Jonathan L Halbach, DO1, Rober Ricca, MD2, Marion Henry, MD1, Romeo C Ignacio, MD1. 1Naval Medical Center San Diego, 2Naval Medical Center Portsmouth
OBJECTIVES: Military surgical subspecialists are challenged to maintain surgical skills and competency in the setting of low-volume practice interrupted by deployments. This potentially compromises the ability to care for pediatric patients and may have a negative impact on military retention. Recent literature focuses on the operative experiences of the military general surgeon but is lacking with regards to surgical subspecialists. We aim to evaluate the career experience of active duty pediatric surgeons (ADPS).
METHODS: An anonymous survey was conducted for all ADPS. Those with less than of one year of active duty experience were excluded. Demographics, military experience, operative volume, case diversity and deployment experience was collected and analyzed. ADPS operative experience was compared to civilian data. Personal fulfillment as a surgeon and military officer was also assessed.
RESULTS: Nine of 13 active duty military pediatric surgeons (6 Navy, 5 Army, 2 Air Force) responded to the survey. Two surgeons were omitted due to limited military experience (< 1year) and two were non-responders. 78% had more than 10 years of active duty time, but only one surgeon had more than 10 years of pediatric surgery experience. In comparison to published average number of pediatric surgery cases (400/year), the majority of ADPS (78%) had less than 250 cases per year. 44% of ADPS relied on locum tenens to maintain their operative experience. ADPS reported lower numbers of pediatric trauma and thoracic experience. The average number of specific neonatal cases (gastroschisis, omphalocele, tracheoesophageal fistula, congenital diaphragmatic hernia and imperforate anus repair) was comparable to published data, but almost half had not performed a CDH or TEF repair in the last year. All respondents were involved in at least one combat/humanitarian deployment and 89% felt comfortable managing adult surgical disease. 78% of respondents were satisfied with their career as a PS and 67% were satisfied with their career as a military officer. The most common challenges cited by AD PS were maintaining adequate case volume/diversity (67%), lack of pediatric support (54%) and deployment schedules interfering with surgical practice (33%).
CONCLUSION: ADPS have lower operative experience and case diversity for selective surgical categories and specific neonatal/infant cases. This leads to decreased satisfaction and may impact competency. Increased opportunities to work within civilian children’s hospitals and improved involvement with humanitarian missions may augment operative volume/case diversity as well as career satisfaction within military medicine. Similar surveys should be considered for other military surgical subspecialists.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88506
Program Number: MSSP01
Presentation Session: Military iPoster (Non CME)
Presentation Type: MSSPoster