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 Best Doctors
The Kindest Cut, p. 6 of 7

Not surprisingly, as the number of laparoscopic procedures has risen over the past ten years, so has the number of malpractice suits filed: Between 1990 and 1994, there were 750 laparoscopic malpractice claims; between 1995 and 1999, that number ballooned to 1,426. The uptick raised enough eyebrows that in August 2000, the Physician Insurers Association of America published a study analyzing the most frequent missteps. As the report puts it, "Several of the claims reported indicated that the physician had trouble with visualization of the anatomical structures, which led to the physician dissecting or clipping the wrong duct or artery." Given that it takes around five years for a malpractice claim to makes its way through the system, Lori Bartholomew, director of research for the PIAA, expects to see these numbers keep rising; and so far, the compensation rate has been higher for laparoscopic claims than with the average surgical-malpractice suit. "These are clear-cut injuries that sometimes require another surgery, or even lifelong treatment," says Bartholomew. She adds that hospitals are starting to discourage laparoscopically assisted vaginal hysterectomies, not only because they take longer in the operating room but because "preliminary data suggests we're seeing comparatively higher complication rates in that particular surgery."

There's no denying that closed surgery is more technically challenging than open surgery, although that perception (as well as malpractice rates) may change as medical schools step up the level of training they require for graduates. And it's expected that younger surgeons more familiar with, yes, Nintendo may find the new techniques comparatively intuitive. "It's not that endoscopic surgery is more difficult than open surgery but that it's a different skill set," says Mount Sinai's Abrams. "People who might have been architectural engineers, automobile engineers -- those folks would certainly enjoy doing this kind of surgery," he says. "You'll be drawing from a different pool."

Already, it appears that the laparoscopic surgeons are getting a jump start professionally: Dr. Michel Gagner, the innovative chief of Mount Sinai's prestigious minimally-invasive-surgery center, rose to that position at the tender age of 38. Dr. Ferzli -- known as one of the most experienced general surgeons in minimally invasive techniques -- says his laparoscopic fellows at suny Downstate are being offered starting salaries upwards of $50,000 higher than those available to their less-trained surgical counterparts. For two fellowship spots, he received 140 applications in 2001, up from 90 the year before. "And when I interview these candidates," he says, "it's like they're desperate for the spots. The demand is so much higher than the availability."

As more and more medical students come out of surgical residencies with new training, he predicts a generation of in-between doctors -- the ones too young to retire but too well established to consider retraining -- will be hard-pressed to continue with profitable practices.

"It used to be that a surgeon was like the symbol of man," says Ferzli. "And we were like the feminine aspect of surgery -- we were called wimps." He savors the memory, then shrugs. "But we were right."

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