The authors hypothesized that the increasing use of nonoperative management, percutaneous and endoscopic intervention, minimally invasive surgery, and endovascular surgery has radically altered case mix and resident training.

A review was performed of the Nationwide Inpatient Sample and Accreditation Council for Graduate Medical Education reports from 1993 to 2007 and of local resident operative logs for 2002 to 2008.

For all nationwide procedures, there have been major increases in percutaneous interventions, angiographic embolizations, and endovascular surgery, with corresponding sharp declines in major open biliary, aortic, colon, and trauma cases. In training programs, there have been small decreases in total case numbers but major changes in the operative case mix at the expense of traditional open surgery. A profound decline in open vascular surgery is noted. At the authors' institution, similar radical changes in the operative case mix were demonstrated.

Nationwide trends toward the increased use of nonoperative, minimally invasive, endoscopic, and endovascular techniques are altering the operative experience of surgeons and residents in training. This may radically change the abilities and expectations for the field of general surgery and what it means to be a “general surgeon.”