On dissatisfaction
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* D.W.C. Johnston

I certainly agree with many of the points made in the interesting editorial “Dissatisfaction: how it has grown” (*Can J Surg* 2005;48:93–4). It is difficult to attract the interest of young students and residents into a surgical subspecialty when the dissatisfaction level of the staff surgeons is so high. We have become a rather grouchy lot.

Increased recruitment of young surgeons on staff at hospitals is crucial to provide safe patient care and to produce a lifestyle acceptable to all surgical staff. As medical director of a large academic health centre, when I raise the issue of a surgical recruit at our regional recruitment meetings, the attendees emit a general sigh because of the 1.2- to 1.6-milion dollar budget associated with a new recruit (e.g., operative time, clinic space, office space, beds).

We are trying to turn this around by asking surgical services to come up with 5-year plans (to the best of their ability) regarding manpower and service delivery. We are trying to tie this future recruitment need to ongoing budget cycles so that funds are available for known service needs in the future. With the monies budgeted for and in place, the recruitment of the individual to fill a position becomes a much easier task.

A commitment to young recruits early should aid in stabilizing services and make everyone’s work more satisfying. This process is only in its infancy, but it seems to me that service delivery planning over a 5-year period needs to lead recruitment. Presently, we must compete for new recruitment dollars annually. Using a regional approach to recruitment tied to service delivery has significant advantages.