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Foreword

Consulting Editor

A state of confusion is a good place from which to start. Recognizing thatone is confused about something is somewhat essential to becoming uncon-fused. The problem with confusion, however, is that sometimes everybody isconfused and sometimes one is alone is his confusion

the latter of which ismerely reflective of lacking education or poor analytical capabilities. Thegenesis of this issue stems out of my trying to ascertain whether my igno-rance about certain aspects of our profession was unique to me, or wasthe confusion that I possessed more widespread. I have had the luxury of talking directly with many of our profession’s leaders over the past coupleof decades, and they have really tried to improve my understanding of how surgery and surgeons fit into society. Despite the very kind attentive-ness that has been afforded me by some extremely wise and busy people,I am still confused. Part of the reason for that is undoubtedly due to myown intellectual challenges, but part of it most certainly arises from the factthat as surgeons, we have collectively made little attempt to truly define ourrole in society in concrete terms. Without doubt, we have a substantial his-tory of how we view ourselves in lofty terms and vague attributes

wewould all agree that we should be compassionate, caring, and technicallyproﬁcient and put the needs of our patients ahead of our own. But thoseattributes are a bit hard to quantify and therefore easy to claim without hav-ing to prove.One approach to dealing with ‘‘overwhelming’’ problems is to break themdown into collections of problems that are surmountable and proceed todeal with them by bits. Assuming that each problem is manageable and that

Ronald F. Martin, MD0039-6109/07/$ - see front matter

surgical.theclinics.com

Surg Clin N Am 87 (2007) xi–xiv

there is enough time, one can usually solve the original question by somemeans. Some aspects of this issue are examples of my personal failure, tosome degree, to address these assumptions: manageable problems and time.The original proposition for this issue was made almost a decade ago,many years before I was asked to be the Consulting Editor for this series.The topic was viewed as interesting, but we did not know where to fit it intothe series at that time; thus we wrote an issue on cancer instead. We werepretty sure that most surgeons would feel that cancer treatment was some-thing a surgeon should know about. Several years later, a number of changes started to occur; the federal desire to train fewer specialists andmore generalists gained traction, the 80-hour work week was imposed forresidency training, the American Board of Surgery introduced the Mainte-nance of Certification concept, and the Residency Review Committee intro-duced its core competencies to name but a few changes. It was becomingclearer and clearer that the landscape for training and employing surgeonswas shifting under our feet. As such, the proposal for this issue was resur-rected with the intent of looking at the topics that influence our role as sur-geons in medical systems and society in a single collection of reviews.We decided to break the issue into components. The first set of topicswould address the following issues: from where to recruit surgeons, andhow many and of what type are needed; how to train them and decide thatthey are competent; and how to evaluate their continued education andtraining as well as certify it. The next set of topics was designed to addresshow surgeons fit into organizations and how to measure not just individualperformance but performance within a system, as well as how performancedata are released and for what purpose should they be used. The last set of topics was perhaps the most unusual. In this group, we offered an opportu-nity for representatives from different segments of society to tell us whatthey want or need from us. Examples of groups that were solicited includemajor industrial corporations that have been besieged by increasing finan-cial burdens for health care, political figures seeking election at the presiden-tial level who have espoused their desire for a change in the health caresystem, consumer advocacy groups, and economic advisers to government.The Leapfrog Group responded to our request as you will read. As muchas I would dearly love to name those who did not respond (especially thoseseeking your vote), it would probably be unwise. Suffice it to say that nota single response, even to say ‘‘No, thanks,’’ was garnered from any individ-ual seeking elected office or from any political party organization to voice anindividual or collective opinion about how they feel that we as physicians orsurgeons could better serve the needs of their constituencies. As for the cor-porations, each that was offered was, in fact, kind enough to reply that theywere not interested.Of further interest to me was that every single physician I approachedeither agreed to contribute or put me in touch with someone who could con-tribute in the event that his or her schedule was too tight. One can make of

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FOREWORD

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2007, Vol.87, Issues 4, Surgery as an Industry Evolution or Revolution

clinica quirurgica de norteamerica no requiere de presentacion, esta es una del 2007 el segundo volumen de ese año, espero que la puedan bajar y disfruten leyendola

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