title: Career phase of board-certified general surgeons: workload composition and outcomes.
abstract: OBJECTIVE
  To examine surgeon career phase and its association with surgical workload composition and outcomes of surgery.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  The study used data from calendar years 2004 through 2006 from 4 Florida general surgeon (GS) cohorts determined by years since board certification.
  
  
  METHODS
  American Board of Surgery-certified GSs regardless of subspecialty (n = 1187) performing 460 881 operations on adults 18 years or older.
  
  
  METHODS
  Workload composition based on the Clinical Classification System, complications identified by patient safety indicators, and in-hospital mortality. Poisson regression with robust error variance estimated adjusted rate ratios (RRs) for complications and mortality.
  
  
  RESULTS
  Compared with late-career surgeons, the rate of complications from cardiovascular procedures was higher for surgeons in the early-career phase (RR, 1.23; 95% CI, 1.06-1.44) and the late middle-career phase (1.18; 1.02-1.37). The mortality rate for cardiovascular procedures also was higher for early-career surgeons (RR, 1.23; 95% CI, 1.04-1.46). For digestive procedures, early-career surgeons had lower complication rates than late-career surgeons (RR, 0.86; 95% CI, 0.75-0.99).
  
  
  CONCLUSIONS
  Late-career GSs perform both better and worse compared with early-career GSs, relative to their workload composition and proportional surgical volume. Factors such as training and case complexity may contribute to these career-phase differences.
authors: Department of Public Health Sciences, College of Health and Human Services, University of North Carolina, Charlotte, NC 28223-0001, USA.
authors: James
authors: J
authors: Studnicki
authors: John W
authors: JW
authors: Fisher
authors: M Maka
authors: MM
authors: Tsulukidze
authors: Yhenneko J
authors: YJ
authors: Taylor
authors: Simone
authors: S
authors: Salandy
authors: James N
authors: JN
authors: Laditka
mesh_terms: D000328:Adult; D002321:Career Choice; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D008297:Male; D012307:Risk Factors; D013043:Specialties, Surgical / Q000458:organization & administration*; D013044:Specialty Boards; D013514:Surgical Procedures, Operative / Q000193:education* / Q000706:statistics & numerical data; D014481:United States; D016526:Workload / Q000706:statistics & numerical data*; D055815:Young Adult