Every conversation about the surgical backlog focuses on the same fix: more OR time, more staff, more beds. That’s necessary, but it treats the bottleneck as a capacity problem. A second bottleneck nobody’s pricing in is how long it takes to produce a surgeon who can operate independently, and that number is quietly getting longer. Cuts in one place always show up in another, and it’s often education that takes the hit without anyone asking what the real price tag will be.
I’m an orthopedic surgeon, and I’ve watched surgical residency change shape without anyone redesigning how we train for it. Duty-hour restrictions, in place since 2003, compressed the time available for resident OR exposure. They were adopted for good reason, but the training model never adjusted to compensate. Complex, high-volume cases have migrated to outpatient surgery centers, which pulls exactly the kind of varied, hands-on experience residents need out of teaching hospitals. Reimbursement pressure means attendings are pushed to move faster in the OR, which leaves less room to hand over the instrument and let a resident struggle through a step. And the pace of device and technique change now outstrips the speed at which training curricula get rewritten; a resident can graduate having trained on hardware that’s already a generation behind what they’ll use in practice.
Meanwhile, the tools we use to measure whether a resident is “ready” haven’t kept up either. Case logs count exposure, not competence; a resident can be logged as present for a hundred procedures without having built independent skill in any of them. In-training exam scores measure knowledge recall, not what happens when a hand is on a bone. And subjective attending sign-off is vulnerable to what I’d call a fluency illusion: A resident who has assisted smoothly many times looks competent, even when they haven’t yet built the independent judgment a real case demands. That gap doesn’t show up until the first time they’re actually alone with the patient. It’s part of why a 2026 Bulletin article from the American College of Surgeons reported that senior surgeons believed more than 50 percent of their younger colleagues were unprepared for attending roles, drawing on the same evidence of limited autonomy that has been building for years.
None of this is a story about individual failure by residents or program directors. It’s structural. The system that trains surgeons hasn’t been redesigned to match the system surgeons now practice in.
This is a genuinely live moment to fix it, and not just because the backlog conversation has made training capacity newly relevant. A new cohort of residents just started this July, stepping into exactly the conditions described above. What would actually help isn’t more of what we have (more case logs, more lecture hours); it’s tools that let residents build real operative judgment before they’re standing over a patient: deliberate, repeatable practice on the specific steps that current training compresses or skips, paired with assessment that measures demonstrated skill rather than time served. Some of that is curricular reform. Some of it is technology. I helped build a virtual reality (VR) surgical training platform for exactly this reason, so I’m not a neutral observer here, but the need for better tools long precedes any one company’s answer to it.
The surgical backlog will get real attention this year, and it should. But if the conversation stops at capacity, we’ll spend money relieving pressure on one end of the pipeline while the other end quietly narrows. Fixing wait times without fixing training capacity just delays the same problem by a few years.
Danny Goel is a practicing orthopedic shoulder surgeon and the CEO and cofounder of PrecisionOS Technology, a Vancouver-based AI immersive medical education company he founded in 2017.
He earned his MD and a master’s degree in cell physiology from the University of Manitoba, completed his orthopedic surgery residency at the University of Calgary, and pursued shoulder fellowships at Western University and Harvard Medical School. He later added advanced training in complex shoulder tendon transfers at the Mayo Clinic and an MBA from the Rotman School of Management at the University of Toronto.
A clinical professor in the arthroscopy division of the department of orthopedics at the University of British Columbia, Goel holds hospital privileges at Burnaby General and St. Paul’s, and he is a Fellow of the Royal College of Physicians and Surgeons of Canada. His research focuses on surgical education and skill acquisition, using virtual reality to close the gap between traditional training and real-world surgical competence.
His scholarship spans immersive virtual reality and AI in orthopedic surgical training, shoulder and elbow arthroplasty outcomes, and cardiovascular physiology, with work appearing in JAMA Network Open, the Journal of Bone and Joint Surgery, and the Journal of Shoulder and Elbow Surgery. He shares updates on Instagram and LinkedIn.
This article was originally published on kevinmd