Swiss health care delivery system: impact of financial restrictions on surgical education.

In 1990 Swiss health care expenditures totaled 26.3 billion Swiss francs, corresponding to 7.8% of the gross national product. Over the last 5 years expenditures have increased by 43.1%. Given the economic and political realities, future endeavors must be directed at stemming escalating costs. As 51.5% of health care resources are spent on hospital care, a substantial portion of financial restrictions and reorganization have been directed at this sector. These restrictions on hospital care have a direct impact on surgical practice and education. The resulting concentration of manpower and resources demand a new definition of the role of the general surgeon within the revised hospital system. In the face of a dilution of experience and knowledge due to an increasing number of specialized surgeons, the role of the general surgeon who provides basic surgical care must be redefined. These new trends must also be integrated into future training programs. The introduction of a structured surgical curriculum can limit the number of surgical trainees and maintain a high standard of quality.