Surg Today Jpn J Surg (1997) 27:581-582 ~ S U ~ R Y T o D A y _

�9 Springer-Verlag 1997

Editorial

Surgeons Today and Tomorrow

HIROSHI YASUHARA

First Department of Surgery, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan

In Japan, more than 7500 students graduated from medical school in 1996. Some students want to be gen- eral internists, others gynecologists. These decisions are personal and are based mainly on the students' interests in specialties, their financial circumstances, or both.

According to an official survey conducted in 1995 by the Ministry of Health and Welfare, the number of surgeons has gradually increased although it recently seems that fewer and fewer medical students are eager to become surgeons. On what do I base this impression? How can we know exactly who wants to become a sur- geon? There are several important indicators that shed light on the surgeon's future.

The Ministry of Health and Welfare estimates that the number of female medical students will reach 50% of the total by the year 2015. This trend is also apparent overseas. In the United States, the Fifth Report to the President and Congress on the Status of Health Person- nel forecasts that by the year 2020 one-third of Ameri- can doctors will be women. Although this trend may not lead to a dramatic increase in the number of female surgeons, we need to recognize that Japan's male- dominated surgical society inevitably has to be opened up to female medical students.

Recently, there has been a great deal of concern re- garding the rapid aging of Japanese society. According to the 1995 census, the proportion of the population aged 65 and over will exceed 25% by the year 2019. The morbidity of this population will thus dramatically af- fect the surgical profession in the future. We can predict the characteristic features of morbidity in the future on the basis of population estimates made by the Ministry of Health and Welfare in 1996. According to that report, the leading cause of death in the general popula- tion, at present, is malignancy, followed by cerebrovas-

Reprint requests to: H. Yasuhara (Received for publication on Feb. 18, 1997; accepted on May 12, 1997)

cular disease and cardiac disease. It is noteworthy that the latter two disorders can be benign in the elderly population. Although most such patients will be managed with medication, a certain percentage will undoubtedly have to undergo some functional and minimally invasive procedures such as endoscopic resections or percutane- ous transluminal coronary augioplasty (PTCA) to im- prove their ability to engage in everyday activities.

The impact of the aging of society will not be small on surgeons, either. In a recent survey of doctors and den- tists, the mean age of those owning a private office was 50 years, and this age continues to rise overall. Many private surgical offices are in danger of disappearing when the owner retires. Consequently, the major work- place of surgeons is expected to shift from small private hospitals to larger referral hospitals in the future.

Surgenos still seem to be heroes in many novels and TV dramas. They perform life-saving operations all day long. However, in the future they will work like busi- nessmen in larger hospitals on a fixed timetable. Are these life-style changes good for the majority of sur- geons? My answer is an emphatic YES. In such a work- ing environment, surgeons will be able to enjoy their lives more than is now possible, because they will have more time for both themselves and their families.

There are at present a variety of surgical specialists such as orthopedic surgeons, neurosurgeons, thoracic surgeons and so on. Surgical specialties will inevitably undergo increasing changes in the future. Specialists will be integrated into the new types of organ-oriented surgical specialties, such as endoscopic surgery, liver and biliary tract surgery, intestinal surgery, cardiac sur- gery, and so on. The working place for general surgeons will therefore inevitably shrink, thus resulting in a sur- plus of general surgeons. Some general surgeons will work in paramedical fields related to surgery, as exem- plified by doctors working for companies developing new surgical technology. Some will also stop performing operations and become hospital managers. In fact, it is

582 H. Yasuhara: Surgeons Today and Tomorrow

possible that the designation 'general surgeon' will no longer be needed. Therefore, surgical specialties will surely undergo major transformations in the future.

At present we only have a fuzzy image of surgical specialists in the future. Many will be women who work for large hospitals. They will perform not only general surgery, but subspecialty procedures and tasks related to surgery. They may even no longer be called 'sur- geons' in the traditional sense. Whatever their label, these individuals will be surgical specialists performing surgery. I thus believe that we will have to discard our increasingly obsolete image of surgeons in the near fu- ture. This process will be uncomfortable for many present-day surgeons since it means altering our own identity. However, I believe that ultimately these changes will enhance the quality of patients' as well as surgeons' lives. My impression that fewer medical stu-

dents have been choosing surgical specialties recently perhaps stems from an inability of many such students to keep pace with the rapid changes constantly taking place in the surgical field.

It is important to keep in mind the fact that the afore- mentioned scenario will be true only if there are enough doctors or medical students who want to work in the surgical field. Nobody knows the exact number of doc- tors that will be required in the future. The demand will depend solely on what kind of medical care both pa- tients and society as a whole require. We must also determine our future based on academic and economic considerations. 'Surgery today' has not yet presented a blueprint for 'surgery tomorrow.' Perhaps we, as active members in the field of surgery, should begin to con- sider some of the numerous alternatives that await us in the coming decades.