Dr. Klinck:
I am a rural hospital CEO and all of our family practice physicians who have
OB privileges are required to have C-sections skills. By training they can
also do appendectomies and hysterectomies. This is the norm for most rural
hospitals especially in Texas. Hope this helps.
George N. Miller, Jr. President and CEO Provena St. Mary's Hospital
500 W. Court Street Kankakee, IL 60901 815-937-2400
"Miller, George"
GeorgeNMiller@ProvenaHealth.com
09/03/2002 11:40 AM
Baraboo residents have the opportunity to learn C-section, tubal
ligation, EGD/Colonoscopy, and of course they learn a full range of
obstetrical procedures including vacuum, manual placental extraction,
D+C, amnioinfusion, fetal monitoring etc. Our first year residents
perform about 100 deliveries on their 3 month OB rotation in Madison.
They then follow anywhere from 20-40 of their own prenatal patients per
year in the second and third years of training (total of 40-80 of their
own continuity patients).
Baraboo is a great place to train. All we need is continued funding and
some applicants who are interested in rural medicine. Things are
looking up. We have four fourth year medical students who are spending
1 month rotations out here now over the next four months. Byron Crouse,
M.D. is looking at establishing a regular med student rotation out here
also. The University of Wisconsin just received a donation of $350
million from Blue Cross/Blue Shield; part of which is to be used for
development of rural health in Wisconsin. We are watching closely to
see how much filters through the hands of the University folks and
makes it to Baraboo. Dr. Crouse is certainly advocating for us.
JAMES DAMOS
jdamos@facstaff.wisc.edu
09/03/2002 04:52 PM
Almost 50 years ago I remember my father[ who was a GP-surgeon] considering the
services of cystoscopy. The volume wasn't hgih enough for him to purchase the
equipment. Although he had some skills in abdominal surgery, he did so few of
them that he gradually stopped doing all but appendectomy. Even these were rare.
He did many tonsillectomies.
Since starting the advanced training [fellowships] programs in 1982, I've
observed that the nonprocedural fellowships in geriatrics and adolescent
medicine are basically nonprocedural. The fellowships in OB and Emergency
medicine are the most procedurally oriented and in the highest demand. Sports
Medicine is somewhere in between. The OB fellowship is the most surgical in that
one of the training benchmarks is the ability to independently perform a
Cesarean section.
There are some programs that could achieve this benchmark without the fourth
year of fellowship training, but they are difficult to locate. John Peter Smith
in Texas, Ventura and Contra Costa in California....were the traditional types
of programs in which this training could be found. However there was no formal
structure with regard to the other issues of ultrasound, bowel repair, bladder
repair, tubal ligation, and risk management. For example you might fo through
the entire 3 years and still not be prepared to repair a fourth degree
laceration. Many still do not require acquisition of the skills for application
of low forceps.
In summary, since 1952 there has been a gradual shift in the volume of
procedures performed surgically. To maker an intelligent choice on this issue,
the young physician should take a look at the epidemiology of need in various
communities. The most commonly performed surgical procedure in the USA today is
Cesarean section. The most common minimally invasive surgery performed in the
USA today is GI endoscopy. Therefore these are the most prominent training goals
in my fellowships. Once you have mastered these, and obtained your hospital
privileges, rural communities will almost always allow you to advance your
surgical privileges to relatively simple things such as appendectomy.
Tonsillectomies have all but disappeared as have open cholecyctectomies and
gastrectomies.
If Surgery as a training choice is linked to emotional needs within the learner,
epidemiology is irrelevant.
Wmrodney@aol.com
09/04/2002 08:26 AM
You may also want to ask the FP residencies in your area for speakers,
particularly the ones mentioned previously, if so go to the AAFP Residencies
site and click on the California map - RCB