The general surgeon through the looking glass: bright reflections from a tarnished image.

The image of the general surgeon is suffering in the eyes of trainees, peers, the public and even general surgeons themselves. The magnitude and importance of this to the future of the specialty is reviewed. A diminishing number of graduates are entering general surgical training, and only one-quarter ultimately complete their training and remain in general surgery practice. A lack of suitable academic role models and the dichotomy that exists between traditional insistence on uniform broad-based training for all and the realities of clinical practice are important parts of the image problem. This is particularly evident in small communities where the general surgeon may be ill prepared for the surgical needs of the community, or conversely where the present generation of general practitioners fails to recognize the capabilities of the general surgeon. The public does not know the meaning of the term general surgeon and fails fails to recognize and reward its highly specialist nature. Solutions to this image problem include the following: acceptance of and emphasis on the generalist nature of the specialty of general surgery; innovation and emulation of technologic advances but with careful evaluation; and reorganization of training programs with emphasis on core training in "surgery in general," flexibility tailored to ultimate career goals and preservation of in-depth general surgical experience for those who ultimately intend to serve its practice.