Impact of Modern Healthcare Systems on Surgical Education

Purpose Healthcare reorganizations, including consolidation of large-scale healthcare systems, pose significant implications for surgical education. We sought to understand how these changes have affected surgical educators and trainee education nationally. 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%). Few thought mergers were somewhat beneficial for undergraduate medical education (12%) or graduate medical education (15%). Of faculty, 45% reported salaried compensation but more reported a clinical RVU-based (29%) 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 the shift towards large-scale healthcare systems impacts surgical education. Surgical educators reported perceived prioritization of clinical productivity over educational objectives, with many expressing experiences of devaluation, exploitation, and burnout as a result. However, many acknowledge the important role of national organizations in protecting education standards. By leveraging these requirements, surgeon educators can advocate for increased investment in educational initiatives.