Dr. Richard Bosshardt exposes how U.S. surgical training collapsed after the 2003 work-hour law slashed residency time, leaving 66% of 2014 graduates unable to operate independently for over 30 minutes while 80% fled to fellowships. DEI mandates—like "racial concordance" mentorship—force retention of unqualified residents, with CMS now penalizing slow surgeons (e.g., 7-hour gallbladders) despite complication spikes. Outpatient shifts hide errors via self-reported data, and board examiners tolerate "witchcraft" like gender-affirming care over evidence-based ethics. Carlson amplifies Bosshardt’s warning: systemic decay may take decades to reverse, with YouTube censoring the critique. [Automatically generated summary]
And that was only confined to New York until 2003. That didn't become a nationwide thing.
General surgery is a five-year residency program, okay?
In the first two years, you learn patient care.
You learn how to take care of patients before and after.
You assist in operations.
You do diagnostic, differential diagnosis, and you learn how to work up a problem.
And if you're good, if you're a good intern, if you're a good first-year, second-year resident, you know, they throw your bone on again.
They'll let you do a hernia, and they'll let you do an appendectomy, and they hold your hand while you do it.
And then in the third and fourth years, you start to operate more.
But you're always operating under the direct supervision of a senior resident or an attending, attending as a fully trained surgeon.
And again, you're having your hands held.
I mean, they have to let you work.
They got to put the knife in your hand.
But they have to be good enough to do that and keep you out of trouble.
And if you get in trouble, to get you out of trouble.
And so you spend those three to four years kind of honing your skills.
And then in the fifth year, when you are what we call a chief resident, you're basically regarded as being a surgeon.
And you do your cases, you assist the younger surgeons in their cases, and the only time you call an attending surgeon in is if you're doing something very major, very complex, or if you haven't done this before.
And so at the end of that fifth year, you should be able to walk out of the hospital.
And go anywhere and operate as a general surgeon and function fully independently.
A study done in 2014 in the Annals of Surgery reported that 80% of the graduating general surgeons were not going into practice.
Thoracic surgery, vascular surgery, colorectal, you name it.
And that was in 2014. They surveyed program directors.
These are the chiefs, the heads of surgical programs to find out what these residents that they were getting, what these surgeons that they were getting in Phillips were like.
They found out that 66% of them could not be relied upon to operate.
Independently for more than about 30 minutes.
That something like 30% or so could not handle tissues in a manner that was appropriate, atraumatically, if you will.
20-30% couldn't sew properly.
Close to the same number couldn't identify the early signs of a complication.
Some could not identify an anatomical tissue plane.
These are...
People that are graduates of general surgery residencies coming out of these programs and going to fellowships.
The saddest thing is that when they survey the young surgeons themselves and say, well, why are you going into this fellowship instead of going out and practicing?
More than half say it's because they did not feel comfortable operating independently after five years of training.
So there's something very wrong with the training they're getting.
They're not getting enough cases to do.
They're not being allowed to operate.
In some places, the attending surgeons are very hesitant to hand over a case to a younger surgeon because, number one, they're responsible for that case.
Number two, you're never going to be as efficient or fast as a young surgeon as you will later on when you've had more experience.
So it takes longer and it impacts your day, your schedule.
It's because since 2014, they've initiated what they call a mentorship program.
And what they do is they try to find experienced surgeons that will mentor these young surgeons to help them come up to speed.
Okay, so a young surgeon out of training that should be able to work on their own and finds that they're struggling or not really able to do that, they would have an experienced surgeon to, I don't want to say hold their hand, but to oversee them, supervise them, scrub with them.
They can't find enough surgeons to do that, for one thing.
Here's where the DEI really comes in, too, is they have this idea of racial concordance that what they need to do is find, if it's a black surgeon, they've got to find a black mentor for him.
And if it's a Hispanic surgeon, they've got to find a Hispanic mentor.
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So in addition to what are demonstrable, provable failures of medical schools to train The next generation of surgeons, and can I just say parenthetically, I feel like if they're not training surgeons adequately, you know, surgeons are a small percentage of all physicians, probably the most important, but they're probably not, and probably the smartest and most driven, then they're probably failing.
People contact me just because my profile has been elevated by being out there a little bit.
I got a call from a young plastic surgery resident that had been fully trained in general surgery and went on to begin her plastic surgery training.
And she was concerned because she wanted to get the most out of her training.
And so she reached out to me to find out what things she could do.
She told me things that were unbelievable.
I mean, I never imagined these things.
And this has been confirmed.
It wasn't just my conversation with her.
I've confirmed it from other sources as well.
A couple of things.
One is she talked about the difficulty getting enough cases under your belt.
That is, you know, not getting given cases to do, not having operations that you can actually perform, not having the attendings turn things over to you.
This I could not believe.
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 to the surgeon as an assistant and whatnot.
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.
Well, the ACS has already anticipated there's going to be a shortage of 19,000 surges by 2030. Five years from now, we're going to be shy on nearly 20,000 surges 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.
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 flunk 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 a year or two because 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.
You'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.
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, you know, 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, you know, 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...
It's not required reporting.
It's all self-reporting.
You know, you get a letter, you know, periodically from the hospital to say, hey, can you please tell us how all of your patients did?
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.
You know, 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.
I've seen this in my own community where, you know, nurses who know, The good surgeons from the bad surgeons say, Dr. So-and-so, he's so slow, he just takes forever to do this operation.
And complications are directly tied to length of surgery.
They've come out and they said, we are not going to pay for anesthesia beyond a certain time.
So if we have, for example, a breast reduction, which for me is about a three and a half to four hour operation, we'll pay for four hours of anesthesia for breast reduction.
If it goes beyond that, we're not paying for that additional time.
And the idea is they recognize that people are taking too long to do these things.
Point is, anesthesia has nothing to do with the length of surgery.
They're just there to keep the patient asleep and stable and alive for you while you're doing an operation, but that's the only way they can think to penalize the surgeon because the surgical time does not come into play unless you look at hospital charges or anesthesia charges.
And so they recognize this, and this goes back to what I said.
You know, a lot of surgeons are not getting enough surgical experience to be able to operate, one, independently, and two, I would say, you know, I'm not a speedster, but I can certainly hold my own with my peers in terms of how long it takes me to finish an operation and do a good job on it.
I've never tried to be the fastest guy on the block.
So all those things go to the fact that you're not going to really recognize this decline because it's so subtle in so many respects, and patients don't know that.
And that's the other reason why I'm here, Tucker.
I want this to be a wake-up call to my fellow surgeons.
This is what can happen to you if you speak up and you try to promote excellence in surgery and you try to object or push back against a liberal ideology, politics ideology, call it what you will, in surgery.
And I would love for there to be a groundswell of surgeons coming in and saying, hey, wait a minute, what's going on in my profession?
Think about the, for example, Celia Nelson, the female Jamaican black surgeon that was on the Zoom call with me.
She's worked as hard as anybody to get to where she is.
She's an excellent surgeon.
I mean, she's experienced racism.
And she'll tell you flat out, yeah, when she first arrived there.
People wouldn't mistake her for, you know, ask her to get a cup of coffee and the surgeon, you know, those sorts of things.
And she also noticed that sometimes when she'd walk into an examining room in the emergency room, that, you know, the look she would get was, you know, who is this?
Is this someone good?
And she's worked through all that, okay?
She's worked through that.
She just put her head down.
She worked hard.
And now she says what happens is when she goes into the ER. That patient has already heard from multiple staff what a wonderful surgeon they're getting.
She's going to be in there to see them.
So, I mean, she's earned her place, okay?
But think how unfair it is for the people coming up now, the minority, if you will, surgeons, that have to face this idea when they go into a room, that person may look at them and say, gee, is this a DEI hire?
Got here because of their excellence, because of their excellent academic performance in college and medical school, because of their excellent performance in their residency, because they met all the standards, the standards that everyone should have to meet, or am I getting someone who's a little bit less because of this?
You're getting someone less, overwhelmingly, and that's obvious.
And it has nothing to do with race, by the way.
It's that preferences, Are always destructive of excellence.
So if you tell me that you're the CEO of a company that your family owns and you got the job because you're the first son, my first assumption is they lowered standards to make you CEO. I mean, right?
It's obvious.
And so if I have a black female surgeon, my first assumption will be this person had to meet lower standards because the school...
Or the certifying board was so anxious to say, we have a black female surgeon.
And of course, it's unfair to the individual, but then the whole system is unfair.
So should you be shocked that it produces unfair results?
You know, the harder you pull to get out, the more stuck you are.
But why would anybody...
You're a surgeon.
Like, you're at the very pinnacle of our system.
Like the science-based, reason-based civilization that we've built, which we consider superior to the witchcraft-based societies of the rest of the world, how in the world could you sit and let this happen?
I'm fortunate in the sense that I was able to get through a career.
And I'm at the twilight of my career.
No, actually, at the end of my career.
I have nothing to lose, Tucker.
I mean, they can't hurt me.
So, I got many messages, private messages, which I can't access any longer, from surgeons, including minority surgeons, that said, you know, we agree with you, but we can't speak up because we're going to get pushed back.
You know, we're going to be called, you know, Uncle Toms or racist or whatever if we agree with the premise that you're putting out there.
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No, I mean, of course, I know that you're describing the real answer.
That is the answer.
But it's just hard to let people like that off the hook.
If you work in some, you know, normal company, it's one thing, but if you're a surgeon, you understand that lowering standards results in the deaths of people.
The stakes are just the highest in any part of our society.
You have the highest stakes.
So, sure, it could hurt your career.
Sure, it could make you unpopular.
Sure, they might call you names, Uncle Tom or whatever.
But you balance that against the deaths of innocence, and you think, I have to say something, don't you?
But if you decide, you know, people will die, but my career is more important or not being called names is more important, then it's kind of a monster, aren't you?
I think that if you give the power that surgeons have, the power to cut people open unsupervised, and someone dies, and you're the surgeon, you're like God in the operating room, you have that power.
In exchange for that power, you have to hold yourself to the highest moral standards.
Anything which works against that, you have to fight.
I think you have to work against that.
It's disconcerting to me.
I have to say, maybe I could use stronger terms, but I get a lot of private affirmation from colleagues, from surgeons.
I don't get a lot of public affirmation for that very reason because Some of them are older and don't want to deal with the blowback, the repercussions and the recrimination that can occur.
Some of them, a few agree with the whole situation, crazy as it may be, all the DEI and so forth.
And most of them were kind of like me.
They were just going along and too busy taking care of their patients to the best of their ability.
You know, I've been doing this for 38 years, and it's really not until about three or four years ago that I popped my head above.
I looked around and said, my gosh, the landscape out there has really changed.
This is not the field of medicine that I went into.
And, you know, you'd like to think when you've devoted your life to a career, a profession, that you're going to leave it a little better than you got it.
You know, I'm building my, I've built my practice on the shoulders of the people that went before.
And I have a...
Very strong sense of responsibility that I have to honor the traditions and the efforts on my behalf to get me to where I was.
And you want to think that you've done somewhat the same.
Now, I wasn't a professor.
I wasn't a researcher.
But in taking care of patients, I've always tried to honor the efforts of the people that trained me and feel like I could go off.
Well, I've got a generation behind me now.
I've got a daughter who's a physician.
I've got a son-in-law, her husband, who's a physician.
And I feel a very strong sense of obligation to someday when I can't do this anymore to say, okay, I did the best I could to leave medicine in their hands better than I got it.
And I can't say that.
And that's tragic when you think about it.
To think that you're leaving a profession that you love and have committed your life to and it's in much worse shape than when it was put into your hands.
But at the same time, I think it's what happened to me.
If the AECS can ban me with the impunity that they have done without accountability, without even following their own bylaws, for God's sakes, and they have no reason to engage with me.
I haven't been a doctor since COVID. What happened in COVID was so egregiously wrong.
That I just couldn't, I mean, I don't look at the CDC, the NIH, FDA in the same way any longer, public health officials.
And the other issue, I don't want to open a can of worms here, but the gender-affirming care.
I mean, how in God's name did we get to a point where you have, in my profession as far as surgery is concerned, is probably the one most closely involved in the whole process of gender affirming care because of the work we do.
And to have this concept that there's no such thing as male and female, that you can take a biological male and convert them to a woman and they're really a woman.
I mean, that is, when you talk about witchcraft and voodoo, that is witchcraft and voodoo.
But that just seems to act against evidence, scientific evidence as a scientist, physicians or scientists.
I'm saying the same thing 10 times in a row, but it just seems like you shouldn't be allowed to conduct science if you've shown that you don't believe in it.
I didn't think it was a good operation, a good idea.
Long and short of that, the study showed that, yes, you could lose weight by doing this, but the weight came back.
These patients gained weight again.
And so it was pretty much abandoned.
We're talking, you know, back in 1984, thereabouts.
And, of course, I remember one young woman who died directly as a result of the operation, which wasn't that big a group of patients, and they had one death in that group.
You know, you're not always allowed to make the decision about what you can do.
Now, if you're in a residency program and you've got surgeons that are doing, you know, gender-affirming surgery, again, in minors, and you don't want to participate in that, I can't speak to this.
I can't say that the resident has the ability to say, no, I'm not going to do that or I won't do that.
I do know that, you know, are you familiar with the case of Eitan Heim?
I've spoken, I've become friends with him, and I've actually called these, you know, divine moments, if you will, but I've made a couple of, just felt, I was compelled to call him a couple of times.
And it just happened to be when he was in a really difficult down period and just needed someone to affirm what he was doing and to encourage him and so forth.
And so, you know, I just happened to be the person that made that phone call.
But you're talking about a long, you know, the pipeline for surgery is five plus years.
So, you know, then you got the four years before the medical school.
So if you're going to fix the problem, you got to go back to the medical school.
Honestly, you may have to go back to universities where people are being indoctrinated in all this social justice stuff where they feel that that's more important than what they're doing.
You know, the young doctors think that righting historic wrongs is more important than taking care of the patient in front of them.
And you can't practice medicine that way.
That's just not medicine.
So it can be fixed.
It's going to be a generational problem.
It's going to take a long time.
We're going to be...
Seeing the effects of this and paying the price for these policies and these ideologies for probably my lifetime, I suspect.
Which brings up the issue, you know, I'm a healthy guy, but every one of us is going to be someday needing a doctor.
And I don't know who I'm going to go to.
I somewhat semi-seriously told friends and family, I said, don't go to a surgeon or a doctor under 40. Because they've been indoctrinated.
Some of these guys are still wearing masks, for Pete's sakes.
I mean, there's so few that a lot of these guys, men, women, whatever, a lot of doctors are there because there's just not enough doctors.
I mean, if you tried to get a doctor recently and make an appointment, just a routine appointment, you're talking months down the road.
You need something more urgently.
Good luck with that.
You know, you'll probably end up going to an urgent care center where you'll see a nurse practitioner or PA or someone that's got a fraction of the education experience of a physician.
So, it's not a real, there's not a simple cure for all of this.
One thing I wanted to try to do with this conversation is not just simply bad mouth, you know.
My organization, the ACS, or Bad Mouth Medicine and Surgery, because I'm devastated by what's happened.
I really want surgery to be elevated to where it should be, which is a very highly regarded profession that is dedicated itself to taking care of all comers, regardless.
We don't judge on who or what you are when you're in front of us and you've got a problem that we're trained to fix.
My solutions, you know, my first solution, obviously, is get DEI out of medicine.
The idea that you can take care of a patient if your first, you know, priority is to judge them based on their color or ethnicity is counter to everything that Hippocratic medicine is all about.
The other is to reinstall standards of excellence.
We have to quit lowering the bar.
We've got to start elevating the bar again and requiring that doctors and prospective doctors meet minimum standards.
There have to be some minimum, but they have to be higher than the lower 5% for Pete's sakes.
They can't be that.
We have to free the doctors in training to do what they have to do.
You can't have...
Restricted hours, when you've got such limited time anyway, in the overall course of a person's lifetime, three, four, five years in surgery is a drop in the bucket.
I mean, to ask a surgeon to devote themselves to learning the craft and what they call the art and the science of surgery, not only do you need the time, you need the person to apply themselves.
One thing I heard, which again is What kind of disturbed me is that a lot of young surgeons are more concerned about comfort, work-life balance, as it's often called, as opposed to learning to be the best doctor they can be.
One thing that they found in asking all the program directors about the...
Surgeons come into their fellowships was that a large proportion did not have ownership of their patients.
And ownership means that, you know, you take that patient as your patient.
That's not just someone that you take care of for a 12-hour shift, and then you turn them over to the next person, and then, you know, you may not ever see that patient again, or not until, you know, two or three shifts later.
You know, so a lot of young doctors don't have ownership for their patient.
And he reported that he went to, he interviewed several surgeons, black surgeons, showed the white surgeon for his surgery because he was the most competent.
So it turns out that YouTube is suppressing this show.
On one level, that's not surprising.
That's what they do.
But on another level, it's shocking.
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