Impact of modern healthcare systems on surgical education

Abstract Purpose Healthcare reorganizations, including consolidation of large-scale healthcare systems, may pose significant implications for surgical education as healthcare becomes increasingly corporatized and productivity focused. We sought to understand how members of the surgical education community perceived the status of surgical education given these ubiquitous environmental changes to the healthcare landscape. Methods An IRB-approved survey about surgeon-educators’ current practice environments was administered via email to members of the ASE and APDS. Quantitative responses were characterized with descriptive statistics. Open-ended free text responses were coded inductively in an open thematic analysis approach. Results One-hundred-nine members responded. Ninety-five respondents reported employment by an academic medical center (54%), hospital system (17%), or medical school (14%). None thought mergers were very beneficial and few thought mergers were somewhat beneficial for undergraduate medical education (12%) or graduate medical education (15%). Of faculty, 45% reported salaried compensation but more (29%) reported a clinical RVU-based model than an educational relative value unit (RVU)-based (7%) compensation component. Wellness and simulation were the most commonly supported educational activities (21%, 21%). Ninety-one percent reported that national organization requirements (e.g., ACGME) impacted education program structure and 61% reported utilizing national guidelines to advocate for education resources. Eighty-three respondents answered open-ended questions, resulting in 449 applied codes falling into 4 major themes: clinical productivity over education, education as a resource-poor endeavor, exploitation of educators/learners, and burnout. Conclusions This is the first study to investigate how surgical educators perceive the status of surgical education during the growing shift towards large-scale healthcare systems and heightened financial concerns of hospitals. Surgical educators reported perceived prioritization of clinical productivity over educational objectives, with many expressing experiences of devaluation, exploitation, and burnout as a result. Many acknowledge the important role of national organizations in protecting surgical educators time for educational roles and efforts. By leveraging these requirements, surgeon educators can advocate for increased investment in educational initiatives.