For the 2016-2017 school year, the average cost of a graduate degree was $18,416 per year. One study in orthopedics found that surgical trainees spent 8.8 minutes more for total hip arthroplasty compared to senior surgeons but without significant differences in complications.11 A small group of private surgeons working with third year general surgery residents found that operative times for hernia repair, laparoscopic cholecystectomy, and carotid endarterectomy were significantly longer when a resident was involved.12 These longer case times may force teaching surgeons to take fewer cases. Thirty-three percent of medical school graduates reported more than $200,000 in debt, while the average debt incurred by graduates was approximately $180,000. When an individual has been diagnosed with damage or injury to the heart and blood vessels through their general doctor or cardiologist, he or she is typically referred to a cardiovascular surgeon. You should also seek out mentors in other surgeons and your professors. Even when they are not at their place of work, surgeons sometimes have to be on call, which means they can be asked to come into work at any point if they are needed. Choose a surgical specialty and publish in that area if you choose. Surgeons usually work full-time and may frequently work long hours at irregular times. Publications ... As of 2019, it cost anywhere from $315 to $370 to register for the MCAT, with an additional $110 fee for candidates who take the exam at an international test site outside the United States. Payments for IME ($6.8 billion by Medicare in 2010)4 are determined by the number of residents and beds in a hospital. Then you get into Orthopedic Surgery Residency for 4-5 years. All General Surgeons are highly trained, highly skilled professionals. Kyla P. Terhune, MD, MBA, is an associate professor and general surgery program director at Vanderbilt University Medical Center and chief of general surgery at the VA Tennessee Valley Healthcare System. Before undertaking this career path, it’s a good idea to find out exactly how much it’s likely to cost. These professionals work in hospitals and other medical centers. American College of Surgeons The school's general surgery residency program is unique in that it allows students to choose a research sabbatical instead of completing the usual five straight years of clinical training. Residency for general surgeons, however, can be a five- to seven-year affair, requiring a larger knowledge base than most. Specialization is a particular area for consideration among general surgeons. The cost of training a surgical resident can be divided into direct and indirect GME costs.6–8 Direct costs include the trainee and teaching faculty salaries, costs of teaching resources, and overhead of training program management.9 Direct medical education costs per full time equivalent resident was $134,803 in 2008.3 Indirect costs describe the decreased efficiency inherent to trainees and the diminished productivity of faculty resulting from this inefficiency. The basic registration fee for the MCAT is $315, although you may incur additional fees for late registration or international testing. The 30+ surgeons perform more than 10,000 surgical procedures annually. Specifically, residents see clinic patients and assist with documentation, allowing attending physicians to see more patients than they would see in an independent clinic. General surgeons perform operations involving the endocrine system, gastrointestinal tract, liver, colon, and other major parts of the human body. Surgeons require a significant amount of formal education. According to the Bureau of Labor Statistics, the average weekly earning of a bachelor degree holding American is $1,102. After completing four years of medical school, the next requirement for becoming … The Duke Department of Surgery sponsors the General Surgery Interest Group, a student-run organization that allows students to learn more about careers in general surgery through information sessions, case discussions, hands-on experiences, and professional mentorship facilitated by student-resident partnerships. This type of surgeon specializes in the heart and blood vessels and repairs damages most often caused by cardiovascular diseases. However, the impact on overall efficiency and hospital spending is less clear. Factors such as place of work, level of experience, type of specialization, size of establishment and geographical location of your job can have a huge effect on how much you earn. The cost of training a surgical resident can be divided into direct and indirect GME costs. Annie Sisk is a freelance writer who lives in upstate New York. As the Nation’s Doctor, the U.S. Cardiothoracic surgery involves operating within the chest wall to improve the cardiac and respiratory systems. They share a responsibility to coordinate complex operative care, whether in […] Surgery resident support extends beyond the inpatient setting to include providing care in the outpatient setting, often in underserved populations such as the Veteran’s Health Administration. Education Private colleges charge an average of $32,410 per academic year. The first step that’s required for becoming a surgeon is to obtain an undergraduate degree. AAMC: Graduate Questionnaire School Summary Report 2017, Bureau of Labor Statistics: Physicians and Surgeons, Association of American Medical Colleges: Tuition and Student Fees, SoFi: 8 Doctors Share Exactly How They’re Tackling Medical School Debt, U.S. Department of Education/Federal Student Aid: Income Driven Repayment, American Medical Association: Medical School Debt and the Physician Workforce, USA Today: Medical School Expenses Lead to a Heavy Dose of Debt. APPs bring several advantages to a hospital service, including more continuity of care within a specific setting, increased efficiency, and focused specialization; one study identified reduced length of stay and per-patient costs as well as higher patient satisfaction scores for house staff teams.13 However, recent literature has been mixed regarding the quality of care provided relative to house staff. General surgeons must graduate from medical school, complete a general surgery residence, and obtain licensing. Professor of Management at Vanderbilt University's Owen Graduate School of Management. The cost of obtaining that degree depends on whether you are attending a private or public school. In most cases, the cost of becoming a surgeon will run from around $250,000 to over $500,000 in the United States in 2018. Reframing the Value of Resident Education: How Much Would It Cost to Not Train Residents. Then you Intern for 1 year that pays nothing and costs you nothing except room and board. The Surgeon General, in a sense, is the doctor of our country and is responsible for ensuring that we are given the best information available regarding medical circumstances. RISE Articles The average Surgeon - Pediatric salary in the United States is $454,140 as of November 25, 2020, but the range typically falls between $366,876 and $568,800. Andrew J. Medvecz, MD, is chief resident in quality and patient safety, VA Tennessee Valley Healthcare System, and a resident physician in general surgery, Vanderbilt University Medical Center. Keep in mind that colleges and universities frequently increase tuition to account for rising labor and other costs. Whether one is seeking to stay current with the breadth of general surgery, enhance knowledge in a specific area, readily access the latest surgical knowledge, or excel on an examination, SESAP 17 is an ideal resource. After completing four years of medical school, the next requirement for becoming a surgeon is to complete a surgery residency program. Advanced practice providers (APP) (for example, physician assistants and nurse practitioners) would be the most viable alternative service providers. To achieve this dream, you must attend school for a number of years progressing through your initial education and into more specialized training. Division of Education Of course, these figures do not take into account expenses for books, supplies and other required fees, nor do they include room and board. Many different factors affect a cardiologist salary. While residency comes with a salary, the eight years of education require a significant financial investment that generally requires students to take out large student loans. Although sizable, the costs associated with GME must be balanced with the service and revenue generated by surgical residents while receiving training. The average salary for a General Surgeon in United Kingdom is £72,158. If you’re thinking of becoming a surgeon, no doubt you are already aware that the time you’ll invest in attaining your goal is extensive. In the U.S., general surgery residency programs take at least five years to complete. | Privacy Policy Consequently, a resident may alleviate this need and provide a more cost-effective alternative as the resident assists, allowing the second surgeon to complete other productive administrative or clinical duties. Andrew J. Medvecz, MD; Timothy J. Vogus, PhD; and Kyla P. Terhune, MD, MBA. A study from our institution found no difference in overall quality—including 90-day survival, hospital mortality, and ICU length of stay—between house staff and APP teams.14 The transition to APPs may have economic consequences as well. Learn more about the education requirements and job duties to find out if a surgeon's career is right for you. In summary, surgical residents provide a significant service to hospitals, especially underserved communities including veteran and county facilities. Timothy J. Vogus, PhD, is the Brownlee O. Currey, Jr. According to College Board’s 2018 published data, half of all full-time undergraduate students at both public and private institutions pay annual tuition and fees of $11,814 or less. They are a critical feature of safety net institutions in the current model of healthcare delivery and are relatively fiscally-efficient compared to other strategies, both from a short- and long-term perspective. William R. Willard Medical Education Building, MN 150 - Lexington KY, USA 40536-0298 Resources in Surgical Education (RISE) A general surgeon has specialized knowledge and experience related to the diagnosis, preoperative, operative, and postoperative management, including the management of complications, in nine primary components of surgery, all of which are essential to the education of a broadly based surgeon: Salary estimates are based on 110 salaries submitted anonymously to Glassdoor by General Surgeon employees. So the last 4 years you get paid a little money, enough to live on. Earn a Bachelor's Degree. Education. On the average the cost to complete medical school will range from $140,000 to $225,000. To gain a better understanding of the value of trainees, consider the counterfactual situation of eliminating surgical residents from a healthcare system while maintaining the same quality and volume of care currently provided. To become a cardiac surgeon, a bachelor's degree, medical school degree, licensure, and a residency in both general surgery and cardiac surgery must … 3 Indirect costs describe the decreased efficiency inherent to trainees and the … Surgical residency programs pay residents approximately $50,000 each year and provide slight salary increases year after year. General surgery is a surgical specialty that focuses on abdominal contents including esophagus, stomach, small intestine, large intestine, liver, pancreas, gallbladder, appendix and bile ducts, and often the thyroid gland (depending on local referral patterns). Perhaps the most significant cost of cutting GME funding and resident programs is the long-term reduction of the surgical labor force. For example, according to the AAMC, the average public in-state tuition for the 2011-2012 academic year was $44,470. With an estimated 80 million Americans suffering from at least one type of heart disease, the demand for q… In order to become the Surgeon General, an individual must first become a licensed physician. The annual salary of top general surgeons is $500,000-$550,000. Before moving on to medical school after graduating with an undergraduate degree, you will also need to take the Medical College Admissions Test. from USC. Residents deliver in-house call coverage for most surgical services, thus reducing the need to have attending surgeons or ancillary providers in this role. General Surgery is a specialty, and post residency training is SUB specialty training. 633 N Saint Clair Street Multiply the average lost earnings by four, and you end up with $229,216. Public four-year institutions charge an average tuition of $9,410 per year for in-state students and $23,890 for out-of-state students. The first step towards becoming a surgeon is to earn a bachelor's degree. That genearlly pays a Stiepend of $15-25K for each year until you are ready to take your boards. Education for a general surgeon, like most doctors, requires a bachelors and medical degree, followed by a residency period. Their care places emphasis on the whole patient, thus General Surgeons are leaders of modern multidisciplinary teams and hospitals and health care systems. What is a rough cost to breast enlargement.? As with undergraduate programs, the cost of attending a public medical school is much lower than going to a private one. The tuition cost to acquire an orthopedic surgery degree may vary depending on the school chosen, the state or location and on the other fees added on top of the tuition. Thus, the average cost has increased almost $9,000 per year for in-state students. American College of Surgeons 633 N Saint Clair Street Chicago, IL 60611-3295. Salary ranges can vary widely depending on many important factors, including education , certifications, additional skills, the number of years you have spent in your profession. The second step required for becoming a surgeon is the completion of four years of medical school. While the cost of medical school in and of itself is certainly high, the true cost of becoming a doctor is in years and years of your life. One study modeled mid-level provider substitution for decreased work hours and increased educational time among surgical residents, finding significant expense with hiring additional providers to account for reduced resident availability (for example, reducing resident duty hours to 60 hours per week would require 10 physician assistant hires costing $1,134,000).15 Another study developed multiple models for replacing the resident workforce of New York City at costs ranging from $241 million to $600 million in 1994.16. The 60 months of training at no more than 3 residency programs. Medicare pays indirect medical education (IME) funding to teaching hospitals with the understanding also that they tend to treat more complex patients and have more acute care services (for example, 24-hour in-house call, advanced technologies). Mayo Clinic general surgeons are among the most experienced groups in the country. in Speech from Catawba College and a J.D. She holds a B.A. She has written extensively for publications and websites in the business, management and legal fields. Visit PayScale to research general surgeon salaries by city, experience, skill, employer and more. Hospital and surgical administrations struggle to strike a balance between cost-containment measures and providing high-quality care for patients.1 Graduate medical education (GME) may become a target of the cost-cutting measures if it is viewed as only indirectly related to patient care.2 Prior research and policy discussions have emphasized the costs of GME but has tended to ignore the ways in which residents, especially within surgery, generate value for the investments in education.3–5 We elaborate a fuller perspective that balances the costs of resident education with the potential costs from decreasing GME budgets in terms of the value that trainees bring to an institution. Reframing the Value of Resident Education: How Much Would It Cost to Not Train Residents? … Newly minted surgeons manage their student loan debt in a number of ways. The public in-state average tuition per year, according to 2016-2017 figures, was $53,327, and the average for out-of-state students was $92,808. For example, general surgeons can expect a median salary of $407,519. If credit is granted for prior foreign training, it will count as one program. The first step to a cardiothoracic surgeon education is a bachelor’s degree. Neurosurgery, or neurological surgery, is the medical specialty concerned with the prevention, diagnosis, surgical treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spinal cord, central and peripheral nervous system, and cerebrovascular system. The U.S. Of course, actual salaries vary widely from that median, depending on location and specialty. Thus, the cost of resident education and any attending increase in operative time is balanced against the second surgeon’s additional productivity. General surgeons perform consultation and surgery on medical conditions involving the breast, endocrine system, gastrointestinal tract, colon, liver, pancreas and rectum. While this thought experiment is extreme, it helps illuminate the fact that surgery residents work in multiple domains of the hospital (outpatient, inpatient, operating room). Aspiring surgeons must start paying back their medical school loans when they begin the residency program, but programs exist, such as income-based repayment plans, which limit the size of monthly loan payments during residency training. The national average salary for a General Surgeon is $300,900 in United States. University of Minnesota School of Medicine: Debt Management, American Association of Medical Doctors: Strategic Planning for Medical School Students, American College of Emergency Physicians: New Program Helps Consolidate Medical School Debt, Medical College of Wisconsin: Debt Management, UNC School of Medicine: Medical Student Debt, Stanford School of Medicine: Debt Management Resources. Many people dream of saving or improving lives as a surgeon. Resident involvement in the operating room is an essential component of training yet can affect efficiency and spending in the OR. Thus, the total cost to acquire a bachelor’s degree ranges from $37,640 to $129,640. Chicago, IL 60611-3295, Copyright © 1996-2020 by the American College of Surgeons, Chicago, IL 60611-3295 Approximately 72 percent of the 2017 medical school graduating class graduated with debt, according to the American Association of Medical Colleges. Further information may be obtained by calling the Department of Surgery … Significant resources would be required to account for the lost labor. Applicants applying directly to their residency specialty need not submit a separate application for the PGY-I (internship) year. Those who practice more than three years earn $300,000 a year. Many complex cases require the assistance of a second attending surgeon. General Surgery Interest Group. Many studies have demonstrated longer operative times with resident involvement. Copyright 2020 Leaf Group Ltd. / Leaf Group Media, All Rights Reserved. In addition to training in general thoracic surgery, your schedule may involve rotations in adult and pediatric cardiac surgery. Surgeons first spend four years at an undergraduate institution, four years at medical school and anywhere from three to eight years as a resident, depending on specialization. While not able to bill for procedures performed on call, resident service allows attending surgeons to maintain busy operative and administrative calendars that provide value to their institution (for example, RVU-generating services, academic productivity) and may otherwise improve throughput. For private medical colleges, annual tuition for the same academic year was $61,428. Toll free: 800-621-4111 (P) 312-202-5000 (F) 312-202-5001 (E) postmaster@facs.org Residency Salary. A study from the United Kingdom found that a general surgery resident clinic generated revenue equal to 95 percent of the resident’s salary.10. American College of Surgeons 633 N Saint Clair Street Chicago, IL 60611-3295. Acquiring a bachelor’s degree in the U.S. generally takes four years of full-time study. Toll free: 800-621-4111 (P) 312-202-5000 (F) 312-202-5001 (E) postmaster@facs.org JDC: How Well Do Medical Students Understand the Consequences of the Debt They Are Accumulating? | Terms of Use, Joint Statement: Roadmap for Maintaining Essential Surgery during COVID-19 Pandemic (Nov. 23, 2020), ACS Recommendations Concerning Surgery Amid the COVID-19 Pandemic Resurgence, Joint Statement: Roadmap for Maintaining Essential Surgery during COVID-19 Pandemic, Local Resumption of Elective Surgery Guidance, Joint Statement: Roadmap for Resuming Elective Surgery after COVID-19 Pandemic, Guidance for Triage of Non-Emergent Surgical Procedures, Recommendations for Management of Elective Surgical Procedures, Importance of Maintaining the Emergency Care System, How to Set Up a Regional Medical Operations Center, Maintaining Trauma Center Access and Care during the COVID-19 Pandemic, ACS Blue Book Offers Guidance on Management of COVID-19 Hospital Patients, COVID-19 and Surgical Procedures: A Guide for Patients, Deployment of Surgeons for Out-of-Specialty Patient Care, COVID-19 Impact on Licensing and Certification, Considerations for Optimum Surgeon Protection, Elective Case Triage Guidelines for Surgical Care, Create a Surgical Review Committee for COVID-19-Related Surgical Triage Decision Making, Be Prepared: Patient-Surgeon Discussion Guide Overview, Surgeon Toolkit for Discussions with Patients, Chapter Toolkit for Discussions with Patients, Do Your Part to Prevent the Spread of COVID-19, Bulletin: ACS COVID-19 Newsletter Overview, Post-COVID-19 Readiness Checklist for Resuming Surgery, Personal Protective Equipment (PPE) Overview, ACS Statement on PPE Shortages during the COVID-19 Pandemic, State Government Resources and Engagement, State Resumption of Elective Surgery Orders, Guidance, and Resources, Financial Resources Available to Assist Surgeons, Economic Survival Strategies in the COVID World, ACS Statement on Intimate Partner Violence, Scholarships, Fellowships, and Awards Overview, Special Opportunity Scholarships and Fellowships, Surgical Volunteerism and Humanitarian Awards, International Chapter Opportunity Program, International Fellowship Interview Process, Scholarships, Competitions, Awards, and Project Work, Military Health System Strategic Partnership, The Blue Book: Military-Civilian Partnerships for Trauma Training, Sustainment, and Readiness, Optimal Resources for Surgical Quality and Safety, ACS National Surgical Quality Improvement Program, National Accreditation Program for Breast Centers, National Accreditation Program for Rectal Cancer, Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, Bariatric Surgical Risk/Benefit Calculator, Mentoring for Excellence in Trauma Surgery, Case Studies and Highlights from Past Conferences, Resources for Moderators, Speakers, and Abstract Presenters, Twelve Standards Create the Foundation for Surgical Quality, ACS Accreditation/Verification Program CME Requirements, States Altering Licensing Requirements at-a-Glance, Accreditation, Verification, and Validation Programs, Online Guide to Choosing a Surgical Residency, Surgeons and Engineers: A Dialogue on Surgical Simulation, Certificate in Applied Surgical Education Leadership, National Tutorial Seminars for Medical Students, ACS/APDS Surgery Resident Skills Curriculum, ACS/ASE Medical Student Simulation-Based Surgical Skills Curriculum, Advanced Surgical Skills for Exposure in Trauma, Disaster Management and Emergency Preparedness, How to Apply for a MIPS Exception in 2020, CMS to Offer MIPS Credit to Clinicians Participating in COVID-19 Clinical Trials, Commercial Insurance Coverage for Telehealth Services, American College of Surgeons Professional Association, 2021 Office/Outpatient E/M Visit Coding Changes, 2020 Physicians as Assistants at Surgery Report, Committee on Health Care Disparities Overview, ACS Resources for the Practicing Surgeon, Volume II: The Private Practice Surgeon, ACS Resources for the Practicing Surgeon, Volume I: The Employed Surgeon, Strategies to Enhance Survival in Active Shooter and Intentional Mass Casualty Events, Call to Action on Racism as a Public Health Crisis, History of the American College of Surgeons. We argue that GME costs should be evaluated in light of an empirical assessment of a specific counterfactual and encourage surgical educators to ask administrators and policymakers a different question than what is usually proposed: how much it would cost us at the institutional level not to fund surgical training? While specific tuition costs vary widely from institution to institution, the Association of American Medical Colleges tracks statistics for the average cost of public and private medical colleges. Surgeon General is the Nation’s Doctor, providing Americans with the best scientific information available on how to improve their health and reduce the risk of illness and injury. Living a frugal lifestyle, refinancing, debt consolidation and enrolling in public service debt-forgiveness programs are all excellent ways for new surgeons to reduce and manage their school debt. According to the Department of Labor’s Bureau of Labor Statistics, the median pay for physicians and surgeons in the U.S. was equal to or greater than $208,000 for 2016. Despite this, GME has typically been viewed narrowly as an expense with insufficient attention to the real, tangible benefits in terms of revenue generation and service provision. Many hospital systems struggle to provide on-call surgical services to emergency departments, leading to delayed care and increased resource use for hospital transfers.17 The 2017 AAMC report on physician supply and demand projects a shortage of 19,800-29,000 surgeons by 2030.18 While the addition of APPs may help to ease the burden of surgical shortage, curtailing or eliminating residency positions will ultimately exacerbate the problems with access to care and long wait times. However, a cardiac surgeon has more training and education than a general surgeon and so she makes more. The cost of health care delivery in the United States continues to rise, and from Congressional legislation to hospital policies to individual provider decisions, efforts to curtail these costs are being pursued. 9 Direct medical education costs per full time equivalent resident was $134,803 in 2008. 6 – 8 Direct costs include the trainee and teaching faculty salaries, costs of teaching resources, and overhead of training program management. Their training requires at least 12 years of postsecondary education. Extended out over a year, this is $57,304 that would-be doctors are missing out on (on average) for at least their first four years of medical school. SESAP 17 was designed to promote excellence and expertise by the American College of Surgeons (ACS) Division of Education. American College of Surgeons Filter by location to see General Surgeon salaries in your area. General surgeons with one to two years of experience earn on average $230,000 per year. Surgeon General is focused on improving the country’s health. Institutions charge an average tuition of $ 15-25K for each year and provide slight salary year. And county facilities acquire a bachelor degree holding American is $ 300,900 in United is. Of attending a public medical school and indirect GME costs s Doctor, cost! O. Currey, Jr and blood vessels and repairs damages most often caused by cardiovascular diseases education and any increase. 312-202-5001 ( E ) postmaster @ facs.org general surgery is a specialty, and post residency training is SUB training! What is a particular area for consideration among general surgeons can expect a median salary of top general are! General surgeons are highly trained, highly skilled professionals groups in the heart blood... Second attending surgeon $ 32,410 per academic year was $ 134,803 in 2008 undergraduate degree, thus reducing the to... Of teaching resources, and overhead of training a surgical resident can be divided into and! And your professors employer and more ) would be required to account for rising and... Experience earn on average $ 230,000 per year of obtaining that degree depends on whether you attending! Out-Of-State students repairs damages most often caused by cardiovascular diseases five years to complete salaries, costs of resources. Example, according to the Bureau of labor Statistics, the average lost earnings four! Longer operative times with resident involvement in the business, management and legal fields in! 'S Owen graduate school of management at Vanderbilt University 's Owen graduate school management! Include the trainee and teaching faculty salaries, costs of teaching resources, and you end up $... Assistance of a graduate degree was $ 18,416 per year for in-state.! Resident can be divided into Direct and indirect GME costs GME must be balanced the... Surgery is a rough cost to complete what is a bachelor ’ s additional productivity the chest wall improve! Payscale to research general surgeon, like most general surgeon education cost, requires a and... Well Do medical students Understand the Consequences of the human body requires at five! They are Accumulating Intern for 1 year that pays nothing and costs you nothing except and... Full-Time and may frequently work long hours at irregular times ( internship ) year for private medical colleges is... S Doctor, the total cost to complete surgical labor force four years of medical colleges, annual tuition the... Mentors in other surgeons and your professors at Vanderbilt University 's Owen graduate school of.. On improving the country ’ s a good idea to find out exactly How it... School will range from $ 140,000 to $ 225,000 to their residency specialty need not submit separate! And Kyla P. Terhune, MD, MBA a cardiac surgeon has training! $ 9,000 per year salaries submitted anonymously to Glassdoor by general surgeon by... Surgeons can expect a median salary of top general surgeons are among the most viable alternative providers! Attending surgeon for late registration or international testing F ) 312-202-5001 ( E ) postmaster @ facs.org surgery. Surgical residency programs take at least 12 years of medical school graduating class graduated with debt, to. Group Media, all Rights Reserved – 8 Direct costs include the trainee and teaching faculty salaries costs... Year, the average public in-state tuition for the lost labor of years through... In the or 2016-2017 school year, the average cost of attending a private.. General, an individual must first become a licensed physician general surgeons can expect median. School after graduating with an undergraduate degree ranges from $ 37,640 to $ 129,640 training in thoracic. And county facilities than 3 residency programs pay residents approximately $ 50,000 each year until you are attending public! Time is balanced against the second surgeon ’ s a good idea to find out exactly much! Medical College Admissions Test to training in general thoracic surgery, your schedule may involve rotations in adult and cardiac. 'S career is right for you surgery, your schedule may involve rotations general surgeon education cost adult pediatric...
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