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Obi M, Obiri-Yeboah D, Han A, Prabhu A, French J, Lipman JM. Understanding General Surgery Recruitment and Attrition During the COVID-Era: A 1-Year Follow-Up Study. J Surg Res 2024; 300:1-7. [PMID: 38788481 DOI: 10.1016/j.jss.2024.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 04/08/2024] [Accepted: 04/21/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION The COVID-19 pandemic resulted in modifications to resident selection. The success of these new recruitment strategies as well as the impact on trainee attrition and competency is unknown. We previously evaluated how selection of general surgery applicants changed early in the pandemic. Here we supplement that work by reporting further modifications to the recruitment process and the perceived impact on resident attrition and competency. METHODS An anonymous cross-sectional survey sent via the Association of Program Directors in Surgery listserv in June 2022 to programs directors (PDs) at Accreditation Council for Graduate Medical Education accredited general surgery programs. Surveys contained demographic questions, 5-point Likert scale questions evaluating factors related to recruitment and match process, and postgraduate year 1 performance. RESULTS 60 PDs responded to the survey. PDs continue to value the same post-COVID factors related to determining a resident's commitment to surgery but began to shift back to nonvirtual based strategies to recruit applicants in this new interview cycle. PD commentary frequently noted desire to return to in-person interviewing. 5.4% of postgraduate year 1s comprising this first class of residents who underwent virtual-only interviews and rotations did not reach Accreditation Council for Graduate Medical Education level 1 milestones, similar to prior years. The attrition rate amongst this class increased from 1.3% to 2.7%. CONCLUSIONS The attrition rate for postgraduate year 1 categorical general surgery residents has increased since the onset of the pandemic. The recruitment strategies adopted early in the pandemic have not maintained their initial perceived impact.
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Affiliation(s)
- Megan Obi
- Department of General Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Derrick Obiri-Yeboah
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Amy Han
- Department of General Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ajita Prabhu
- Department of General Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Judith French
- Department of General Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jeremy M Lipman
- Department of General Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
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Murphy VL, Chao P, Koea J, Srinivasa S. Systematic review of the efficacy and purpose of student surgical interest groups. ANZ J Surg 2023; 93:2580-2588. [PMID: 37861106 DOI: 10.1111/ans.18732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND There is concern around projected unmet need in the surgical workforce internationally. Current barriers to medical students pursuing surgical careers include lack of early exposure, low confidence in surgical skills, and perceived lifestyle barriers. This review aimed to examine both the purpose of student surgical interest groups (SIGs) globally, and their effect on metrics representing student surgical career interest. barriers. METHODS MEDLINE, EMBASE, PubMed, and Google Scholar were searched for papers analysing surgical interest group purpose and efficacy. Risk of bias was assessed for survey-based papers using a 20-point checklist. Descriptive analysis was performed based on qualitative data. RESULTS Twenty-eight papers were included in the analysis including 13 surveys. These were of moderate quality. The analysed SIGs had 100-1000 student members and a diverse range of funding sources. Purpose of SIGs was described by 26 of 28 papers with common themes including promotion of surgical career choice and developing theoretical/practical surgical skills. Common initiatives of SIGs included surgical lectures/teaching and practical skills workshops. Data from 15 papers analysing efficacy of SIGs suggested they positively influenced self-reported student interest in surgical careers (78.6%) and confidence in surgical knowledge (80%), as well as confidence in practical skills, knowledge about surgical careers/lifestyle, mentorship opportunity, and research involvement. CONCLUSION Student SIGs make a unique contribution to early medical student experience through positive effect on promoting surgical careers. They target relevant metrics such as surgical knowledge and confidence that are known to influence surgical career choice in the modern surgical landscape.
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Affiliation(s)
| | - Phillip Chao
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
| | - Jonathan Koea
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
| | - Sanket Srinivasa
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
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3
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Rivard SJ, Kemp MT, Sandhu G, Heximer AC, Hughes T, Byrnes ME. "Why would you want to do that?"Surgical Interns Reflect on Discouragement From Entering Surgical Fields. JOURNAL OF SURGICAL EDUCATION 2022; 79:1150-1158. [PMID: 35662535 DOI: 10.1016/j.jsurg.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/20/2022] [Accepted: 04/30/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Decreasing numbers of medical students are choosing to pursue surgical careers. This study highlights individual experiences of surgical interns receiving discouragement from pursuing surgery as a career. METHODS We interviewed 24 incoming surgical interns from 7 institutions and 7 surgical subspecialties about their experiences with discouragement from surgery. RESULTS All surgical interns discussed experiencing discouragement from pursuing surgery as a career. Family, friends, the general public, and medical professionals, including surgeons, served as sources of discouragement. Reasons for discouragement fell into 3 main themes: The Surgeon and Surgical Culture, The Sacrifices, and The Sexism. Despite its pervasiveness, participants reconciled the discouragement received. DISCUSSION Discouragement from surgery is pervasive and centered around surgeon stereotypes and perceptions of surgical culture, significant personal sacrifices required, and traditional gender-related expectations. These results highlight the importance of individual surgeons' comments on student experience and can be used to improve the perception of surgery amongst prospective interns.
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Affiliation(s)
| | - Michael T Kemp
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Tasha Hughes
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Mary E Byrnes
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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4
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Oslock WM, Satiani B, Way DP, Tamer RM, Maurer J, Hawley JD, Sharp KL, Williams TE, Pawlik TM, Ellison EC, Santry HP. A contemporary reassessment of the US surgical workforce through 2050 predicts continued shortages and increased productivity demands. Am J Surg 2021; 223:28-35. [PMID: 34376275 DOI: 10.1016/j.amjsurg.2021.07.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND We aimed to predict practicing surgeon workforce size across ten specialties to provide an up-to-date, national perspective on future surgical workforce shortages or surpluses. METHODS Twenty-one years of AMA Masterfile data (1997-2017) were used to predict surgeons practicing from 2030 to 2050. Published ratios of surgeons/100,000 population were used to estimate the number of surgeons needed. MGMA median wRVU/surgeon by specialty (2017) was used to determine wRVU demand and capacity based on projected and needed number of surgeons. RESULTS By 2030, surgeon shortages across nine specialties: Cardiothoracic, Otolaryngology, General Surgery, Obstetrics-Gynecology, Ophthalmology, Orthopedics, Plastics, Urology, and Vascular, are estimated to increase clinical workload by 10-50% additional wRVU. By 2050, shortages in eight specialties are estimated to increase clinical workload by 7-61% additional wRVU. CONCLUSIONS If historical trends continue, a majority of surgical specialties are estimated to experience workforce deficits, increasing clinical demands substantially.
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Affiliation(s)
- Wendelyn M Oslock
- The University of Alabama Birmingham Medical Center, Department of Surgery, Birmingham, AL, USA.
| | - Bhagwan Satiani
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA.
| | - David P Way
- Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, OH, USA.
| | - Robert M Tamer
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, OH, USA.
| | - Julie Maurer
- John Glenn College of Public Affairs, Ohio State University, Columbus, OH, USA.
| | - Joshua D Hawley
- John Glenn College of Public Affairs, Ohio State University, Columbus, OH, USA.
| | - Kyle L Sharp
- Ohio State University Wexner Medical Center, Department of SCN Administration, Columbus, OH, USA.
| | - Thomas E Williams
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA.
| | - Timothy M Pawlik
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA.
| | - E Christopher Ellison
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA.
| | - Heena P Santry
- Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, OH, USA.
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5
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Zagales I, Bourne M, Sutherland M, Pasarin A, Zagales R, Awan M, McKenney M, Elkbuli A. Regional Population-Based Workforce Shortages in General Surgery by Practicing Surgeon and Resident Trainee. Am Surg 2021; 87:855-863. [PMID: 34176319 DOI: 10.1177/00031348211029870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The physician shortage in the United States (US) continues to become more apparent. We aimed to evaluate the relationship between the US physician distribution from 2012-2019 by specialty at the state/regional level relative to the corresponding population growth. METHODS US matched residents and practicing physicians from 2012-2019 were extracted from the National Resident Matching Program and Association of American Medical College databases, respectively. Residents and practicing physicians were divided by geographic regions (West, Midwest, South, Northeast), states, and specialties (anesthesiology, emergency medicine, family medicine, general surgery (GS), internal medicine, obstetrics/gynecology and pediatrics). RESULTS Entering residents and physicians increased across 7 specialties from 2012-2019 with the exception of GS, which showed .2% decrease in practicing physicians. GS experienced decreases in entering residents in all US regions except the South. All specialties showed a decrease in the people-per-physician (PPP) except GS and pediatrics, which had a 4.1% and 71.3% increase, respectively. EM showed the largest growth overall, both in entering residents and overall workforce. CONCLUSION GS experienced slow growth of residents, decreases in practicing physicians and workforce overall, and an increase in PPP from 2012-2019. Our findings suggest that current population growth rate is exceeding the rate of physicians entering the field of GS and highlights the need for interventions to promote the recruitment of GS residents and retainment of attending physicians, particularly for rural areas. Future research to measure surgeon distribution in relation to patient outcomes and the efficacy of recent policy to address shortages can help define additional interventions to address physician shortages moving forward.
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Affiliation(s)
- Israel Zagales
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Mitchell Bourne
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Mason Sutherland
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Anthony Pasarin
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Ruth Zagales
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Muhammed Awan
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
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Mahoney ST, Irish W, Strassle PD, Schroen AT, Freischlag JA, Tuttle-Newhall JEB, Brownstein MR. Practice Characteristics and Job Satisfaction of Private Practice and Academic Surgeons. JAMA Surg 2021; 156:247-254. [PMID: 33326032 DOI: 10.1001/jamasurg.2020.5670] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Private practice and academic surgery careers vary significantly in their daily routine, compensation schemes, and definition of productivity. Data are needed regarding the practice characteristics and job satisfaction of these career paths for surgeons and trainees to make informed career decisions and to identify modifiable factors that may be associated with the health of the surgical workforce. Objective To obtain and compare the differences in practice characteristics and career satisfaction measures between academic and private practice surgeons. Design, Setting, and Participants In this cross-sectional survey performed from June 4 to August 1, 2018, an online survey accommodating smartphone, tablet, and desktop formats was distributed by email to 25 748 surgeons who were actively practicing fellows of the American College of Surgeons; had completed a general surgery residency or categorical fellowship in plastic, cardiothoracic, or vascular surgery; and had an active email address on file. Main Outcomes and Measures Demographic, training, and current practice characteristics were obtained, and satisfaction measures were measured on a 5-point Likert scale and compared by surgeon type. Nonresponse weights adjusted for respondent sex, age, and presence of subspecialty training between respondents and the total surveyed American College of Surgeons population. Results There were 3807 responses (15% response rate) from surgeons: 1735 academic surgeons (1390 men [80%]; median age, 53 years [interquartile range (IQR), 44-61 years]) and 1464 private practice surgeons (1276 men [87%]; median age, 56 years [IQR, 48-62 years]); 589 surgeons who reported being neither an academic surgeon nor a private practice surgeon and 19 surgeons who did not respond to questions on their practice type were excluded. Academic surgeons reported working a median of 59 hours weekly (IQR, 38-65 hours) compared with 57 hours weekly (IQR, 45-65 hours) for private practice surgeons. Academic surgeons reported more weekly hours performing nonclinical work than did private practice surgeons (24 hours [IQR, 14-38 hours] vs 9 hours [IQR, 4-17 hours]; P < .001). Academic surgeons were more likely than private practice surgeons to be satisfied with their career as a surgeon (1448 of 1706 [85%] vs 1109 of 1420 [78%]; P < .001) and their financial compensation (997 of 1703 [59%] vs 546 of 1416 [39%]; P < .001). Academic surgeons were less likely than private practice surgeons to feel that competition with other surgeons is a threat to financial security (341 of 1705 [20%] vs 559 of 1422 [39%]; P < .001) and less likely to feel that malpractice experience has decreased job satisfaction (534 of 1703 [31%] vs 686 of 1413 [49%]; P < .001). Conclusions and Relevance This study suggests that, although overall surgeon satisfaction was high, academic surgeons reported higher career satisfaction on several measures when compared with private practice surgeons. Advocacy for private practice surgeons is important to encourage career longevity and sustain US surgeon workforce needs.
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Affiliation(s)
- Stephen T Mahoney
- Department of Surgery, St Joseph Mercy Ann Arbor, Ann Arbor, Michigan
| | - William Irish
- Department of Surgery, East Carolina University, Greenville, North Carolina
| | - Paula D Strassle
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill.,Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill
| | | | - Julie A Freischlag
- Department of Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
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7
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Current status of trauma surgery at a Japanese prefectural academic institute: improved organization in a regional prefecture. Surg Today 2021; 51:1001-1009. [PMID: 33392752 DOI: 10.1007/s00595-020-02196-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/17/2020] [Indexed: 10/22/2022]
Abstract
PURPOSES Balancing scheduled surgery and trauma surgery is difficult with a limited number of surgeons. To address the issues and systematize education, we analyzed the current situation and the effectiveness of having a trauma team in the ER of a regional hospital. METHODS This retrospective study analyzed the demographics, traumatic variables, procedures, postoperative morbidities, and outcomes of 110 patients who underwent trauma surgery between 2012 and 2019. The trauma team was established in 2016 and our university hospital Emergency Room (ER) opened in 2012. RESULTS Blunt trauma accounted for 82% of the trauma injuries and 39% of trauma victims were transported from local centers to our institute. The most frequently injured organs were in the digestive tract and about half of the interventions were for hemostatic surgery alone. Concomitant treatments for multiple organ injuries were performed in 31% of the patients. The rates of postoperative severe complications (over Clavien-Dindo IIIb) and mortality were 10% and 13%, respectively. Fourteen (12.7%) of 24 patients who underwent damage-control surgery died, with multiple organ injury being the predominant cause of death. CONCLUSION Systematic education or training of medical students and general surgeons, as well as the co-operation of the team at the regional academic institute, are necessary to overcome the limited human resources and save trauma patients.
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8
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Oslock WM, Ricci KB, Ingraham AM, Rushing AP, Baselice HE, Paredes AZ, Heh VK, Byrd CA, Strassels SA, Santry HP. Role of interprofessional teams in emergency general surgery patient outcomes. Surgery 2020; 168:347-353. [DOI: 10.1016/j.surg.2020.04.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/09/2020] [Accepted: 04/15/2020] [Indexed: 11/30/2022]
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Sibia US, Turcotte JJ, Klune JR, Feather CB. How Does a New General Surgery Residency Program's Junior Residents Impact Hospital Efficiency and Productivity? JOURNAL OF SURGICAL EDUCATION 2020; 77:309-315. [PMID: 31889692 DOI: 10.1016/j.jsurg.2019.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/21/2019] [Accepted: 10/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The general surgery workforce deficit is projected to grow to 15% to 21% by 2050. An estimated 6.6% increase to existing general surgery residency (GSR) programs is needed to meet this shortfall. The purpose of this study was to examine the impact of a new GSR program on efficiency and productivity at a regional healthcare center. STUDY DESIGN An institutional database was retrospectively queried for all GSR related procedures between July 2015 and June 2018. Procedures done prior to GSR initiation (pre-GSR) were compared to those done after (post-GSR). Univariate and multivariate analyses were performed. RESULTS We reviewed 10,617 procedures (6365 pre-GSR vs. 4252 post-GSR). Patients had lower preoperative Hierarchical Condition Category scores in the post-GSR group (0.71 vs. 0.58, p < 0.01). Operative times increased post-GSR (101.7 vs. 109.1 minutes, p < 0.01), but length of stay decreased (6.4 vs. 5.5 days, p = 0.01). Thirty-day readmissions (4.0% vs. 3.4%, p = 0.11) were comparable, but reoperations significantly decreased post-GSR (10.1% vs. 8.6%, p = 0.01). Average hospital costs remained unchanged ($10,765 vs. $10,140, p = 0.12). Multivariate analysis revealed no statistical difference in operative times, length of stay, 30-day readmissions and reoperations, and hospital costs between the 2 groups. Subset analysis based on surgical service also showed no statistical difference. Productivity increased on the general surgery service post-GSR (7.1 vs. 7.8 cases per day, p = 0.02). Patient satisfaction increased post-GSR (76% vs. 81%, p = 0.31), but without statistical significance. CONCLUSION The initiation of a new GSR program did not negatively impact operative times, length of stay, 30-day readmissions and reoperations, hospital costs, case volume, or patient satisfaction.
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Affiliation(s)
- Udai S Sibia
- Department of Surgery, Anne Arundel Medical Center, Annapolis, Maryland.
| | - Justin J Turcotte
- Department of Surgery, Anne Arundel Medical Center, Annapolis, Maryland
| | - John R Klune
- Department of Surgery, Anne Arundel Medical Center, Annapolis, Maryland
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10
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Mahoney ST, Strassle PD, Schroen AT, Agans RP, Turner PL, Meyer AA, Freischlag JA, Brownstein MR. Survey of the US Surgeon Workforce: Practice Characteristics, Job Satisfaction, and Reasons for Leaving Surgery. J Am Coll Surg 2020; 230:283-293.e1. [DOI: 10.1016/j.jamcollsurg.2019.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
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11
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Shin SH, Tang GL, Shalhub S. Integrated residency is associated with an increase in women among vascular surgery trainees. J Vasc Surg 2020; 71:609-615. [DOI: 10.1016/j.jvs.2019.03.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/28/2019] [Indexed: 11/25/2022]
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12
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Ohki T. Reviving surgery with the smile, excitement, and Gemeinschaft concept: attempt at the Department of Surgery, Jikei University. Innov Surg Sci 2019; 4:69-74. [PMID: 31579806 PMCID: PMC6754056 DOI: 10.1515/iss-2019-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/22/2019] [Indexed: 11/20/2022] Open
Abstract
Between 1994 and 2004, the number of surgeons in Japan declined by 18%, whereas the total number of medical doctors increased by 30% during the same period. This was due to the fact that the younger generation avoided tough working environments with long working hours. We attempted to revive surgery by reintroducing the good old Japanese community as the model under the slogan of “intimate community with excitement and sense of secureness”. In the absence of financial incentives, we were able to recruit young staff, and the number of surgeons at Jikei University has increased by 28% over the last 12 years and currently we have 280 surgeons. Our experience showed that although the younger generation is conscious about quality of life and financial success, they also value excitement, friendship, and happiness, something we were able to provide without financial spending. However, our success may be an exception and cannot be generalized; therefore, we should continue to strive to improve the surgeon’s quality of life by creating a better working environment, including sustainable work hours and decent financial incentives.
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Affiliation(s)
- Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
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13
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Abelson JS, Sosa JA, Symer MM, Mao J, Michelassi F, Bell R, Sedrakyan A, Yeo HL. Association of Expectations of Training With Attrition in General Surgery Residents. JAMA Surg 2019; 153:712-717. [PMID: 29710278 DOI: 10.1001/jamasurg.2018.0611] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Attrition from general surgery training is highest during internship. Whether the expectations and attitudes of new trainees affect their subsequent risk of attrition is unknown. Objective To identify the expectations of general surgery residency associated with attrition from training. Design, Setting, and Participants This prospective observational cohort study included categorical general surgery interns entering training in the 2007-2008 academic year. Residents were surveyed regarding their expectations of training and of life as an attending at the start of their intern year (June 1 to August 31, 2007). Expectations were grouped into factors by principal component analysis, and a multivariable model was created using these factors in addition to known demographic and program characteristics associated with attrition. Follow-up was completed on December 31, 2016. Main Outcomes and Measures Attrition from training was determined by linkage to American Board of Surgery resident files through 2016, allowing 8 additional years of follow-up. Results Of 1048 categorical surgery interns in the study period, 870 took the survey (83.0% response rate), and 828 had complete information available for analysis (524 men [63.3%], 303 women [36.6%], and 1 missing information [0.1%]). Most were white (569 [69.1%]) and at academic programs (500 [60.4%]). Six hundred sixty-six residents (80.4%) completed training. Principal component analysis generated 6 factors. On adjusted analysis, 2 factors were associated with attrition. Interns who choose their residency based on program reputation (factor 2) were more likely to drop out (odds ratio, 1.08; 95% CI, 1.01-1.15). Interns who expected as an attending to work more than 80 hours per week, to have a stressful life, and to be the subject of malpractice litigation (career life expectation [factor 6]) were less likely to drop out (odds ratio, 0.90; 95% CI, 0.82-0.98). Conclusions and Relevance Interns with realistic expectations of the demands of residency and life as an attending may be more likely to complete training. Medical students and residents entering training should be given clear guidance in what to expect as a surgery resident.
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Affiliation(s)
- Jonathan S Abelson
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Julie A Sosa
- Department of Surgery, Duke Cancer Institute, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Matthew M Symer
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Jialin Mao
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Fabrizio Michelassi
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Richard Bell
- Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia Pennsylvania
| | - Art Sedrakyan
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Heather L Yeo
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York.,Department of Healthcare Policy and Research, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
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14
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Vallböhmer D, Fuchs H, Dittmar R, Krones CJ. Is there anybody out there: what do senior surgeons expect of their youngsters? Innov Surg Sci 2019; 4:3-6. [PMID: 31579795 PMCID: PMC6754063 DOI: 10.1515/iss-2018-0031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 12/28/2018] [Indexed: 11/20/2022] Open
Abstract
Surgery is indeed one of the most fascinating medical professions. However, it is also a stressful field of work with a high workload, and often leaves little time for personal and family needs. Within the last decade, a noticeable decline occurred in the willingness of medical students to enter a surgical residency. In fact, Generation Y is highly interested in a medical career with a respectful working atmosphere and balanced work and private life, as published in several recent papers. Therefore, surgery must evolve with the times to retain its attractiveness as a career choice for medical students and to compete for the best talents from Generation Y. However, little is known about what senior surgeons really expect from young surgical residents. On the basis of a recent survey by the Professional Association of German Surgeons, this paper tries to give some insights in this very relevant topic and a perspective on how to increase the attractiveness of our fascinating specialty. In fact, in this survey, senior surgeons defined a very clear requirement profile for surgical residency applicants. While the colleagues defined accurate applicant documents, a previous internship, self-motivation, and impressions from the job interview as the most important factors for a successful application for a surgical residency, a standard period of study or a dissertation was deemed of lower importance.
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Affiliation(s)
| | - Hans Fuchs
- Department of General, Visceral and Tumor Surgery, University Hospital of Cologne, Cologne, Germany
| | - Ronny Dittmar
- Professional Association of German Surgeons, Berlin, Germany
| | - Carsten J Krones
- Department of General, Visceral and Minimal Invasive Surgery, Marienhospital Aachen, Aachen, Germany
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Elsey EJ, West J, Griffiths G, Humes DJ. Time Out of General Surgery Specialty Training in the UK: A National Database Study. JOURNAL OF SURGICAL EDUCATION 2019; 76:55-64. [PMID: 30093329 DOI: 10.1016/j.jsurg.2018.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/08/2018] [Accepted: 06/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE General surgery specialty training in the United Kingdom takes 6 years and allows trainees to take time out of training. Studies from the United States have highlighted an increasing trend for taking time out of surgical training for research. This study aimed to evaluate trends in time out of training and the impact on the duration of UK general surgical specialty training. DESIGN, SETTING, AND PARTICIPANTS A cohort study using routinely collected surgical training data from the Intercollegiate Surgical Curriculum Program database for General surgery trainees registered from August 1, 2007. Trainees were classified as Completed Training or In-Training. Out of training periods were identified and time in training calculated (both unadjusted and adjusted for out of training periods) with a predicted time in training for those In-Training. RESULTS Of the trainees still In-Training (n = 994), a greater proportion had taken time out of training compared with those who had completed training (n = 360; 54.5% vs 45.9%, p < 0.01). A greater proportion of the In-Training group had undertaken a formal research period compared with the Completed Training group (35.1% vs 6.1%, p < 0.01). Total unadjusted training time in the Completed Training group was a median 6.0 (interquartile range 6.0-7.0) years compared with a predicted unadjusted training time in the In-Training group, with an out of training period recorded, of a median 8.0 (interquartile range 7.0-9.0) years. CONCLUSIONS Trainees are increasingly taking time out of surgical training, particularly for research, with a subsequent increase in total time of training. This should be considered when redesigning surgical training programs and planning the future surgical workforce.
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Affiliation(s)
- Elizabeth J Elsey
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
| | - Joe West
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - David J Humes
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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My name is *** and I am a general surgeon. Am J Surg 2018; 217:995-999. [PMID: 30447799 DOI: 10.1016/j.amjsurg.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 11/08/2018] [Indexed: 11/23/2022]
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Symer MM, Abelson JS, Yeo HL, Sosa JA, Rosenthal MZ. The Surgical Personality: Does Surgery Resident Motivation Predict Attrition? J Am Coll Surg 2018; 226:777-783. [DOI: 10.1016/j.jamcollsurg.2018.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/08/2018] [Accepted: 02/05/2018] [Indexed: 10/17/2022]
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Abstract
Integration of advanced practitioners (APs) into academic medical centers can improve processes of care and decrease physician workload but may adversely impact general surgery residency training. The aim of the present study was to characterize general surgery resident perceptions of APs and their impact on resident training. We conducted an institutional review board–approved survey covering five topic areas: knowledge of AP training, interaction with APs, scope-of-practice of APs, role of APs in the health-care team, and impact of APs on physician training. The survey was administered to general surgery residents at six large academic medical centers. One hundred eighteen general surgery residents completed the survey. The majority (43.6%) of respondents were junior residents. All respondents had interactions with APs with 90.7 per cent having worked directly with an AP in the last month. Residents reported minimal formal educational involvement by APs with 6.8 per cent reporting participation in didactics and 22.2 per cent teaching operative techniques. Almost half (44.1%) of the respondents reported that APs played an important role in their education, and 42.4 per cent of respondents disagreed or strongly disagreed that the role of the AP is well defined in their hospital. Today's general surgery residents work closely with APs who seem to positively impact resident education. Although residents perceive significant benefit with integration of APs, well-defined roles are lacking.
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Jackson TN, Pearcy CP, Khorgami Z, Agrawal V, Taubman KE, Truitt MS. The Physician Attrition Crisis: A Cross-Sectional Survey of the Risk Factors for Reduced Job Satisfaction Among US Surgeons. World J Surg 2017; 42:1285-1292. [DOI: 10.1007/s00268-017-4286-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schmidt LE, Cooper CA, Guo WA. Factors influencing US medical students' decision to pursue surgery. J Surg Res 2016; 203:64-74. [PMID: 27338536 DOI: 10.1016/j.jss.2016.03.054] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/09/2016] [Accepted: 03/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Interest and applications to surgery have steadily decreased over recent years in the United States. The goal of this review is to collect the current literature regarding US medical students' experience in surgery and factors influencing their intention to pursue surgery as a career. We hypothesize that multiple factors influence US medical students' career choice in surgery. METHODS Six electronic databases (PubMed, SCOPUS, Web of Science, Education Resources Information Center, Embase, and PsycINFO) were searched. The inclusion criteria were studies published after the new century related to factors influencing surgical career choice among US medical students. Factors influencing US medical student surgical career decision-making were recorded. A quality index score was given to each article selected to minimize risk of bias. RESULTS We identified 38 relevant articles of more than 1000 nonduplicated titles. The factors influencing medical student decision for a surgical career were categorized into five domains: mentorship and role model (n = 12), experience (clerkship n = 9, stereotype n = 4), timing of exposure (n = 9), personal (lifestyle n = 8, gender n = 6, finance n = 3), and others (n = 2). CONCLUSIONS This comprehensive systemic review identifies mentorship, experience in surgery, stereotypes, timing of exposure, and personal factors to be major determinants in medical students' decisions to pursue surgery. These represent areas that can be improved to attract applicants to general surgery residencies. Surgical faculty and residents can have a positive influence on medical students' decisions to pursue surgery as a career. Early introduction to the field of surgery, as well as recruitment strategies during the preclinical and clinical years of medical school can increase students' interest in a surgical career.
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Rudnicki M, Armstrong JH, Clark C, Marcus SG, Sacks L, Moser AJ, Reid-Lombardo KM. Expected and Unexpected Consequences of the Affordable Care Act: The Impact on Patients and Surgeons-Pro and Con Arguments. J Gastrointest Surg 2016; 20:351-60. [PMID: 26589524 DOI: 10.1007/s11605-015-3032-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 11/13/2015] [Indexed: 01/31/2023]
Abstract
The Patient Protection and Affordable Care Act (PPACA), called the Affordable Care Act (ACA) or "ObamaCare" for short, was enacted in 2010. The Public Policy and Advocacy Committee of the Society for Surgery of the Alimentary Tract (SSAT) hosted a debate with an expert panel to discuss the ACA and its impact on surgical care after the first year of patient enrollment. The purpose of this debate was to focus on the impact of ACA on the public and surgeons. At the core of the ACA are insurance industry reforms and expanded coverage, with a goal of improved clinical outcomes and reduced costs of care. We have observed supportive and opposing views on ACA. Nonetheless, we will witness major shifts in health care delivery as well as restructuring of our relationship with payers, institutions, and patients. With the rapidly changing health care landscape, surgeons will become key members of health systems and will likely need to lead transition from solo-practice to integrated care systems. The full effects of the ACA remain unrealized, but its implementation has begun to change the map of the American health care system and will surely impact the practice of surgery. Herein, we provide a synopsis of the "pro" and "con" arguments for the expected and unexpected consequences of the ACA on society and surgeons.
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Affiliation(s)
- Marek Rudnicki
- Department of Surgery, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - John H Armstrong
- Department of Surgery, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Clancy Clark
- Department of Surgery, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Stuart G Marcus
- Department of Surgery, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Lee Sacks
- Advocate Health Care, Downers Grove, IL, USA
| | - A James Moser
- Institute for Hepatobiliary and Pancreatic Surgery Beth Israel Deaconess Medical Center and Dana Farber Harvard Cancer Center, Harvard Medical School, Boston, MA, USA
| | - K Marie Reid-Lombardo
- Department of Surgery, Mayo Clinic, Rochester, MN, USA.
- Division of Subspecialty General Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55902, USA.
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Jarman BT, Joshi ART, Trickey AW, Dort JM, Kallies KJ, Sidwell RA. Factors and Influences That Determine the Choices of Surgery Residency Applicants. JOURNAL OF SURGICAL EDUCATION 2015; 72:e163-e171. [PMID: 26143518 DOI: 10.1016/j.jsurg.2015.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/20/2015] [Accepted: 05/27/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE We sought to evaluate characteristics of residency applicants selected to interview at independent general surgery programs, identify residency information resources, assess if there is perceived bias toward university or independent programs, and determine what types of programs applicants prefer. STUDY DESIGN An electronic survey was sent to applicants who were selected to interview at a participating independent program. Open-ended responses regarding reasons for program-type bias were submitted. Multivariable logistic regression models were estimated to identify applicant characteristics associated with program-type preference. SETTING Independent general surgery residency programs. PARTICIPANTS A total, of 1220 applicants were selected to interview at one of 33 independent programs. RESULTS In total, 670 surveys were completed (55% response rate). Demographics of respondents were similar to the full invited population. Median United States Medical Licensing Examination Step 1 and Step 2 scores were between 230 to 239 and 240 to 249, respectively. Most applicants reported receiving general information about surgery residency programs and specific information about independent programs from residency program websites. 34% of respondents perceived an imbalanced representation of program types, with 96% of those reporting bias toward university programs. CONCLUSIONS Applicants selected to interview at independent programs are competitive for general surgery training and primarily use residency program websites for information gathering. Bias is common toward university programs for a variety of perceived reasons. This information will be useful in applicant evaluation and selection, serve as a stimulus to update program websites, and challenge independent program directors to work to alleviate bias against their programs.
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Affiliation(s)
- Benjamin T Jarman
- Department of General and Vascular Surgery, Gundersen Health System, La Crosse, Wisconsin.
| | - Amit R T Joshi
- Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Amber W Trickey
- Advanced Surgical Technology and Education Center, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Jonathan M Dort
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Kara J Kallies
- Department of Research, Gundersen Medical Foundation, La Crosse, Wisconsin
| | - Richard A Sidwell
- Department of Surgery Education, Iowa Methodist Medical Center, Des Moines, Iowa
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