The interlocking of American surgery. An analysis of surgical leadership in the United States, 1945 through 1985.

To analyze surgical leadership in the United States from 1945 to 1985, 15 positions of influence have been identified. Appointments to these positions have been reviewed by age at appointment, medical school of graduation, site of residency training, solo appointments, and geographic distribution. A weighting scheme was designed to quantify institutional and personal performance. The 460 surgeons involved in this study graduated from 72 medical schools and 68 residency programs. The top ranking medical schools were Harvard, Johns Hopkins, University of Pennsylvania, Washington University in St. Louis, and Northwestern, which together accumulated 48 percent and 47 percent of all points and appointments, respectively. The top ranking residency training programs were Harvard, Johns Hopkins, the Mayo Clinic, Washington University in St. Louis, and the University of Pennsylvania, with Cornell, University of Michigan, Columbia, University of Minnesota, and the University of California in San Francisco occupying the second tier. Personal performances revealed that 40 percent of the top 20 surgeons were located in Southern-based institutions. Since 1965, geographic and institutional diversity has begun to appear in the surgical leadership.