Surgery in Norway: beyond the scalpel in the 21st century.

Norwegian surgeons provide for a wide range of modern surgical services with excellent results. With a thriving economy and a high standard of living and education, the major disease spectrum relates to cancer and cardiovascular diseases. Almost all types of surgery are performed in Norway. Improvements have been achieved through national programs and population-based registries have served as instrumental tools (eg, for cancer surgery). About 1 in every 5 general surgeons holds a PhD degree, with an even greater number for some subspecialties (30%-40% have PhD degrees). Trauma and acute care surgery is not a formal specialty, but a formal trauma system is likely to be established in the near future. Ring-fencing of elective surgical tasks from emergency surgery is increasingly being performed in surgical departments. Governmental coverage (85% of health care costs) and equal access to care have created waiting lists and given rise to private surgical outpatient clinics. The increase of women in medical school (>60%) has yet to be paralleled in most surgical specialists (eg, about 10% of general surgeons are women). Subspecialization, the 40-hour workweek, technical improvements (interventional and minimally invasive procedures), and quality demands have changed the surgical work scenario for both junior and senior staff members. Formal requirements in training duration and educational content are likely to change. Recruitment to surgery and ensuring continuity of patient care take surgery in Norway beyond the scalpel into the 21st century.