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Background: To evaluate debt and other factors that help formulate the career paths of future surgical and primary care physicians, a survey was undertaken., Methods: Surgical specialty (SS) and primary care (PC) residents were surveyed regarding demographics, factors influencing choice of specialty, methods of financing education, debt characteristics, and outlooks regarding future earnings and practice characteristics., Results: The clinical years of medical school and personalities of specialists and residents were important factors in career choices for both PC and SS. The length of residency, desirable lifestyle, and working hours were all more important to PC residents. Surgeons found intellectual challenge and procedure-based practice of greater importance. Although not highly regarded by either group, scholarship obligation and student loans had a significantly greater impact on specialty choice and practice plans for PC residents. At the completion of training, 55% of SS and 28% of PC residents anticipate owing more than $100,000. Debt was especially significant in specialty choice and practice plans for PC residents with debt over $100,000., Conclusion: Surgical residents are less concerned about personal sacrifices in their quest to become surgeons. It appears state funded scholarships are successful in attracting students to primary care. Both SS and PC residents have significant debt, although, SS residents have greater financial debt than primary care residents. However, the anticipation of indebtedness was a more significant factor in determination of career path for PC.

Background: Immediate reconstruction following mastectomy provides patients the benefit of emerging from their operation with a reconstructed breast mound., Methods: A survey was distributed to 197 Kansas surgeons to determine the frequency of breast reconstruction and to identify factors that may influence them to refer patients for immediate reconstruction., Results: A response of 78.2% was obtained. Ten percent of mastectomy patients had breast reconstruction. Significant findings were that younger surgeons were more likely to discuss reconstruction with all patients and were more likely to preoperatively refer their patients to a plastic surgeon; surgeons in larger communities had more patients who had undergone immediate reconstruction; surgeons who discussed reconstruction with all patients had more patients who underwent immediate reconstruction; and frequency of immediate reconstruction increased along with increased time spent discussing reconstruction preoperatively., Conclusion: Our survey indicated that immediate breast reconstruction was rarely performed; however, when it was, a number of factors were correlated. These included the surgeon's age and practice location, attitude toward reconstruction, and time spent preoperatively with patients.

Fifty-one burn patients were studied in a retrospective manner to determine the effects of the burn injury on their ability to return to their pre-burn physical and social status. The results of this study indicate that: 1) 79% of the patients were able to return to work or school, though 45% required a change in work and 25% were not able to continue with their peer groups in school; 2) the average time of disability was 6 months; 3) there was a significant psychological morbidity as demonstrated by self-confessed depression, juvenile delinquency and divorce. There is a need for awareness of these problems so that proper counseling can be offered to the burn patient and his family both during his hospitalization and after discharge.