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Objective: The objective of this study is to explore the patient characteristics and practice patterns of non-certified surgeons who treat Medicare patients in the United States., Background: Although most surgeons in the United States are board-certified, non-certified surgeons are permitted to practice in many locations. At the same time, surgical workforce shortages threaten access to surgical care for many patients. It is possible that noncertified surgeons may be able to help fill these access gaps. However, little is known about the practice patterns of non-certified surgeons., Methods: A 100% sample of Medicare claims data from 2014 to 2019 was used to identify practicing general surgeons. Surgeons were categorized as certified or non-certified in general surgery​​ based on data from the American Board of Surgery. Surgeon practice patterns and patient characteristics were analyzed., Results: A total of 2,097,206 patient cases were included in the study. These patients were treated by 16,076 surgeons, of which 6% were identified as non-certified surgeons. Compared with certified surgeons, non-certified surgeons were less frequently fellowship-trained (20.5% vs 24.2%, P =0.008) and more likely to be foreign medical graduates (14.5% vs 9.2%, P <0.001). Non-certified surgeons were more frequently practicing in for-profit hospitals (21.2% vs 14.2%, P <0.001) and critical access hospitals (2.2% vs 1.3%, P <0.001) and were less likely to practice in a teaching hospital (63.2% vs 72.4%, P <0.001). Compared with certified surgeons, non-certified surgeons treated more non-White patients (19.6% vs 14%, P <0.001) as well as a higher percentage of patients in the 2 lowest SES quintiles (36.2% vs 29.2%, P <0.001). Operations related to emergency admissions were more common amongst non-certified surgeons (68.8% vs 55.7%, P <0.001). There were no differences in sex or age of the patients treated by certified and non-certified surgeons., Conclusions: For Medicare patients, non-certified surgeons treated more patients who are non-White, of lower socioeconomic status, and in more rural, critical-access hospitals., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Surgery residents who complete a nondesignated preliminary year have an additional year of training compared to those who begin as categorical residents. While this additional year is sometimes perceived negatively, these more experienced residents may outperform traditional categorical (TC) residents in their first year of training., Methods: Operative assessment ratings were recorded for first year categorical general surgery residents in the United States between 2015 and 2023 using the Society for Improving Medical and Professional Learning assessment platform. Residents were categorized based on the completion of a nondesignated preliminary year ("Previous Prelim" [PP]) or not ("Traditional Categorical"). Ratings were analyzed using generalized mixed effects models. Performance and autonomy outcomes were dichotomized: "less experience" or "more experience" and "no autonomy" or "some autonomy", respectively. Fixed effects included academic month and case complexity, while random effects included resident, faculty, program, and procedure., Results: A total of 34,353 evaluations from 86 general surgery programs were collected. Of these, 829 were evaluations from PP residents. Faculty ratings of PP versus TC revealed no differences in adjusted probabilities of achieving a "more experience" rating (82% versus 76%, P = 0.26) but a higher adjusted probability of achieving a "some autonomy" rating (88% versus 80%, P = 0.04) for PP compared to TC. Analysis of resident self-reported ratings revealed higher adjusted probabilities of a "more experience" rating (77% versus 50%, P = 0.01) and "some autonomy" rating (87% versus 73%; P = 0.02) for PP compared to TC., Conclusions: First year general surgery residents who previously completed a preliminary year have similar operative performance faculty ratings when compared to their peers., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To evaluate severe complications and mortality over years of independent practice among general surgeons., Background: Despite concerns that newly graduated general surgeons may be unprepared for independent practice, it is unclear whether patient outcomes differ between early and later career surgeons., Methods: We used Medicare claims for patients discharged between July 1, 2007 and December 31, 2019 to evaluate 30-day severe complications and mortality for 26 operations defined as core procedures by the American Board of Surgery. Generalized additive mixed models were used to assess the association between surgeon years in practice and 30-day outcomes while adjusting for differences in patient, hospital, and surgeon characteristics., Results: The cohort included 1,329,358 operations performed by 14,399 surgeons. In generalized mixed models, the relative risk (RR) of mortality was higher among surgeons in their first year of practice compared with surgeons in their 15th year of practice [5.5% (95% CI: 4.1%-7.3%) vs 4.7% (95% CI: 3.5%-6.3%), RR: 1.17 (95% CI: 1.11-1.22)]. Similarly, the RR of severe complications was higher among surgeons in their first year of practice compared with surgeons in their 15th year of practice [7.5% (95% CI: 6.6%-8.5%) versus 6.9% (95% CI: 6.1%-7.9%), RR: 1.08 (95% CI: 1.03-1.14)]. When stratified by individual operation, 21 operations had a significantly higher RR of mortality and all 26 operations had a significantly higher RR of severe complications in the first compared with the 15th year of practice., Conclusions: Among general surgeons performing common operations, rates of mortality and severe complications were higher among newly graduated surgeons compared with later career surgeons., Competing Interests: R.A.H. receives unrelated funding from the Blue Cross Blue Shield of Michigan Foundation and the National Institute of Diabetes and Digestive and Kidney Diseases (5T32DK108740-05). A.E.T. receives unrelated funding from the Ruth L Kirschstein Institutional National Service Award administered by the National Institutes of Health. C.S.B. receives unrelated funding from the Ruth L. Kirschstein Postdoctoral Research Fellowship Award administered by the National Institute on Drug Abuse (F32-DA050416). A.M.R. receives unrelated funding from the NIH and AHRQ. B.M. receives funding from the NIH. J.B.D. receives grant funding from the NIH, AHRQ, Blue Cross Blue Shield of Michigan Foundation, and is a cofounder of ArborMetrix, Inc. B.C.G received funding for this work from the Agency for Healthcare Research and Quality (AHRQ; 5K08HS027653-02) and receives unrelated funding from the National Board of Medical Examiners (NBME) Edward J. Stemmler M.D. Medical Education Research Fund, the American Board of Medical Specialties, the American Board of Family Medicine, and the Accreditation Council for Graduate Medical Education (ACGME). The remaining authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)