Symposium on surgical manpower in the smaller community. Is there a future for the community general surgeon?

The author attempts to assess the factors affecting the future of surgery in Canadian communities with a population of 10 000 to 30 000. Five problems are identified: (a) unrealistic patient expectations, (b) government cutbacks causing reduced equipment budgets, (c) difficulty in getting competent, modern anesthesia from well-trained general practitioners, (d) undergraduate and postgraduate training focus and (e) political enlargement of medical schools and reduced funding for health care. The proposed solutions are as follows: realistic patient expectations should be possible through authoritarian advertising compaigns; residency training should be keyed to community surgery; community health care standards can be promoted and maintained by creating a link between the community surgeon (specialist) and the tertiary hospital of his choice. This can be accomplished by creating a new class of staff appointment in the tertiary hospital, the "referring consultant" (i.e., the community surgeon).