samedi 3 octobre 2015

Cancer surgery: causes of a shortage

"The good news is that surgery is effective and surgery is cost-effective.... In fact, it's the most cost-effective treatment,"
Right. But does it mean that cancer surgery will survive?
Several empirical remarks about this paper:
1/ among young physicians and residents the choice of surgery is deeply motivated by the rewards of a very well known heavy duty. Tariffs are in some countries a negative incentive toward cancer surgery.
So every shortage should be assessed in this perspective. In other words the surgical career is by far become a highly risky career because of several risks which are not alleviated or compensated by salaries, fees or other systems.
2/ healthcare systems and their resources tended to be crowded by the low risk patients detrimentally to the high risk patient. This is a worrisome as resources are very stable due to the great stagnation either in high income countries or others. Eventually extension of the welfare state cannot be done at the expense of the mandatory resources allocated to major diseases.
3/ Recent regulations about working time and duties of interns and residents had badly impacted the efficiency of surgical programs in countries where they are implemented. Cancer surgery is still a conventional surgery where skill and surgical anatomy are keys. Consequently over-regulation is a very detrimental politics in this setting.
4/ Cancer surgery needs evaluation of results as other medical procedures. Regulation of cancer centers is the opposite. We assume that because it is a cancer center with a heavy load and high number of cases results will be as expected... We only need to know the quality of care which in cancer surgery is amazingly easy to report. Length of stay, readmissions, SSI and other complications can be easily monitored and should be the base of cancer center evaluation and cancer surgery practices.
"A powerful political commitment is needed in all countries to increase investment and training in publicly funded systems of cancer surgery," Dr Sullivan emphasized.

Increasing investment and training and on the other hand impairing the process of training is completely contradictory. A high level of autonomy should be the rule in medical training.

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