Thursday, October 29, 2009
A NY Times op ed from October 10 makes the case that the management of breast cancer ought to be coordinated and run entirely by fellowship trained specialists hereafter to be known as "mammologists". The article was written by an OB/Gyn who runs the breast fellowship program at the University of Rich Rod. Basically, it's another barely camouflaged attempt by a sub-sub specialist to corner the surgical market on a type of operation that is about as straight forward and simple as it gets. (Surgical training programs assign junior residents and interns to all the breast lumpectomies). The decision-making in breast oncology is certainly complex and patients benefit from a multi-disciplinarian approach but the actual surgical procedures are not exactly enigmatic. The idea that you need to have your mastectomy done by an expert, i.e. a "breast surgeon" is rather absurd.
But the article does raise an interesting point. Specifically, why don't OB/Gynes do breast surgery? They do pap smears and pelvic exams and formal breast exams and usually are the ones who order yearly mammograms on their patients. It has always struck me as odd that once breast pathology is identified, the patient is all of a sudden shunted off to a general surgeon.
The super-specialization of surgery is an apparent inevitability. The paradigm of practicing "general surgery" is a dying ideal. I can read the writing on the wall. But these specialists are going to have to do a better job in coming up with new appellations. I mean, "mammologist"? That sounds terrible. It sounds zoologic. Just call yourself a breast surgeon, dammit.