Статья о хирургах

Вчера в Бостон Глоуб была очень интересная статья о кардиохирургах. Честно говоря, прочитав ее, я была просто в шоке. Я и не предполагала, что хирург в 41 год может не иметь собственного дома, зато иметь долги (loans)в размере 300к...

А описание его дня - боже, как же человек может выдержать так работать???? Прониклась диким уважением.


Heart surgeons suffer long hours, less pay


By Liz Kowalczyk, Globe Staff, 6/30/2002

hen Dr. Thomas MacGillivray"s phone rang at 5:10 a.m., he suspected bad news and he was right: His chief medical resident was on the line about a Bosnian patient whose heart MacGillivray had repaired. He could barely breathe and his blood pressure had plummeted. The day had begun.



During the next 17 hours at Massachusetts General Hospital, MacGillivray, a cardiac surgeon, would perform two five-hour operations, oversee the care of seven patients, and comfort a husband who had had heart surgery the same week as his wife. She did not survive.

At 4:45 p.m., as most people were winding down their day, MacGillivray, mid-operation, peered inside the open chest of Richard Rowell, 80, and ran his left forefinger over a stiff, diseased artery. A couple of minutes later, a resident accidentally dropped a tube on Rowell"s chest. MacGillivray snapped at him.

And six hours later, at 10:40 p.m., the 41-year-old surgeon finished his paperwork and closed his office door. His only break: a goodnight call to his 5-year-old daughter.

Even with the hours he logs, MacGillivray doesn"t own a house. He pays nearly $3,000 a month in medical school loans. And Mass. General may cut cardiac surgeons" salaries this fall because the surgery group is losing money.

MacGillivray loves heart surgery, but he"s worried about neglecting his family and says, ""Sometimes I think if I were to do it again, I"d do it differently."" Yet, given the growing pressures in medicine, he said, he doesn"t believe it"s possible to work fewer hours.

Many doctors in specialties from internal medicine to radiology feel stretched thin these days, worried about falling incomes and growing caseloads of older, sicker patients. And nowhere is that more true than in surgery, once considered the golden ring of medicine. Of the surgical subspecialties, cardiac surgery is among the most demanding.

The national board that oversees doctor training, concerned about fatigue-related errors, said this month that it will force all medical residents to reduce their hours to 80 a week. The board was especially concerned about surgical residents, whose work weeks are the longest of any doctors in training. But surgeons say this is a difficult time to cut back, given the growing competition, falling fees, and sicker patients.

Asserting that heart surgeons have been overpaid compared to primary care doctors for years, the national Medicare program has been cutting their fees since the late 1980s. Medicare reduced the payment for a triple-artery bypass operation to $1,800 this year, half what it was 15 years ago. The practice that includes eight heart surgeons at Mass. General is losing money, and the division chairman, David Torchiana, expects fees to fall another 15 percent over the next three years. As a result, he said, salary cuts are likely - a new reality that surgeons in private practice already are experiencing.

And while other medical specialties are short residents because of an overall drop in medical school graduates, cardiac surgery, with its culture of grueling hours and now its declining pay, has been hit especially hard. The number of US medical school students choosing cardiothoracic surgery fell to 110 last year from 155 in 1996 - and is expected to drop to 90 this year, according to the American College of Surgeons. Last year, hospitals could not fill all of the 143 new training slots.