FED: Breast surgeon shortage looming - study

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FED: Breast surgeon shortage looming - study

By Judy Skatssoon, National Medical Writer

SYDNEY, Aug 10 AAP - Stress, fear of being sued and demanding patients are turningAustralia's brightest trainee surgeons off a career in breast cancer surgery.

An alarming study warns of an impending shortage of surgical breast cancer specialistsas trainees opt for more lucrative and glamorous options such as plastic surgery.

Breast surgery was an unpopular subspecialty for trainees in the Royal AustralasianCollege of Surgeons (RACS), the survey published in the latest Australia and New ZealandJournal of Surgery found.

A questionnaire of almost 300 Australian and New Zealand trainees found only four percent nominated breast surgery as their first choice.

A significant proportion of these were women.

Almost 50 per cent of trainees spurning breast surgery cited repetitive stress, litigationand demanding patients.

There also was a general perception that breast surgery was technically unchallenging.

Almost 200 of the 277 trainees chose careers other than breast surgery.

The most popular choices were plastic surgery (15.8 per cent), orthopaedics (15.5 percent) and general surgery (15.4 per cent).

Co-author James Kollias of the Royal Adelaide Hospital said there was a need to makebreast surgery training more interesting, possibly by including components of breast reconstruction.

"Most young trainees are more interested in areas of surgery that are either more technicallychallenging or lucrative," he said.

"If the training for young surgeons was made a little bit more interesting, particularlywith regards to aspects of surgery such as reconstruction, then they might find it moreattractive."

He also said there needed to be recognition that breast surgery attracted a certaintype of personality who was empathetic to patients and able to communicate well.

Dr Kollias said he did not believe Australia was facing an immediate crisis.

However, he said a shortage of breast cancer specialists in the UK should set alarmbells ringing.

"In the UK there are gross deficiencies in (availability of) breast surgeons in certainareas," he said.

"There are some concerns for (Australia's) future where ... there may not be as manydedicated breast surgeons attending to breast cancer surgery as there were in the past.

"What that means is you will have unqualified surgeons performing breast surgery ...

which may affect outcomes."

In an editorial, Colin Furnival of the Royal Women's Hospital in Brisbane said breastsurgery in Australia had historically been considered a component of general surgery andit was still being performed by surgeons with a broad range of interests.

However he said recent changes, including recognition of the need for breast surgeonsto have specialist communication skills and to understand tumour biology, highlightedthe need for specialist training.

"It is important to ensure that all surgeons who intend to treat breast disease spendsome part of their training in a specialised breast unit," he said.

The survey comes as RACS formulates is new curriculum for a provisional training programin breast surgery.

In November 2002, the breast section of the RACS had 523 members including 264 associatemembers, most of whom were general surgeons with an interest in breast surgery.

About 10,000 Australian women require surgery for breast cancer each year.

AAP jjs/cat/bwl

KEYWORD: BREAST