Dr. Richard Bosshardt
speaker
190 appearances
1 recordings
1 series
first heard Feb 2025
last heard Feb 2025
Dr. Richard Bosshardt’s voice in public audio — every appearance, attributed to the second.
Trend
recordings per month · last 12 monthsNo recordings in the last 12 months.Older appearances are listed below; set an alert to hear about the next one.
Appearances
One of the requisites to become board certified, at least in surgery, is you have to turn over to the board of examiners for the American Board of Surgery, the American Board of Plastic Surgery, a log of the cases you have done in the course of your residency program. So they list every case you've done as a surgeon, as an assistant, and whatnot. Yeah.
Well, they're now permitted to list operations in there as part of the surgical experience that they've only watched. So if they sit behind the anesthesia screen or look over the shoulder of the surgeon and watch an operation, they can list that in the logbook as part of their surgical experience. And I can tell you personally that you don't learn surgery that way.
You learn about getting your hands in there.
And that's what's scary. And that allows them to qualify for taking their boards.
Why would you allow that? Well, the ACS has already anticipated there's going to be a shortage of 19,000 surgeons by 2030. Five years from now, we're going to be shy on nearly 20,000 surgeons in this country. Right now, the USA is short 1,200 trauma surgeons. There are places that need a trauma surgeon that can't get one because they're just not around.
So one idea, you know, as bad as it may be, is to put out anybody and everybody and you don't want to drop anybody just so you can get the numbers up there. Gosh, there's so much to this, Tucker, that goes into this.
Yes.
Yeah. They've taken the medical licensee examination, the three-part medical licensee examination, taken it from a graded exam to a pass-fail. And to pass it, you only have to be above the bottom 5% in grade. If you are above the bottom 5%, you are going to pass the medical licensure examinations.
And in spite of that, which is an abysmal standard when you think about it, in spite of that, something like 10% or more students at UCLA, 10% or more students flunk one or more of the exams. And a number of them flunked these exams two and three times. And yet they're still being put through medical school. They don't want to drop you. I know what I wanted to say.
Again, back to the DEI for a second. If you're an attending in a surgical training program and you have a surgeon that is inadequate, he's just not cutting it. And I saw this. I had, and while I was in training, there were surgeons or people that came into the program that were dropped after year two. It was clear that they weren't going to be able to do it. They just didn't have the dexterity.
They didn't have the whatever. Today, if you do that, and it's a minority or underrepresented in medicine, you know, minority surgeon, as intending, if you hold them back or if you drop them, what's going to happen is you're going to get reported. They'll get reported to the DEI establishment in that program. And invariably, they're going to side with the resident and not with the attending.
Well, the thing is this. How do you recognize... the quality going down. How do you recognize bad surgery? And one way that you recognize that is by complications. So the question would be, are people dying? Are complications going up, okay, in surgery? Right now, you can't answer that question.
And one big reason why you can't answer the question is that, at least, and I'll have to say, this is my opinion. I can't keep quoting this, but I know this is how surgery has evolved. The vast majority of surgery done today is done as an outpatient. So the people that are in the hospital and have an operation are not the majority. They're the minority.
So if you do outpatient surgery, you do the operation, the patient goes home that day or after an overnight stay. Most complications don't arise immediately. Bleeding occurs in the first day or two after. Infections, three, four days. Pulmonary problems. In my particular profession, if I do a flap reconstruction, I may not know if that flap's going to live or die for five, six, seven days or more.
So when you do have complications, they occur after the patient's out of the system, so to speak, out of the hospital system. So there's no required reporting. It's all self-reporting. You know, you get a letter, you know, periodically from the hospital saying, hey, can you please tell us how all of your patients did? Do you have any complications? They did great. And it's human nature. Of course.
If a patient gets an infection, you treat them with antibiotics, you know, do you report that as a complication? And the patient ultimately did okay. You could argue, no, you might not report that, and you could rationalize that it's okay. So that's one of the issues. The other issue, and I got this directly from one of the examiners.
I know someone who has been examining surgeons for 15 years for their boards. So when you go to take your board examinations, he's one of the people that sits in the room and asks you questions and whatnot. And what he's noticed is that a lot of these residents are coming in and he's looking at their cases and he's thinking, oh my gosh, they're taking way too long to do these operations.
Now, one thing that's interesting is when you go for your boards, the cases that they look at are not cases you did in training. These are cases you've done since you've been out. You know, when you finish your residency, you're allowed to go out and practice. I could practice. I practiced for two years before I became board certified because it took two years to get my board certification.
So of course I have to be able to practice. And I'm regarded at that point as a board eligible surgeon. And I'm entitled to full privileges and all those things. So when I go to take my board examination, I present them, you know, in my case, I present them with a log of everything I had done for the past year. And they select cases to examine you on and so forth.
It's an interesting experience to do that. So these are the cases that these examiners are looking at. And he's saying, they're taking way too long. Here's an operation that should normally take three to four hours. It's taking seven to eight hours for this person to complete this operation. And I've seen this locally.
Showing 101–120 of 190 · page 6 of 10
← Previous
Next →