Canadian Association of University Surgeons' Annual Symposium: W(h)ither generalism(?)

This 2008 Symposium of the Canadian Association of University Surgeons (CAUS) brought together surgeons from a number of jurisdictions to discuss generalism in general surgery and its future. Dr. John Birkmeyer, the 2008 Charles Tator lecturer, started the symposium by framing the problem: the need to improve surgical outcomes, selective referral, centres of excellence, process compliance and performance feedback. Dr. John Bohnen, chair of the Royal College of Physicians and Surgeons of Canada's (RCPSC) General Surgical Specialty Committee, underscored the mismatch between the provision of care and regional Canadian patient needs. By measuring structure and process and maintaining a national dialogue, solutions to potential care inequities will be found. Dr. Bill Fitzgerald, president of the RCPSC and past president of the Canadian Association of General Surgeons (CAGS), defined the enormous breadth in the scope of practice that is available to general surgeons across Canada. He highlighted the importance of the community surgeon not only in his or her specialty but also as a vital trainer of students, residents and international medical graduates. He identified the importance of general surgery in the country's military mission. He called for a thorough re-examination of the compensation model to ensure equity and recognition of diversity. Dr. Bill Pollett, president of CAUS, identified the alternative types of practice encountered in communities of 50 000 or less. Surveys of members and trainees of the CAGS showed how much postfellowship training is done, and that whereas the perception is one of diminished quality of life and less remuneration, the nature of community general surgery makes it a highly desirable career choice. He called for focused community general surgical training to recognize the unique demands compared with urban and large city practices.