Vascular surgery in Switzerland

Abstract

The state of vascular surgery in Switzerland today cannot be understood without a brief review of this country's history. The present constitution of Switzerland dates back to 1848; its three dominant principles are federalism (cantonal sQvereignty), liberalism and democracy. It is the principle of federalism which needs to be fully recognised in order to grasp the state of vascular surgery in Switzerland. The Swiss constitution guarantees each canton, whether powerful or poor, two seats in the senate and to be part of a body that has the means to check the house of representatives. Switzerland has 20 cantons and six half-cantons which exercise all the powers of government not delegated to the federal government. Notably, the cantons are in charge of education, income tax and health care (as far as this does not interfere with nationwide health regulations), as well as the administration and regulation of drugs. Practically all cantons run public hospitals (district, regional or cantonal) which function as community hospitals and represent the backbone of basic medical hospital care. Their duties also include the care of the socially disadvantaged and thus, without exception and contrary to the private hospitals, are regularly in deficit. This deficit is covered by the communities being served and by money derived from income taxes of the respective cantons. With the exception of open heart surgery and neurosurgery, the cantonal hospitals will therefore insist on being adequately competent in all other fields of surgery. This includes vascular surgery. Although some large non-university hospitals have recognised the need for specialised units, the fact remains that vascular surgery in a country of 7 million inhabitants is being practised by surgeons with an interest in vascular surgery in almost all cantonal hospitals, in many regional hospitals and even in some district hospitals serving a population of hardly more than 50000 inhabitants. It is unnecessary to say that the caseload is therefore often insufficient to provide the necessary expertise and to afford the ancillary infrastructure for an up-to-date vascular service in every domain of vascular surgery. As a result of the wide dissemination of vascular patients, the academic potential of teaching hospitals is compromised. It is also difficult for general surgeons practising vascular as well as the whole spectrum of general surgery to attend the various scientific meetings and courses where the latest developments on the state of the art are presented. This is one of the great drawbacks of the principles of federalism, which has resulted in the construction of barriers unquestionably preventing concentration in generally acknowledged specialities and hampering promotion of professional competence. On the other hand, it might be said that the widespread surgical practice of generalists allows for a comprehensive approach to the patient, and credit must be given to these polyvalent all-round surgeons for doing their utmost to follow developments in the multiple fields and subspecialties. The system of consultant surgeons is, unfortunately, unknown in Switzerland, and therefore specialists cannot be called upon routinely where necessary. So where does vascular surgery in Switzerland stand academically and scientifically? In the late fifties, when vascular surgery began to pick up in the European countries, Switzerland was internationally or at least in central Europe at the forefront. At that time vascular surgery in Switzerland was the privilege of