalidades de la práctica quirúrgica. El segundo, de formación avanzada, desarrollará en profundidad la subespecialidad elegida. El quinto año otorgará a todos la posibilidad de actuar a modo de cirujano independiente. Planteada como una subespecialidad, la Cirugía General volvería a ser un fin en sí misma y no un medio para llegar a una subespecialidad.

ABSTRACT Background: Training in surgery has remained relatively uniform since the residency programs were introduced. The continuous advances in science have led to the progressive super-specialization of surgeons; 70% of them continue their training with a subspecialty. Objectives: The aim of this study was to identify the proportion of surgeons who dedicate hours of their practice in another activity and to analyze how surgeons enter the workforce. Material and methods: We conducted a prospective and descriptive cross-sectional study with data from a survey, records of the General Directorate of Teaching and Research, and records of competitive selection processes and professional profiles available online. Results: Of 435 survey respondents, 73.3% of the resident graduates continued postresidency training in a surgical subspecialty. Only 24.7% immediately started working in general surgery. Among the graduate trainees in general surgery, only 17.4% were exclusively dedicated to general surgery. Conclusions: The lack of confidence to perform procedures independently and the need for completing 4 years of training in the residency program in general surgery to start training in the professional field of interest, appear as the issued to be solved. We propose a 5-year program with a 2+3 model. The initial period comprises 24 months of basic training covering the general aspects of surgical practice. The second period of advanced training will provide thorough training in the subspecialty chosen. In the last year of the 5-year program trainees will have the opportunity to act as attending surgeons. General surgery, conceived as a subspecialty, would regain its status as an objective and no longer a pathway to become a subspecialist.

Surgical Practice and Fellowship Training

Although the subspecialization of surgical practice and fellowship training have progressed well in most of the university hospitals in Korea, no apparent supervision system has yet been activated. There have recently been active debates and discussions between society members on the issue of a certification for fellowship training, which ultimately prompted the Korean Surgical Society to prepare appropriate measures. In order to facilitate the process of establishing ideal measures, in our unique circumstance of surgical practice, I can suggest some of my personal opinions. First of all, I recommend that the Korean Surgical Society and its all member to strive against government interference and achieve an attending system for surgical practice and to obtain reasonable insurance reimbursement for surgeons' work, which are all prerequisites for both general and subspecialty surgical practices. Rigorous criteria for approval and credentialing of a fellowship training program should be established, whether certification will be given or not. Certification should be offered only when there is agreement between all the members of subspecialty boards and the association of practicing surgeons. All measures should be taken so as not to compromise surgical residency training by subspecialty fellowship. As subspecialization progresses, the specialty of general surgery also needs to be redefined. A discreet long-range plan of the surgical work force should be done to keep the proper number of both generalist- general surgeons and subspecialist-general surgeons. In order to take the initiative for the moderation of the interests between different subspecialty boards, and to establish a structured fellowship training program, the Korean Surgical Society should reinforce its administrative functions.