With advances in medicine and technology, treatment modalities for diseases have evolved. Consequently, physicians’ roles have also changed. Because of advances in endovascular treatment, neurosurgeons specializing in cerebrovascular surgery are increasingly using endovascular techniques. Accordingly, the number of so-called “hybrid neurosurgeons” who perform both traditional craniotomy cerebrovascular surgeries and endovascular treatments is on the rise. This phenomenon is also occurring in department of neurology, traditionally a non-surgical specialty, and the number of neurologists using endovascular treatments is also increasing. Nowadays endovascular treatments become more common across medical specialties such as neurointerveional radiology, neurosurgery, and neurology. In this time, what should be the role of neurosurgeons? Standardized hybrid surgeons should contribute to society by treating hemorrhagic stroke and ischemic stroke, maintaining a proper number of hybrid-neurosurgeons to ensure demand for such treatments is met. Further, more neurosurgeons should be trained to perform sophisticated traditional surgeries, as these surgeries cannot be performed by anyone else. Finally, neurosurgery patients often require a combination of surgical and medical treatment. In these situations, primary and secondary prevention are also crucial. And, many neurosurgery patients also have psychoneurotic symptoms. Within neurosurgery backgrounds, we, neurosurgeons, need to be intensivists for critical care medicine, hospitalization experts, epidemiologists, neuropsychiatry experts, and basic researchers. Because we have to be in charge of neurosurgical patients with various problems in our healthcare environment. Therefore, advancing beyond hybrid neurosurgeons and beginning an era of convergence neurosurgeons should be our role in the future.
Critical care medicine is to provide advanced medical care to critically ill-patients threatened by severe diseases. Although critical care is a core area of surgery, surgeons have fewer interests and opportunities for participating in it, and the dedicated intensivists with other specialties have had a deeper involvement. It is difficult to recruit surgical intensivists or trauma surgeons for critical care due to the high labor intensity, high risk of medical accidents and conflicts, and inappropriate remuneration. The most common cause, however, is the lack of opportunities for surgical cases. There is a negative perception among surgeons that surgical intensivists are ‘the surgeons who do not operate.’ That makes the surgeons feel the gap between what they majored and what they practice. Acute care surgery, that is a relatively new, but more specialized surgical area including emergency surgery, trauma and critical care, can be a good alternative. Critically ill-patients who suffered from hemorrhagic shock, septic shock, acute renal injury, and acute respiratory distress syndrome need the intensive and aggressive treatments. Surgeons have been used to these invasive and aggressive procedures. Surgeons who have trained the critical care may be able to acquire the expertise, easily. The intensivists as a surgeon, who fully understands the operations, postoperative courses or complications, or the optimal time of surgery, can provide more efficient and accurate treatments for surgically critically ill-patients than any intensivists with other specialties. It is needed to change the surgeons' negative perceptions themselves with the support of the Korean Society of Surgery.
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