1. General Surgery versus Fellowship: the Role of the Independent Academic Medical Center
Souheil W. Adra, MD
Amber 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

2. Disclosures
NONE

3. 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)

4. 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
University= university hospital is the prime hospital of the training program

5. Results Respondents are representative of all 250 programs
Any response: N = 91 (36%)
Surveys completed: N = 74 (30%)

6. Program Characteristics
IAMC
N (%)
UAMC
p-value
Hospital Size
0.36
< 300 beds
1 (3)
5 (12)
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
1 (2)
Number of Cases
0.37
5 (16)
6 (14)
10 (32)
> 1050
16 (37)
Total
31 (100)
43 (100) -

7. Program Characteristics, cont.
IAMC
N (%)
UAMC
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)
≥ 500,000
17 (40)
Region
0.25
Midwest
5 (16)
9 (21)
Northeast
13 (42)
10 (23)
South
18 (42)
West
5 (12)
Total
31 (100)
43 (100) -

8. Distribution of Fellowships
UAMC
IAMC

9. Reasons to Pursue Fellowships
UAMC
IAMC
Lifestyle was more commonly listed as a top three reasons for choosing a fellowship by program directors of IAMCs

10. Reasons to Pursue General Surgery
UAMC
IAMC

11. UAMC vs. IAMC Responses
There was a trend to more residents going into general surgery from IAMC as compared to UAMC
This shows the percentage of program directors that had more than a quarter of their residents go on to become general surgeons

12. General Surgery by Region

13. 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

14. 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

15. 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
Using program directors’ perception vs. residents for our pilot study
Representative sample: Our sample had a comparable ratio of IAMCs in the respondants as in the total programs our sample had comparable distribution of programs regionally and by size of city.

16. 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

17. Future Studies Direct surveys of residents
Further evaluation of program type in shaping career choices
Develop strategies for reducing the general surgeon shortage
Further evaluation of program type in shaping career choices should be considered while designing studies as it could be a confounding variable.