title: Specialization and the current practices of general surgeons.
abstract: BACKGROUND
  The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons' operative practices to inform surgical education and workforce planning.
  
  
  METHODS
  We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project for 3 US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and percentage of practice that made up their most common operation were calculated. Correlation was measured between general surgeons' case volume and the number of other specialists in a health service area.
  
  
  RESULTS
  There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure constituted no more than 30% of total practice. The most common operations, ranked by the frequency they appeared as general surgeons' top procedure, included cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice composed of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (rho = -0.50; p = 0.005).
  
  
  CONCLUSIONS
  Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment.
authors.affiliation: Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Marquita R
authors.initials: MR
authors.lastname: Decker
authors.affiliation: Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Dodgion
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
authors.forename: Alvin C
authors.initials: AC
authors.lastname: Kwok
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Yue-Yung
authors.initials: YY
authors.lastname: Hu
authors.affiliation: Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Jeff A
authors.initials: JA
authors.lastname: Havlena
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.affiliation: Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: K Craig
authors.initials: KC
authors.lastname: Kent
authors.affiliation: Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI. Electronic address: greenberg@surgery.wisc.edu.
authors.forename: Caprice C
authors.initials: CC
authors.lastname: Greenberg
mesh_terms: D015331:Cohort Studies; D013502:General Surgery / Q000706:statistics & numerical data*; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013038:Specialization; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014481:United States