The ivory tower from outside and in: A survey of Minnesota surgeons

Background. Increasing competition has eroded the patient base of many university hospitals and may jeopardize their teaching programs. Methods. We questioned all private surgeons (PS), university surgeons (US), and resident surgeons (RS) in our state. Chi-squared analysis was used. Results. Most PS, US, and RS, respectively, answered 'yes' when asked to respond to the following items: whether teaching hospitals were the best way to educate new surgeons (77% versus 96% versus 87%), whether surgery residencies should be based at a university hospital (72% versus 96% versus 91%), and whether PS should refer complicated clinical cases for teaching purposes (75% versus 87% versus 68%). Differences appeared when the groups were asked whether the university should take the lead in guaranteeing the quality of surgical care in the state (67% versus 100% versus 77%, p = 0.002) and whether PS are better teachers of surgery than US (40% versus 4% versus 59%, p = 0.0001). An unexpected and disturbing trend was observed in RS when groups were asked whether practicing surgeons had any obligation to the state's university (57% versus 74% versus 22%, p = 0.0001) and whether surgeons had an obligation to repay society for their education (77% versus 83% versus 56%, p = 0.005). Conclusions. Despite recent changes in medical economics, most PS still feel residency programs should be university based. A significantly smaller percentage of RS feel an obligation to their university and to society than do either PS or US.