Being both a clinically active surgeon involved in resident education and also being the principal at a locums-type company, this time of year always causes me to reflect. Beginning around May, Chief residents begin to approach me because they have finally begun to explore the employment landscape and become rather disenchanted. Chief among the complaints are a lack of understanding of the contract which leads to a feeling that they're being taken advantage of, an impossibly restrictive call commitment which paints a bleak landscape for the next year or two, and only a vague promise of a bonus. The dilemma is that these very surgeons are oftentimes not prepared for the demands of independent practice let alone the premium locums practice where they will be called upon to perform difficult cases, oftentimes with limited ability to consult a senior surgeon.
It is rare in these times that residents completing their training are ready for full independent practice the way the previous-generation was. This is because of decreasing autonomy on call and in the operating theatre. Almost every facility has an in-house attending now. This is good for patient care in the short term, however it poses a great challenge to the trainee who is forced to be on call by themselves for the very first time when there is no one available to assist them. It is a shame that there cannot be a balance between the need to prepare residents for independent practice and optimal patient care.
This always poses a great dilemma for myself because I would like to provide an optimal alternative to a traditional practice setting where Physicians are empowered. I have to recognize the limitations of individual providers as a result of the modern training paradigm. The way that I deal with this is by addressing is on a case-by-case basis. The best way for me to handle this is to consider each case and try to pair them with the optimal practice setting. For example a resident that does not feel particularly comfortable with emergency situations would be best suited in a busy elective practice where most of the action takes place during the day where there are other surgeons around. Alternatively some facilities require formal proctoring of the first 10 procedures. These are oftentimes good settings for these young surgeons. Sometimes we have to refuse a recent graduate because they do not have the skill required to take on independent trauma surgery. This is where being on both sides of the equation is a great benefit to InterTrauma Consulting. Unlike traditional a traditional locums company which is very interested in business we are also concerned with patient safety, the reputation of the clinicians, and ensuring that there is a good fit between the provider and the center. It seems obvious to me that companies that are tasked with providing coverage should have clinical insight and I am disappointed that more are not. All this is however our greatest advantage.