Current scope of practice of today's HPB surgeons

Abstract

Introduction: Hepatopancreatobiliary (HPB) surgeons encompass a diverse group of surgical subspecialists from multiple training pathways. The goal of this study was to determine the current scope of practice of today's HPB surgeons. Methods: An online survey was sent to all the “Americas Hepato-Pancreato-Biliary Association” (AHPBA) members. Data collection included demographics, education, the type of practice, complexity of the cases, etc. Results: Out of the total 172 responses that were obtained, 73% came from HPB surgeons that are currently in the USA and evenly distributed across the country. About half the surgeons (48%) are HPB fellowship trained; and only 1/3 of them have been out in practice for >10 years. Majority (70%) of them are practicing in academic centers. Only a fraction (7.32%) of the surveyors have a “HPB only” practice; majority supplement their practice with general surgery (34%), surgical oncology (24%) or transplant (21%). 2/3 of the surveyors perform less than 30 pancreatic and less than 30 liver cases annually. Only a quarter of the surgeons use minimally invasive techniques. 68% of the surgeons did not have any specific HPB credentialing requirements from their institutions, beyond general surgery privileges. Conclusion: The responses highlight the challenges faced in order to run a solo HPB practice, given the limited number of cases encountered annually and the need to maintain financial stability. Changes may be needed with respect to HPB training across HPB, transplant and surgical oncology, in order to provide uniformity and enhance the scope of practice for upcoming HPB surgeons.