It is important to note that very few surgeons will be able to establish an HPB practice that completely fills their operating room schedule or clinic. Most HPB surgeons practice something else in addition to their HPB speciality. There simply is not a sufficient volume of cases in most hospitals to provide a full-time job in this speciality area. Therefore, most HPB surgeons will benefit from training in a broader speciality such as transplantation or surgical oncology. This allows the surgeon to more easily establish a practice outside of HPB-specific cases. HPB as a speciality also runs the risk of focusing on an organ and on operations rather than an underlying disease. After all, it is a speciality that only specifies organs. HPB specialists who train in transplantation or surgical oncology have studied the underlying clinical science of organ failure (transplantation) or cancer (surgical oncology). The HPB specialist who only sees the operation will be the least effective surgeon.
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