PRESIDENTIAL-ADDRESS, 1993 - THE GENERAL SURGEON THROUGH THE LOOKING-GLASS - BRIGHT REFLECTIONS FROM A TARNISHED IMAGE

The image of the general surgeon is suffering in the eyes of trainees, peers, the public and even genera surgeons themselves. The magnitude and importance of this to the future of the specialty is reviewed. A d iminishing number of graduates are entering general surgical training, and only one-quarter ultimately complete their training and remain in general surgery practice. A lack of suitable academic role models and the dichotomy that exists between traditional insistence on uniform b road-based training for all and the realities of clinical practice are important parts of the image problem. This is particularly evident in small communities where the general surgeon may be ill prepared for t he surgical needs of the community, or conversely where the present ge neration of general practitioners fails to recognize the capabilities of the general surgeon. The public does not know the meaning of the te rm general surgeon and fails fails to recognize and reward its highly specialist nature. Solutions to this image problem include the followi ng: acceptance of and emphasis on the generalist nature of the special ty of general surgery; innovation and emulation of technologic advance s but with careful evaluation; and reorganization of training programs with emphasis on core training in ''surgery in general,'' flexibility tailored to ultimate career goals and preservation of in-depth genera l surgical experience for those who ultimately intend to serve its pra ctice.