When Is General Surgery a "Specialty"? Always
There are certain days when surgeon Mathew J. Finnegan, M.D. seems to log as many hallway steps as the patient food service workers at Our Lady of Lourdes Medical Center.
He visits a breast cancer patient in one area, a gastrointestinal patient in another and then heads into the emergency department to check out a trauma case.
Such is the long and varied journey of the "general surgeon."
"General surgery is the heart and soul of surgery," said Dr. Finnegan, who was trained nearly two decades ago. Back then, he said, "the concept was that a well-rounded surgeon needed to do thoracic surgery, endocrine surgery, vascular surgery, breast surgery, gastrointestinal, oncologic surgery."
And he added the key phrase: "Each as well as the other."
As far back as nearly a century there were only medical doctors and general surgeons. "Over time, different subgroups split off from general surgery, but most of them still had to—and still do—general surgery training for a number of years because we wanted them to have a grasp of general surgical principles," said the doctor. "General surgery gave everyone a well-rounded basis of knowledge in those areas."
The American College of Surgeons describes general surgery as "the basic core specialty within the discipline of surgery" that requires knowledge of a long list of medicine, including anatomy, physiology, metabolism, immunology, nutrition, pathology, wound healing, intensive care and more.
It lists the primary areas of responsibility for general surgery as:
Alimentary tract; abdomen and its contents; breast, skin, and soft tissue; head and neck; vascular system, excluding the intracranial vessels, the heart, and those vessels intrinsic and immediately adjacent thereto; comprehensive management of trauma and complete care of critically ill patients with underlying surgical conditions, in the emergency room, intensive care unit, and trauma/burn units.
The rigorous five-year general surgery residency Dr. Finnegan completed at Graduate Hospital in Philadelphia close to 20 years ago required innumerable hours in the O.R. on all of the above cases, he said. And as laparoscopic technology became pervasive, he became skilled in that as well.
Dr. Finnegan and his associate, Brian C. Smeal, M.D., also specialize in wound management and breast cancer surgery. The third associate in their practice, James O. Finnegan, M.D., is a general surgeon who specializes in video-assisted thoracic surgery, esophageal and lung surgery.
"General surgery allows you to move on and be a surgical specialist in areas where you practice as long as you maintain your skills and educational level," he said.
While some specialization is needed, Dr. Finnegan suggests that maybe the pendulum has swung too far in that direction.
"If I recruit students to do breast surgery, I tell them they are going to have to cover the emergency room and if they don't want to do it—the appendectomy, the emergency colorectal surgery—then they are of no use in the emergency room."
"To be honest with you, in most strong general surgery programs the resident may do five times the amount of breast surgery as they do in their one-year breast fellowship."
Surgeons in sub-specialties often are able to handle a lighter workload than general surgeons who travel the hallways for long hours, Dr. Finnegan said.
"The younger generation (of surgeons) wants a better lifestyle and God bless them, maybe it's a better way of life", he said. "I mean we're only here for so long. Maybe they are smarter than we are and maybe there is something more than working your butt off every day, all day. But when that's all you know like me and my father (Dr. James Finnegan) then that's all you do."
(Dr. James Finnegan pointed out that the number of physicians entering major surgery fields is decreasing at the very time the American population is growing older and surgical needs are mounting. Residencies in cardiothoracic (heart and lung) surgery, once highly prized, go unfilled throughout the nation, according to the elder Finnegan.)
