General Surgery vs Fellowship: The Role of the Independent Academic Medical Center

• Published in: Journal of surgical education Vol. 69; no. 6; pp. 740 - 745
• Main Authors: Adra, Souheil W., MD, Trickey, Amber W., MS, Crosby, Moira E., MPH, Kurtzman, Scott H., MD, Friedell, Mark L., MD, Reines, H. David, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2012
• Subjects: Academic Medical Centers; Career Choice; career choices; fellowship; Fellowships and Scholarships; Female; general surgery; General Surgery - education; Humans; Interpersonal and Communication Skills; Male; Professionalism; Surgery; surgical residency programs; Surveys and Questionnaires; Systems Based Practice; United States; United States; surgical residency programs; Systems Based Practice; career choices; general surgery; fellowship; Professionalism; Interpersonal and Communication Skills
• ISSN: 1931-7204; 1878-7452
• DOI: 10.1016/j.jsurg.2012.05.006

Objectives To compare career choices of residency graduates from Independent Academic Medical Center (IAMC) and University Academic Medical Center (UAMC) programs and evaluate program directors' perceptions of residents' motivations for pursuing general surgery or fellowships. Design From May to August 2011, an electronic survey collected information on program characteristics, graduates' career pursuits, and career motivations. Fisher's exact tests were calculated to compare responses by program type. Multivariate logistic regression was used to identify independent program characteristics associated with graduates pursuing general surgery. Setting Data were collected on graduates over 3 years (2009-2011). Participants Surgery residency program directors. Results Seventy-four program directors completed the survey; 42% represented IAMCs. IAMCs reported more graduates choosing general surgery. Over one-quarter of graduates pursued general surgery from 52% of IAMC vs 37% of UAMC programs (p = 0.243). Career choices varied significantly by region: over one-quarter of graduates pursue general surgery from 78% of Western, 60% of Midwestern, 40% of Southern, and 24% of Northeastern programs (p = 0.018). On multivariate analysis, IAMC programs were independently associated with more graduates choosing general surgery (p = 0.017), after adjustment for other program characteristics. Seventy-five percent of UAMC programs reported over three-fourths of graduates receive first choice fellowship, compared with only 52% of IAMC programs (p = 0.067). Fellowships were comparable among IAMC and UAMC programs, most commonly MIS/Bariatric (16%), Critical Care/Trauma (16%), and Vascular (14%). IAMC and UAMC program directors cite similar reasons for graduate career choices. Conclusions Most general surgery residents undergo fellowship training. Graduates from IAMC and UAMC programs pursue similar specialties, but UAMC programs report more first choice acceptance. IAMC programs may graduate proportionately more general surgeons. Further studies directly evaluating surgical residents' career choices are warranted to understand the influence of independent and university programs in shaping these choices and to develop strategies for reducing the general surgeon shortage.