[Hierarchy in surgery in the United States]

There are few if any hierarchical structures in American surgery. The surgical department consists of general surgery and a variable number of subspecialties. It usually has a small number of main teaching hospitals, frequently in addition to the University Hospital, a County Hospital and a Veterans Administration Hospital. The faculty consists of all physicians who have finished their specialty training and hold a teaching appointment at the university. The members of the faculty are free and independent in their clinical teaching and research activities. Each teaching hospital has chief of surgery and each academic division (i.e. general surgery, cardiovascular surgery, oncologic surgery) is also headed by a chief of this section. The chairman of the department represents the department externally and internally, is responsible for the organization and the finances of the department, the education and training of students and residents as well as quality control relating to clinical activities, research and teaching.