Penny Wise, Pound Foolish: The Troubling Parallels of Corporatization in the Aviation Industry and Academic Surgery

Abstract

The passengers of Lion Air Flight 610 and Ethiopian Airways Flight 302 paid the ultimate price for decades of prioritizing profits over technical expertise at The Boeing Company. Now, American surgical education is showing similar signs of turbulence. While surgical training has long been known for its rigor and potency, corporatized medicine is compromising what was once a proud standard. The American Board of Surgery has recently overhauled graduation requirements from surgical residency, hoping to increase the trustworthiness of new surgeons to the public. However, we are at a tipping point where the decisions being made in hospitals mirror those that led to aviation failures. This is more than a professional issue; it's a public one. How we train the next generation of surgeons will determine the quality-of-care millions of people receive. This story is about systemic cracks-and how we can begin to repair them. Boeing's trajectory shifted from an engineering-first culture to a profit-driven one, and this shift has compromised safety and performance. Similarly, surgical education is undergoing a transformation driven by financial pressures. Hospitals are increasingly prioritizing revenue generation over the quality of training. The consequences? A lack of operative autonomy for residents, fewer opportunities for hands-on learning, and ultimately, a generation of surgeons less prepared for independent practice. Now surgeons are forced to meet productivity and "relative-value unit" demands that leave little time to train the next generation. While the field of surgery has initiated changes in surgical education from within, these efforts are not enough. We need funding and prioritization of educational endeavors. We aim to engage readers in this discussion because improving the quality of the next generation of surgeons is crucial to the quality of care they will receive. It's a conversation we need to have now-before the consequences become as visible as they have in the aviation industry.

Keywords: Competency-based education; Healthcare corporatization; Healthcare quality; Patient safety; Surgical education; Value-based care; Workforce sustainability.