According to the American College of Surgeons Health Policy Research Institute, in 2006, only 12.8% of counties in the United States had a single pediatric surgeon of any type, and only a little more than half of those counties had a pediatric general surgeon.
Children in rural counties are particularly poorly served by pediatric surgeons. In 2006, 97% of rural counties lacked a pediatric surgeon. For those of us fortunate enough to work with well-trained pediatric general surgeons and pediatric surgical subspecialists on a daily basis, it's difficult to imagine caring for infants and children whose congenital, traumatic, infectious, or oncologic conditions require surgical intervention without a surgeon trained and inclined to provide care for pediatric patients and to support their families.
The article in this issue by Jeffrey Lukish, MD, on minimal access surgery, as well as the article by Thomas Inge, MD, and Linda Kollar, RN, on bariatric surgery for adolescents in the October issue, highlight the importance of distinct considerations when infants and children require or are being considered for surgical interventions.
Lukish describes concerns for safety and the particular need for right-sized surgical instruments in extrapolating what has been learned about minimal access surgery in adults to infants and children.
Adoption of these techniques and procedures by pediatric surgeons requires care and patience as well as thoughtful consideration of their risks and benefits. Dissemination of experiences with new approaches through publications that reach colleagues throughout the country and the world is essential, so that benefits as well as unanticipated pitfalls can be recognized.
I'm afraid that pediatricians sometimes think we are the most vocal and important advocates for improved health and access to medical care for children. It's true that the approximately 60,000 pediatricians present a larger voice for advocacy than the approximately 3,000 pediatric general surgeons and pediatric surgical subspecialists. However, our pediatric surgical colleagues are important teammates in our efforts to enhance recognition of the distinct needs of infants and children.
The mission statement of the American Pediatric Surgical Association, "To Ensure Optimal Pediatric Surgical Care of Patients and Their Families, to Promote Excellence in the Field, and to Foster a Vibrant and Viable Community of Pediatric Surgeons," highlights the importance of pediatric surgeons as partners in making sure that our patients receive the most expert care possible.
1. Poley S, Ricketts T, Belsky D, Gaul K. Pediatric surgeons: subspecialists increase faster than generalists. Bull Am Coll Surg. 2010;95(10):35-38.