R.M. Middelton et al,  http://dx.doi.org/10.1016/j.arthro.2016.10.025

Can Surgical Trainees Achieve Arthroscopic Competence at the End of Training Programs? A Cross-sectional Study Highlighting the Impact of Working Time Directives.

This study provides quantified guidance for arthroscopic training and highlights the positive relationship between arthroscopic case load and arthroscopic competency. We have estimated that the number of arthroscopies required to achieve competency in a basic arthroscopic task exceed those recommended in some countries. These estimates provide useful guidance to those responsible for training programs.

This new study out of the UK analyzed the impact of increased regulation and shortened training hours on surgical competency of Orthopedic residents. They found new physicians are not ready for surgical practice, even for basic arthroscopic surgery. Prior data has suggested that 10,000 hours or 10 years is required to MASTER a skill. Similar data has been published on US physician training as well. With changes in healthcare, and the rapid increase in experienced, skill surgeons leaving medicine and being replaced with both foreign physicians and young, inexperienced domestic physicians, the quality of surgical healthcare may lead to increased morbidity (complications) in patients. This problem has exponentially increased with the passing the ACA (Obamacare).

Perhaps changes can be made to incentivize experienced physicians to stay in medical practice during their peek years, when they are needed most. Once can infer that with the cost controls artificially placed on healthcare providers will come a decrease in quality simply because those that have the requisite experience, knowledge and skill are limiting the scope of their practice or leaving medicine altogether, as a result of the increased administrative burden, decreased reimbursement from health insurers and lack of medical malpractice reform. Insurance carriers do not use any real quality metrics or consider skill/experience when determining reimbursement rates.