What I've learned

[...]despite the title, I do not wish to be seen as arrogant in presuming there would be any interest in “what I have learned.” [...]as is my habit, I have made every effort to be politically correct by carefully navigating my way through anything relating to the “big 5”: money, politics, religion, sex, and work hours. Yearly, the American College of Surgeons Board of Governors is polled as to the most important problems currently facing the surgeons they represent and every year, for the past several years, the top areas have been health care reform, reimbursement, tort reform, graduate medical education, and workforce issues (Fig. 1).4 Before I address each of these areas, let us first recognize where we stand relative to the problems we have ranked as most concerning to surgeons today. Yet, even though general surgeons perform more than 10 million procedures a year, we somehow fail to recognize our worth in the grand scheme of health care.6 When it comes to defending our position, we should consider the fact that one active general surgeon can mean up to $2 million dollars per year toward a hospital's bottom line.7 Further, we often react too readily to market forces and adopt new and expensive technologies, procedures, and even gimmicks before considering the overall effect on costs.