[lll-o-lll]

> Do we really want to be in a world where surgeon scarcity is a thing?

Surgeon scarcity is entirely artificial. There are far more capable people than positions.

Do we really want to live in a world where human experts are replaced with automation?

[Calavar]

I used to think this myself in the past, but my opinion has shifted over time.

If a surgeon needs to do X number of cases to become independently competent in a certain type of surgery and we want to graduate Y surgeons per year, then we need at least X * Y patients who require that kind of surgery every year.

At a certain point increasing Y requires you to decrease X and that's going to cut into surgeon quality.

Over time, I've come to appreciate that X * Y is often lower than I thought. There was a thread on reddit earlier this week about how open surgeries for things like gall bladder removal are increasingly rare nowadays, and most general surgeons who trained in the past 15 years don't feel comfortable doing them. So in the rare cases where an open approach is required they rely on their senior partners to step in. What happens when those senior partners retire?

Now some surgeries are important but not urgent, so you can maintain a low double digit number of hyperspecialists serving the entire country and fly patients over to them when needed. But for urgent surgeries where turnaround has to be in a matter of hours to days, you need a certain density of surgeons with the proper expertise across the country and that brings you back to the X * Y problem.

[lll-o-lll]

To summarise your view, more surgeons means not enough experience in a given surgery to maintain base levels of skill.

I think this is wrong; you would need a significant increase, and the issue I was responding to was “shortage”. There’s no prospect of shortages when the pipeline has many more capable people than positions. Here in Australia, a quota system is used, which granted, can forecast wrong (we have a deficit of anaesthetists currently due to the younger generation working fewer hours on average). We don’t need robots from this perspective.

To your second point, “rare surgery”; I can see the point. Even in this case, however, I’d much rather see the robot as a “tool” that a surgeon employs on those occasions, rather than some replacement for an expert.

[Calavar]

"Rare" is an overloaded word, so let me clarify: I asked one of my friends who's a general surgeon, and he estimates he does 1 to 2 open cholecystectomies or appendectomies per year. It falls in an unfortunate gray zone where the cases aren't frequent enough for you to build up skills, but they are frequent enough that you can't just forward all the cases on to one or two experienced surgeons in the area. (They would get incredibly backed up.) And sometimes a case starts laparoscopic and has to be converted to open partway through, so you can't always anticipate in advance that a senior surgeon will need to be available.

I agree that robotic surgery is not a solution for this. We haven't even got L5 long haul trucking yet, so full auto robotic surgery in the real world, as opposed to controlled environments, is probably decades away.

[pixl97]

> I’d much rather see the robot as a “tool” that a surgeon employs on those occasions, rather than some replacement for an expert.

I mean we already have this in the sense of teleoperated robots.

[wizzwizz4]

Have human surgeons cross-train as veterinary surgeons. Instant increase to the maximum X×Y (depending which parts of the practice contribute to competence).

[PartiallyTyped]

We should always have human experts, things can and will go wrong, as they do with humans.

When thinking about everything one goes through to become a surgeon it certainly looks artificial, and the barrier of entry is enormous due to cost of even getting accepted, let alone the studies themselves.

I don’t expect the above to change. So I find that cost to be acceptable and minuscule compared to the cost of losing human lives.

Technology should be an amplifier and extension of our capabilities as humans.