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General Surgery versus Fellowship: the Role of the

Independent Academic Medical Center

Souheil W. Adra, MDAmber W. Trickey, MS Moira E. Crosby, MPH

Scott H. Kurtzman, MD *Mark L. Friedell, MD *H. David Reines, MD *

* Independent Training Program Committee of the Association of Program Directors in Surgery

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Disclosures

• NONE

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Introduction

• Fellowship training is increasing among graduates of United States surgical residency programs

• Worsening shortage of general surgeons• Reasons leading to fellowship training are not

completely understood• The impact of the type of surgery program on

fellowship training is unknown– University Academic Medical Centers (UAMC) vs.

Independent Academic Medical Centers (IAMC)

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Survey Methods

• May-August 2011• Electronic survey 14 multiple-choice

questions, 1 open-ended question• Sent to all 250 general surgery program

directors• Analyzed the data using Fisher’s exact tests

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Results

• Respondents are representative of all 250 programs

• Any response: N = 91 (36%)• Surveys completed: N = 74 (30%)

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Program CharacteristicsIAMCN (%)

UAMCN (%) p-value

Hospital Size 0.36< 300 beds 1 (3) 5 (12)

300-500 beds 14 (45) 21 (49)> 500 beds 16 (52) 17 (40)

Number of Chiefs 0.001< 3 6 (19) 0 (0)

3 – 5 22 (71) 28 (65)> 5 3 (10) 14 (33)

Missing 0 (0) 1 (2)Number of Cases 0.37

750-900 5 (16) 6 (14)901-1050 10 (32) 21 (49)

> 1050 16 (52) 16 (37)Total 31 (100) 43 (100) -

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Program Characteristics, cont.IAMCN (%)

UAMCN (%)

p-value

Female Chiefs 0.99< 30% 12 (39) 16 (37)

30 – 50% 15 (48) 21 (49)> 50% 4 (13) 6 (14)

City Population 0.13< 10,000 1 (3) 0 (0)

10,000 – 49,999 7 (23) 4 (9)50,000 – 499,999 9 (29) 21 (49)

≥ 500,000 12 (39) 17 (40)Region 0.25

Midwest 5 (16) 9 (21)Northeast 13 (42) 10 (23)

South 7 (23) 18 (42)West 4 (13) 5 (12)

Total 31 (100) 43 (100) -

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Distribution of Fellowships

UAMC IAMC

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Reasons to Pursue Fellowships

UAMC IAMC

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Reasons to Pursue General Surgery

UAMC IAMC

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UAMC vs. IAMC Responses

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General Surgery by Region

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Discussion

• There is a perception that IAMC graduates do not have the same opportunities for fellowships as UAMC graduates

• IAMCs tend to graduate proportionately more general surgeons than UAMCs

• May impact growing general surgeons deficit

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Discussion

• The 80-hour workweek is perceived by Program Directors to increase the interest in fellowships– Need tactics to attract fellowship trained surgeons

back to general surgery

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Limitations

• Small sample size despite good response rate– underpowered for detection of statistically significant

differences• Using program directors’ perception vs. residents• Survey based study:

– Self-selection bias– Respondents’ memory– Respondents may be motivated to give answers that

present themselves in a favorable light• Selection bias unlikely, representative sample

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Conclusions

• Residents enter similar types of fellowships in IAMC vs. UAMC

• Reasons for career choices were similar in IAMC vs. UAMC

• Geographic location of residency may influence choice of career

• Trends without statistical significance:– More general surgeons from IAMC– First choice of fellowships from UAMC

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Future Studies

• Direct surveys of residents

• Further evaluation of program type in shaping career choices

• Develop strategies for reducing the general surgeon shortage