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Yilma M, Brown AE, Harvey J, Stahl CC, Quillin RC, Syed SM, Cortez AR. Examining the Influence of a General Surgery Resident's Transplant Experience on Their Pursuit of Transplant Surgery Fellowship. Clin Transplant 2024; 38:e15398. [PMID: 39023094 DOI: 10.1111/ctr.15398] [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: 03/22/2024] [Revised: 06/08/2024] [Accepted: 06/22/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Transplant surgery has historically been a less desirable fellowship among general surgery graduates. Limited work has been done to understand factors associated with residents' interest in transplantation. Using a multi-institutional cohort, we examined how the resident experience on transplant surgery may influence their decision to pursue transplant fellowship. METHODS Individual demographics, program characteristics, and transplant-specific case logs were collected for graduates from 2010 to 2020 at 20 general surgery residency programs within the US Resident OPerative Experience (ROPE) Consortium. Residents who pursued transplant surgery fellowship were compared to those who went directly into practice or pursued a non-transplant fellowship. RESULTS Among 1342 general surgery graduates, 52 (3.9%) pursued abdominal transplant fellowship. These residents completed more transplant (22 vs. 9), liver (14 vs. 9), pancreas (15 vs. 11), and vascular access operations (38 vs. 30) compared to residents who did not pursue transplant fellowship (all p < 0.05). Multivariable logistic regression found that residents underrepresented in medicine were three times more likely (95% CI 1.54-6.58, p < 0.01) and residents at a program co-located with a transplant fellowship six times more likely (95% CI 1.95-18.18, p < 0.01) to pursue transplant fellowship. Additionally, a resident's increasing total transplant operative volume was associated with an increased likelihood of pursuing a transplant fellowship (OR = 1.12, 95% CI 1.09-1.14, p < 0.01). CONCLUSION The findings from this multi-institutional study demonstrate that increased exposure to transplant operations and interaction within a transplant training program is associated with a resident's pursuit of transplant surgery fellowship. Efforts to increase operative exposure, case participation, and mentorship may optimize the resident experience and promote the transplant surgery pipeline.
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Affiliation(s)
- Mignote Yilma
- Division of Transplant Surgery, University of California San Francisco, San Francisco, California, USA
| | - Audrey E Brown
- Division of Transplant Surgery, University of California San Francisco, San Francisco, California, USA
| | - Jalen Harvey
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Ralph C Quillin
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, Ohio, USA
| | - Shareef M Syed
- Division of Transplant Surgery, University of California San Francisco, San Francisco, California, USA
| | - Alexander R Cortez
- Division of Transplant Surgery, University of California San Francisco, San Francisco, California, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Karataş H, Balas Ş. Navigating Cultural Challenges in Transplant Surgery: Insights from Turkish Surgeons. Healthcare (Basel) 2024; 12:1252. [PMID: 38998787 PMCID: PMC11240981 DOI: 10.3390/healthcare12131252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 07/14/2024] Open
Abstract
To achieve expertise, transplant surgeons in Turkiye undergo rigorous training, including medical school, residency, compulsory service, and extensive training in transplant surgery. Despite their high academic and clinical knowledge level, success in transplant surgery heavily depends on cultural competency. Through semi-structured interviews with 21 transplant surgeons specializing in kidney and liver transplants in Ankara, this study reveals how health illiteracy, culture, and folklore create significant barriers. Surgeons navigate these challenges while enduring harsh working conditions. This research highlights the critical role of cultural competency in transplant surgery, emphasizing the necessity for surgeons to understand and address the diverse cultural needs of their patients. Key findings indicate that surgeons must balance medical expertise with cultural sensitivity to deliver effective care. This study identifies four main cultural barriers: spiritual trust, family politics, health illiteracy, and subcultural incompetency. Effective transplant surgery requires a combination of theoretical proficiency and cultural awareness to meet a patient's needs and improve surgical outcomes.
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Affiliation(s)
- Hicran Karataş
- Sociology Department, Faculty of Letters, Kutlubey Campus, Bartın University, 74100 Bartın, Türkiye
| | - Şener Balas
- Ankara Etlik City Hospital, 74100 Ankara, Türkiye;
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3
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Faria I, Montalvan A, Kazimi M, Martins PN, Eckhoff D. Representation of Women Authorship in the Top 5 Transplantation Journals in the United States. Transplantation 2024; 108:802-812. [PMID: 37917944 DOI: 10.1097/tp.0000000000004844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND In the United States, only 13% of transplant surgeons are women. We evaluated gender distribution and trends of American authorship over the past 10 y in high-impact solid organ transplantation journals to gain insight into the current status of women authorship in transplantation. METHODS Original articles from 2012 to 2021 from the 5 highest-impact solid organ transplantation journals were extracted from Scopus. First and last author's gender was predicted using Genderize.io. Data of first and last authors, article type and topic, location, citation, and funding metrics were analyzed. Chi-square, logistic regression, and trend tests were performed where appropriate. Statistical significance was set at <0.05. RESULTS Women's first and last authorship increased over time among all journals. There was an increase in women first authors in the American Journal of Transplantation and in senior women authors in Liver Transplantation and Transplantation . Significant differences in gender authorship in lung, intestine, pancreas, general, and islet cell transplantation were found. Women's last authorship was associated with 1.69 higher odds of having a woman first author when adjusting for year and journal. There was an increase in the rate of women's first and last author collaborations over the years. Women last authors had 1.5 higher odds of being funded by the National Institutes of Health over the years. CONCLUSIONS Despite an increase in women transplant surgeons and physicians, the gap in women authorship in transplantation persists. Women's last authorship was associated with higher odds of having a woman first author, pointing to the importance of mentorship for women joining the transplant academia.
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Affiliation(s)
- Isabella Faria
- Division of Transplant Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Adriana Montalvan
- Division of Transplant Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Marwan Kazimi
- Division of Transplant Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Paulo N Martins
- Division of Organ Transplantation, Department of Surgery, University of Massachusetts, Worcester, MA
| | - Devin Eckhoff
- Division of Transplant Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Fakunle DR, Ammann AM, Sisak S, Delman AM, Vaysburg DM, Lemon K, Silski L, Holm T, Shah SA, Quillin RC. Sex Disparities in Academic Productivity and Rank Among Abdominal Transplant Faculty in the United States. Transplant Proc 2024; 56:260-264. [PMID: 38267336 DOI: 10.1016/j.transproceed.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/30/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND The aim of this study was to examine sex differences in academic rank and productivity among members of the American Society of Transplant Surgeons in the United States. METHODS Cross-sectional, focusing on current board-certified abdominal transplant surgeons in the United States. Demographic factors such as sex, region, and faculty rank were collected from institutional websites. Academic metrics, including H-index, total publications, and relative citation ratio, were collected from Scopus and iCite. RESULTS We identified 536 surgeon members of the American Society of Transplant Surgeons with an academic institution. The majority were men (83%). Men were in practice longer than women (17.9 ± 11 vs 11.7 ± 9 years, P < .0001) and had higher academic metrics, including H-index (25.6 ± 20 vs16.4 ± 14, P < .0001) and total publications (110 ± 145 vs 58.8 ± 69, P < .0001). There was a significant difference in faculty appointments by sex (P < .05), with men showing evidence of increased academic advancement. After adjusting for academic rank, PhD status, and location of medical school and residency, women remained associated with a lower H-index on multivariate analysis (P < .01). CONCLUSION Sex disparities in academic rank and achievement are present among transplant surgical faculty in the United States, and future efforts are needed to promote sex equity in transplant surgery academia.
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Affiliation(s)
- Damilola R Fakunle
- Cincinnati Research and Education in Surgical Training, Department of Surgery, University of Cincinnati, Cincinnati, Ohio; University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Allison M Ammann
- Cincinnati Research and Education in Surgical Training, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Stephanie Sisak
- Cincinnati Research and Education in Surgical Training, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Aaron M Delman
- Cincinnati Research and Education in Surgical Training, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Dennis M Vaysburg
- Cincinnati Research and Education in Surgical Training, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Kristina Lemon
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Latifa Silski
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Tammy Holm
- Cincinnati Research and Education in Surgical Training, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Shimul A Shah
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Ralph C Quillin
- Cincinnati Research and Education in Surgical Training, Department of Surgery, University of Cincinnati, Cincinnati, Ohio; Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
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5
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Delman AM, Kassam AF, Turner KM, Ammann AM, Lynch C, Morris MC, Vaysburg DM, Cortez AR, Quillin RC. Incidence of attrition among early-career abdominal transplant surgeons. Surgery 2023; 173:1113-1119. [PMID: 36167700 DOI: 10.1016/j.surg.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The prevalence of burnout and depression among abdominal transplant surgeons has been well described. However, the incidence of early-career transplant surgeons leaving the field is unknown. The objective of this study was to quantify the incidence of attrition among early-career abdominal transplant surgeons. METHODS A custom database from the Organ Procurement and Transplantation Network with encrypted surgeon-specific identifiers was queried for transplant surgeons who entered the field between 2008 and 2019. Surgeons who experienced attrition, defined as not completing a subsequent transplant after a minimum of 5, were identified. Surgeon-specific case volumes, case mix, and recipient outcomes were modeled to describe their association with attrition. RESULTS Between 2008 and 2018, 496 abdominal transplant surgeons entered the field and performed 76,465 transplant procedures. A total of 24.4% (n = 121) experienced attrition, with a median time to attrition of 2.75 years. Attrition surgeons completed fewer kidney (7 vs 21, P < .01), pancreas (0.52 vs 1.43, P < .01), and liver transplants (1 vs 4, P < .01) in their first year of practice. Attrition surgeons completed a smaller proportion of their transplant center's volume (9% vs 18%, P < .01) and were less likely to participate in pediatric transplants (26.5% vs 52.5%, P < .01) and living donor kidney transplants (64.5% vs 84.5%, P < .01). On multivariable analysis, performing fewer kidney (odds ratio: 0.98, 95% confidence interval: 0.98-0.99) and liver transplants (odds ratio: 0.98, 95% confidence interval: 0.97-0.98) by year 5 and completing a smaller proportion of their centers' volume (odds ratio: 0.96, 95% confidence interval: 0.94-0.98) were associated with attrition. Furthermore, attrition surgeons had worse allograft and patient survival for liver transplant recipients (both log-rank P < .01). CONCLUSION This investigation was the first to quantify the high incidence of attrition experienced by early-career abdominal transplant surgeons and its association with surgeon-specific case volumes, case mix, and worse recipient outcomes. These findings suggested the abdominal transplant workforce is struggling to retain their fellowship-trained surgeons.
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Affiliation(s)
- Aaron M Delman
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH. https://twitter.com/AaronDelman
| | - Al-Faraaz Kassam
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH. https://twitter.com/afkassam
| | - Kevin M Turner
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH. https://twitter.com/KevinTurnerMD
| | - Allison M Ammann
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH
| | - Caroline Lynch
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH
| | - Mackenzie C Morris
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH. https://twitter.com/MackMorrisMD
| | - Dennis M Vaysburg
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH. https://twitter.com/DMVaysburg
| | - Alexander R Cortez
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH. https://twitter.com/AlexCortezMD
| | - Ralph C Quillin
- Cincinnati Research in Outcomes and Safety in Surgery Research Group, Department of Surgery, University of Cincinnati College of Medicine, OH; Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, OH.
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6
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Choubey AP, Bullock B, Hoste B, Ortiz A, Khan SA, Mishra A, Pearson T, Koizumi N, Ortiz J. Diversity in American Society of Transplant Surgeons Governance: Equitable but Unequal. EXP CLIN TRANSPLANT 2022; 20:973-979. [PMID: 34498553 DOI: 10.6002/ect.2021.0111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The diversity in the governance of the American Society of Transplant Surgeons has not been described. We aimed to quantify the present state of its leadership as a baseline to inform future research. MATERIALS AND METHODS Lists of leaders on the American Society of Transplant Surgeons Council, the COVID-19 Strike Force, and 20 different American Society of Transplant Surgeons committees were obtained from the Society's website. Demographic and training information for the members were compiled through internet searches and analyzed. RESULTS The American Society of Transplant Surgeons Council included 15 members, with 20% women. It was 93.3% non-Hispanic White. The COVID-19 Strike Force included 12 surgeons, 16.7% of whom were female, with 75% non-Hispanic White. Of the 198 committee members, 23.7% were women, 68.7% were nonHispanic White, 16.6% were Asian, 8.1% were Hispanic, and 6.6% were Black. Among female committee members, underrepresented minorities comprised 23.6%. Committee chairs included 23% women, 23% underrepresented minorities, and 2.3% minority women. International medical graduates were more likely men (P = .02). CONCLUSIONS Representation of women in the American Society of Transplant Surgeons leadership has kept pace with their membership in the transplant surgery workforce. There is a deficiency of female under - represented minorities in leadership positions at the Society. Further interventions are required to recruit underrepresented minorities to transplant surgery, catalog their footprint in the workforce, and champion their role as leaders within the American Society of Transplant Surgeons.
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Affiliation(s)
- Ankur P Choubey
- From the Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA
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7
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Social Media in Transplantation: An Opportunity for Outreach, Research Promotion, and Enhancing Workforce Diversity. Transplantation 2022; 106:2108-2110. [DOI: 10.1097/tp.0000000000004143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Choubey AP, Bullock B, Choubey AS, Ortiz J. Diversity among transplant surgery fellowship program directors: a call to action. HPB (Oxford) 2022; 24:386-390. [PMID: 34400052 DOI: 10.1016/j.hpb.2021.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/04/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The diversity among general surgery residency, HPB and other fellowship program directors has been previously analyzed. However, the diversity in abdominal transplant surgery fellowship program directors remains unknown. METHODS Abdominal transplant fellowship programs and the corresponding program directors were identified from the American Society of Transplant Surgeons website. Demographic and training information for the members was compiled through internet searches and analyzed. RESULTS 72 program directors were included. 83.33% were male. 63.9% were non-Hispanic White, 25% were Asian, along with 5.56% Hispanic and Black each. Male program directors were more likely to be Associate Professor (p = 0.041), while females were more likely to be Assistant Professor (p = 0.021). 66% of female program directors were non-Hispanic White. CONCLUSION Transplant surgery fellowship programs are primarily led by male and non-Hispanic White surgeons. Female representation as leaders is on par with their membership in the transplant surgery workforce. There is a deficiency of both male and female underrepresented minorities in program director positions.
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Affiliation(s)
- Ankur P Choubey
- Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick NJ, USA.
| | - Brenna Bullock
- Department of Surgery, University of Toledo Medical Center, OH, USA
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9
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Choubey AP, Bullock B, Choubey AS, Pai K, Ortiz AC, Khan SA, Mishra A, James R, Koizumi N, Pearson T, Ortiz J. Transplant surgery departmental leaders do not represent workforce demographics especially among women and underrepresented minorities - A retrospective analysis. Am J Surg 2021; 224:153-159. [PMID: 34802691 DOI: 10.1016/j.amjsurg.2021.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/20/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The diversity among surgical directors for liver, kidney, and pancreas transplant departments has not been previously evaluated. We aim to quantify the sex and racial demographics of transplant department leaders and assess the impact on patient outcomes. METHODS Demographics were collected for 116 liver, 192 kidney, and 113 pancreas transplant directors using Organ Procurement and Transplantation Network (OPTN) directory and program websites. Scientific Registry of Transplant Recipients (SRTR) 5-tier program outcomes rankings were obtained for each program and matched to leader demographics. A retrospective analysis of transplant recipients from 2010 to 2019 was performed using the United Network for Organ Sharing (UNOS) database. RESULTS 91.5% of transplant surgical directors were male. 55% of departments had a Non-Hispanic White leader. Asian, Hispanic and Black transplant chiefs were at the helm of 23.3%, 9%, and 5% of divisions respectively. Multivariate cox regression analysis did not identify any differences in patient outcomes by transplant director demographics. CONCLUSION There is a paucity of female and URM leaders in transplant surgery. Initiatives to promote research, mentorship, and career advancement opportunities for women and URM are necessary to address the current leadership disparity.
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Affiliation(s)
- Ankur P Choubey
- Department of Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.
| | - Brenna Bullock
- Department of Surgery, University of Toledo Medical Center, OH, USA
| | - Apurva S Choubey
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kavya Pai
- Department of Surgery, University of Toledo Medical Center, OH, USA
| | | | - Samar A Khan
- Department of Surgery, University of Toledo Medical Center, OH, USA
| | - Anil Mishra
- Department of Surgery, University of Toledo Medical Center, OH, USA
| | - Rosy James
- Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
| | - Naoru Koizumi
- Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
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10
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Choubey AP, Reilly M, Bullock B, Ireland M, Brown M, Ortiz A, Pai K, Sureddi S, Khan SA, Mishra A, Koizumi N, Pearson T, Ortiz J. The Academic Footprint of Women in Transplantation: Leaky Pipeline Persists. Transplantation 2021; 105:2334-2336. [PMID: 34019360 DOI: 10.1097/tp.0000000000003748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ankur P Choubey
- Department of Surgery, University of Toledo Medical Center, OH
| | - Margaret Reilly
- Department of Surgery, University of Toledo Medical Center, OH
| | - Brenna Bullock
- Department of Surgery, University of Toledo Medical Center, OH
| | - Megan Ireland
- Department of Surgery, University of Toledo Medical Center, OH
| | - Meghan Brown
- Department of Surgery, University of Toledo Medical Center, OH
| | | | - Kavya Pai
- Department of Surgery, University of Toledo Medical Center, OH
| | - Sriya Sureddi
- Department of Surgery, University of Toledo Medical Center, OH
| | - Samar A Khan
- Department of Surgery, University of Toledo Medical Center, OH
| | - Anil Mishra
- Department of Surgery, University of Toledo Medical Center, OH
| | - Naoru Koizumi
- Schar School of Policy and Government, George Mason University, Fairfax, VA
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Valbuena VSM, Obayemi JE, Purnell TS, Scantlebury VP, Olthoff KM, Martins PN, Higgins RS, Blackstock DM, Dick AAS, Watkins AC, Englesbe MJ, Simpson DC. Gender and racial disparities in the transplant surgery workforce. Curr Opin Organ Transplant 2021; 26:560-566. [PMID: 34524181 PMCID: PMC8524746 DOI: 10.1097/mot.0000000000000915] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review explores trends in the United States (US) transplant surgery workforce with a focus on historical demographics, post-fellowship job market, and quality of life reported by transplant surgeons. Ongoing efforts to improve women and racial/ethnic minority representation in transplant surgery are highlighted. Future directions to create a transplant workforce that reflects the diversity of the US population are discussed. RECENT FINDINGS Representation of women and racial and ethnic minorities among transplant surgeons is minimal. Although recent data shows an improvement in the number of Black transplant surgeons from 2% to 5.5% and an increase in women to 12%, the White to Non-White transplant workforce ratio has increased 35% from 2000 to 2013. Transplant surgeons report an average of 4.3 call nights per week and less than five leisure days a month. Transplant ranks 1st among surgical sub-specialties in the prevalence of three well-studied facets of burnout. Concerns about lifestyle may contribute to the decreasing demand for advanced training in abdominal transplantation by US graduates. SUMMARY Minimal improvements have been made in transplant surgery workforce diversity. Sustained and intentional recruitment and promotion efforts are needed to improve the representation of women and minority physicians and advanced practice providers in the field.
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Affiliation(s)
- Valeria S. M. Valbuena
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- National Clinician Scholars Program, University of Michigan, Ann Arbor, MI, USA
| | - Joy E. Obayemi
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Tanjala S. Purnell
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Velma P. Scantlebury
- Texas Christian University and University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Kim M. Olthoff
- Department of Surgery, Division of Transplant Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paulo N. Martins
- Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, University of Massachusetts, Worcester, MA, USA
| | - Robert S. Higgins
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - André A. S. Dick
- Department of Surgery, Division of Transplantation, University of Washington, Seattle, WA, USA
| | - Anthony C. Watkins
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Dinee C. Simpson
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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12
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Quillin RC, Cortez AR, Dageforde LA, Watkins A, Collins KM, Garonzik-Wang J, Glorioso JM, Tevar AD, Emond JC, Segev DL. Transplant Surgery Pipeline: A Report from the American Society of Transplant Surgeons Pipeline Taskforce. J Am Coll Surg 2021; 233:262-271. [PMID: 34015454 DOI: 10.1016/j.jamcollsurg.2021.04.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/05/2021] [Accepted: 04/27/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Transplant surgery fellowship has evolved over the years and today there are 66 accredited training programs in the US and Canada. There is growing concern, however, about the number of US-trained general surgery residents pursuing transplant surgery. In this study, we examined the transplant surgery pipeline, comparing it with other surgical subspecialty fellowships, and characterized the resident transplantation experience. METHODS Datasets were compiled and analyzed from surgical fellowship match data obtained from the National Resident Matching Program and ACGME reports and relative fellowship competitiveness was assessed. The surgical resident training experience in transplantation was evaluated. RESULTS From 2006 to 2018, a total of 1,094 applicants have applied for 946 transplant surgery fellowship positions; 299 (27.3%) were US graduates. During this period, there was a 0.8% decrease per year in US-trained surgical residents matching into transplant surgery (p = 0.042). In addition, transplant surgery was one of the least competitive fellowships compared with other National Resident Matching Program surgical subspeciality fellowships, as measured by the number of US applicants per available fellowship position, average number of fellowship programs listed on each applicant's rank list, and proportion of unfilled fellowship positions (each, p < 0.05). Finally, from 2015 to 2017, there were 57 general surgery residency programs that produced 77 transplant surgery fellows, but nearly one-half of the fellows (n = 36 [46.8%]) came from 16 (28.1%) programs. CONCLUSIONS Transplant surgery is one of the least competitive and sought after surgical fellowships for US-trained residents. These findings highlight the need for dedicated efforts to increase exposure, mentorship, and interest in transplantation to recruit strong US graduates.
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Affiliation(s)
- Ralph C Quillin
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, OH.
| | - Alexander R Cortez
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, OH
| | - Leigh Anne Dageforde
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Kelly M Collins
- Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI
| | | | - Jamie M Glorioso
- Department of Surgery, Thomas Jefferson University, Philadelphia
| | - Amit D Tevar
- Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA
| | - Jean C Emond
- Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, NY
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
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13
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Gender Disparities in Authorships and Citations in Transplantation Research. Transplant Direct 2020; 6:e614. [PMID: 33134490 PMCID: PMC7575186 DOI: 10.1097/txd.0000000000001072] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 11/25/2022] Open
Abstract
Background. Over the past decades, there has been a rapid change in the gender ratio of medical doctors, whereas gender differences in academia remain apparent. In transplantation research, a field already understaffed with female doctors and researchers, there is little published data on the development in proportion, citations, and funding of female researchers over the past years. Methods. To evaluate the academic impact of female doctors in transplantation research, we conducted a bibliometric analysis (01 January 1999 to 31 December 2018) of high-impact scientific publications, subsequent citations, and funding in this field. Web of Science data was used in combination with software R-Package “Gender,” to predict gender by first names. Results. For this study, 15 498 (36.2% female; 63.8% male) first and 13 345 (30.2% female; 69.8% male) last author gender matches were identified. An increase in the percentage of female first and last authors is seen in the period 1999–2018, with clear differences between countries (55.1% female authors in The Netherlands versus 13.1% in Japan, for example). When stratifying publications based on the number of citations, a decline was seen in the percentage of female authors, from 34.6%–30.7% in the first group (≤10 citations) to 20.8%–23.2% in the fifth group (>200 citations), for first (P < 0.001) and last (P = 0.014) authors, respectively. From all first author name-gender matches, 6574 (41.6% female; 58.4% male, P < 0.001) publications reported external funding, with 823 (35.5% female; 64.5% male, P = 0.701) reported funding by pharmaceutical companies and 1266 (36.6% female; 63.4% male, P < 0.001) reporting funding by the National Institutes of Health. Conclusions. This is the first analysis of gender bias in scientific publications, subsequent citations, and funding in transplantation research. We show ongoing differences between male and female authors in citation rates and rewarded funding in this field. This requires an active approach to increase female representation in research reporting and funding rewarding.
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14
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Giacoma T, Ayvaci MU, Gaston RS, Mejia A, Tanriover B. Transplant physician and surgeon compensation: A sample framework accounting for nonbillable and value-based work. Am J Transplant 2020; 20:641-652. [PMID: 31566885 PMCID: PMC7042066 DOI: 10.1111/ajt.15625] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 01/25/2023]
Abstract
Work relative value unit (wRVU)-based fee schedules are predominantly used by both the Centers for Medicare & Medicaid Services (CMS) and private payers to determine the payments for physicians' clinical productivity. However, under the Affordable Care Act, CMS is transitioning into a value-based payment structure that rewards patient-oriented outcomes and cost savings. Moreover, in the context of solid organ transplantation, physicians and surgeons conduct many activities that are neither billable nor accounted for in the wRVU models. New compensation models for transplant professionals must (1) justify payments for nonbillable work related to transplant activity/procedures; (2) capture the entire academic, clinical, and relationship-building work effort as part of RVU determination; and (3) move toward a value-based compensation scheme that aligns the incentives for physicians, surgeons, transplant center, payers, and patients. In this review, we provide an example of redesigning RVUs to address these challenges in compensating transplant physicians and surgeons. We define a customized RVU (cRVU) for activities that typically do not generate wRVUs and create an outcome value unit (OVU) measure that incorporates outcomes and cost savings into RVUs to include value-based compensation.
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Affiliation(s)
- Tracy Giacoma
- Transplant Institute at Methodist Dallas, Dallas, TX
| | - Mehmet U.S. Ayvaci
- Information Systems & Operations Management, the University of Texas at Dallas, Richardson, TX
| | - Robert S. Gaston
- Division of Nephrology, the University of Alabama at Birmingham, Birmingham, AL
| | - Alejandro Mejia
- Department of Surgery, Methodist Dallas Transplant Institute, Dallas, TX
| | - Bekir Tanriover
- Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, TX
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15
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Hamoda RE, McPherson LJ, Lipford K, Jacob Arriola K, Plantinga L, Gander JC, Hartmann E, Mulloy L, Zayas CF, Lee KN, Pastan SO, Patzer RE. Association of sociocultural factors with initiation of the kidney transplant evaluation process. Am J Transplant 2020; 20:190-203. [PMID: 31278832 DOI: 10.1111/ajt.15526] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 06/21/2019] [Accepted: 06/25/2019] [Indexed: 01/25/2023]
Abstract
Although research shows that minorities exhibit higher levels of medical mistrust, perceived racism, and discrimination in healthcare settings, the degree to which these underlying sociocultural factors preclude end-stage renal disease (ESRD) patients from initiating kidney transplant evaluation is unknown. We telephone surveyed 528 adult ESRD patients of black or white race referred for evaluation to a Georgia transplant center (N = 3) in 2014-2016. We used multivariable logistic regression to examine associations between sociocultural factors and evaluation initiation, adjusting for demographic, clinical, and socioeconomic characteristics. Despite blacks (n = 407) reporting higher levels of medical mistrust (40.0% vs 26.4%, P < .01), perceived racism (55.5% vs 18.2%, P < .01), and experienced discrimination (29.0% vs 15.7%, P < .01) than whites (n = 121), blacks were only slightly less likely than whites to initiate evaluation (49.6% vs 57.9%, P = .11). However, after adjustment, medical mistrust (odds ratio [OR]: 0.59; 95% confidence interval [CI]: 0.39, 0.91), experienced discrimination (OR: 0.62, 95% CI: 0.41, 0.95), and perceived racism (OR: 0.61; 95% CI: 0.40, 0.92) were associated with lower evaluation initiation. Results suggest that sociocultural disparities exist in early kidney transplant access and occur despite the absence of a significant racial disparity in evaluation initiation. Interventions to reduce disparities in transplantation access should target underlying sociocultural factors, not just race.
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Affiliation(s)
- Reem E Hamoda
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Laura J McPherson
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Kristie Lipford
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Kimberly Jacob Arriola
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Laura Plantinga
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | | | | | - Laura Mulloy
- Augusta University Kidney and Pancreas Transplant Program, Augusta University Medical Center, Augusta, Georgia
| | - Carlos F Zayas
- Augusta University Kidney and Pancreas Transplant Program, Augusta University Medical Center, Augusta, Georgia
| | - Kyung Na Lee
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Stephen O Pastan
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Rachel E Patzer
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
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16
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DiBrito SR, Bowring MG, Holscher CM, Haugen CE, Rasmussen SV, Duncan MD, Efron DT, Stevens K, Segev DL, Garonzik-Wang J, Haut ER. Acute Care Surgery for Transplant Recipients: A National Survey of Surgeon Perspectives and Practices. J Surg Res 2019; 243:114-122. [PMID: 31170553 PMCID: PMC6773475 DOI: 10.1016/j.jss.2019.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/13/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Transplant recipients are living longer than ever before, and occasionally require acute care surgery for nontransplant-related issues. We hypothesized that while both acute care surgeons (ACS) and transplant surgeons would feel comfortable operating on this unique patient population, both would believe transplant centers provide superior care. METHODS To characterize surgeon perspectives, we conducted a national survey of ACS and transplant surgeons. Surgeon- and center-specific demographics were collected; surgeon preferences were compared using χ2, Fisher's exact, and Kruskal-Wallis tests. RESULTS We obtained 230 responses from ACS and 204 from transplant surgeons. ACS and transplant surgeons believed care is better at transplant centers (78% and 100%), and transplant recipients requiring acute care surgery should be transferred to a transplant center (80.2% and 87.2%). ACS felt comfortable operating (97.5%) and performing laparoscopy (94.0%) on transplant recipients. ACS cited transplant medication use as the most important underlying cause of increased surgical complications for transplant recipients. Transplant surgeons felt it was their responsibility to perform acute care surgery on transplant recipients (67.3%), but less so if patient underwent transplant at a different institution (26.5%). Transplant surgeons cited poor transplanted organ resiliency as the most important underlying cause of increased surgical complications for transplant recipients. CONCLUSIONS ACS and transplant surgeons feel comfortable performing laparoscopic and open acute care surgery on transplant recipients, and recommend treating transplant recipients at transplant centers, despite the lack of supportive evidence. Elucidating common goals allows surgeons to provide optimal care for this unique patient population.
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Affiliation(s)
- Sandra R DiBrito
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Mary Grace Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Courtenay M Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christine E Haugen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah V Rasmussen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark D Duncan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David T Efron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kent Stevens
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Elliott R Haut
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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17
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Kaldas FM, Rocca JP, Bhati CS, Duan N, Evenson AR, Tan HP, Redfield RR, di Sabato DM, Yoshida A, Abt PL, Geevarghese SK. The Abdominal Transplant Surgery Workforce: Current state and future trends. Clin Transplant 2019; 33:e13659. [DOI: 10.1111/ctr.13659] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/21/2019] [Accepted: 07/01/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Fady M. Kaldas
- Ronald Reagan UCLA Medical Center Los Angeles California
| | | | | | - Ning Duan
- American Society of Transplant Surgeons Arlington Virginia
| | - Amy R. Evenson
- Beth Israel Deaconess Medical Center Boston Massachusetts
| | - Henkie P. Tan
- University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Robert R. Redfield
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin
| | | | | | - Peter L. Abt
- University of Pennsylvania Philadelphia Pennsylvania
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18
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Blanco Fernández G, Gómez Bravo MÁ, Briceño Delgado J, Valdivieso López A. A survey of Heads of Surgery and Residents on accessibility and employment in liver transplant teams in Spain. Cir Esp 2019; 97:560-567. [PMID: 31078281 DOI: 10.1016/j.ciresp.2019.03.018] [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: 02/22/2019] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The access of surgeons to liver transplant teams in Spain is heterogeneous. This study aims to portray the current human resources of Spanish transplant teams, distribution of transplant duties among team members, how transplant team members acquire their skills, their leaders' view of their future, as well the motivations of Spanish General Surgery residents to choose transplantation as their future career choice. METHODS Two different surveys were created, one for head surgeons and one for residents, about the number of team members and their training, recruitment, organization of tasks and motivation to work in transplantation. The questionnaires were e-mailed to both the transplant program directors and the surgical residents. RESULTS There are on average 8 surgeons in each transplant unit. More than four surgeons perform the hepatectomy in 54.2% of the groups, while the graft implantation is performed by more than 4 surgeons at just 25% of the centers. Forty-two percent of the transplant chiefs advocated a fellowship training system, and 87.5% believe that generational turnover is guaranteed. Out of 525 residents, 101 responded. Regarding training, 12.8% had no interest in transplantation. Concerning their work preferences, 37.6% were not interested in transplantation because it is excessively demanding, and 52.5% would not like to be part of a liver transplant team in the future. CONCLUSIONS The generational turnover seems to be guaranteed according to liver transplant program directors. The new generations of surgeons generally opt for other areas of surgery other than transplantation. Studies with a greater number of responses are necessary to validate these results.
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Affiliation(s)
- Gerardo Blanco Fernández
- Servicio de Cirugía Hepatobiliopancreática y Trasplante Hepático, Hospital Universitario de Badajoz, Universidad de Extremadura, Badajoz, España.
| | - Miguel Ángel Gómez Bravo
- Sección de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, España; Sección de Cirugía HPB de la Asociación Española de Cirujanos
| | - Javier Briceño Delgado
- Unidad de Trasplantes, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, España; Sección de Trasplantes de la Asociación Española de Cirujanos
| | - Andrés Valdivieso López
- Sección de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Cruces, Bilbao, España; Sección de Trasplantes de la Asociación Española de Cirujanos
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19
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Van Pilsum Rasmussen SE, Zhou S, Thomas AG, Segev DL, Nicholas LH. Transplant community perceptions of the benefits and drawbacks of alternative quality metrics for regulation. Clin Transplant 2019; 33:e13500. [PMID: 30773685 PMCID: PMC6465095 DOI: 10.1111/ctr.13500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/01/2019] [Accepted: 02/11/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is concern that the metrics currently used to regulate transplant centers, one-year patient and graft survival, may have adverse consequences including decreasing higher risk donor organ acceptance and transplant volume. This raises questions about whether alternative measures would be more appropriate. METHODS We surveyed American Society of Transplant Surgeons (ASTS) and American Society of Transplantation (AST) members (n = 270) to characterize perceptions of several metrics that are used for regulation, are publicly reported, or have been suggested elsewhere, regarding their effectiveness, amenability to risk adjustment, and predicted effects on volume, mortality, and waitlist size. RESULTS Respondents rated one-year patient and graft survival the most effective measure of quality of care (mean scores = 7.44, 7.31, respectively, out of 10) and most amenable to risk adjustment (mean scores = 6.26, 6.13, respectively). Most respondents believed alternative metrics would not impact their center's volume, waitlist size, or one-year transplant mortality. However, some did predict unintended consequences; for example, some believed using one-year waitlist mortality, one-year mortality of patients listed, or one-year mortality of patients referred for transplant would decrease the number of transplants performed (48.6%, 46.7%, and 48.3% of respondents, respectively). DISCUSSION Despite previously published concerns with existing regulatory metrics, most participants did not believe any metrics would outperform one-year patient and graft survival.
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Affiliation(s)
| | - Sheng Zhou
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., , ,
| | - Alvin G. Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., , ,
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., , ,
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.,
| | - Lauren Hersch Nicholas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., , ,
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD
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20
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Briceno J, Ciria R, Gomez-Luque I. Planning Generational Change in a Liver Transplant Team. Transplant Proc 2019; 51:71-73. [PMID: 30655124 DOI: 10.1016/j.transproceed.2018.04.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/18/2018] [Accepted: 04/27/2018] [Indexed: 11/19/2022]
Abstract
Liver transplantation (LT) is a demanding and stressful practice. It requires full dedication and great personal sacrifice. It carries with it a long, difficult learning curve. We present the current situation with one LT team and carried out a critical analysis on the current problems in LT units with regard to access to leadership the future generational changes. An LT team has several similarities with a family-owned company. A generation change planning in liver transplantation may address 3 important aspects: the succession of the leader; establishment and reinforcement of the talent pool; and accessibility to the working group. An LT team is manned by highly qualified personnel. The ideal scenario is when the successor surgeon is accepted by every member in a joint agreement; all the surgeons on the team have the potential to be the next team leader; and the working group presents a high level of personal effort and a motivated attitude. There is an ongoing problem in LT units, however-the growing lack of interest from young surgeons to be part of a transplant team. There are many reasons for this, but it primarily involves the high level of dedication required. The formation of a good transplant team, with a pool of high-quality young surgeons and the realization of a proper generational change, could improve its operation and its results in the future.
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Affiliation(s)
- J Briceno
- Liver Transplantation Unit, Department of General Surgery, University Reina Sofía Hospital, Instituto Maimónides de Investigaciones Biomédicas, CIBERehd, Córdoba, Spain.
| | - R Ciria
- Liver Transplantation Unit, Department of General Surgery, University Reina Sofía Hospital, Instituto Maimónides de Investigaciones Biomédicas, CIBERehd, Córdoba, Spain
| | - I Gomez-Luque
- Liver Transplantation Unit, Department of General Surgery, University Reina Sofía Hospital, Instituto Maimónides de Investigaciones Biomédicas, CIBERehd, Córdoba, Spain
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21
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Jesse M, Shkokani L, Eshelman A, De Reyck C, Abouljoud M, Lerut J. Transplant Surgeon Burnout and Marital Distress in the Sandwich Generation: The Call for Organizational Support in Family Life. Transplant Proc 2018; 50:2899-2904. [DOI: 10.1016/j.transproceed.2018.01.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/23/2018] [Indexed: 11/16/2022]
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22
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Van Pilsum Rasmussen SE, Thomas AG, Garonzik-Wang J, Henderson ML, Stith SS, Segev DL, Nicholas LH. Reported effects of the Scientific Registry of Transplant Recipients 5-tier rating system on US transplant centers: results of a national survey. Transpl Int 2018; 31:1135-1143. [PMID: 29802802 PMCID: PMC6219856 DOI: 10.1111/tri.13282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/17/2018] [Accepted: 05/17/2018] [Indexed: 11/30/2022]
Abstract
In the United States, the Scientific Registry of Transplant Recipients (SRTR) provides publicly available quality report cards. These reports have historically rated transplant programs using a 3-tier system. In 2016, the SRTR temporarily transitioned to a 5-tier system, which classified more programs as under-performing. As part of a larger survey about transplant quality metrics, we surveyed members of the American Society of Transplant Surgeons and American Society of Transplantation (N = 280 respondents) on transplant center experiences with patient and payer responses to the 5-tier SRTR ratings. Over half of respondents (n = 137, 52.1%) reported ≥1 negative effect of the new 5-tier ranking system, including losing patients, losing insurers, increased concern among patients, and increased concern among referring providers. Few respondents (n = 35, 13.7%) reported any positive effects of the 5-tier ranking system. Lower SRTR-reported scores on the 5-tier scale were associated with increased risk of reporting at least one negative effect in a logistic model (P < 0.01). The change to a more granular rating system provoked an immediate response in the transplant community that may have long-term implications for transplant hospital finances and patient options for transplantation.
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Affiliation(s)
| | - Alvin G. Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Macey L. Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sarah S. Stith
- Department of Economics, University of New Mexico, Albuquerque, NM
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Lauren Hersch Nicholas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Establishing the Number of Procedures for Optimal Renal Transplantation Training With the Use of a Canine Model. Transplant Proc 2016; 48:3053-3058. [PMID: 27932145 DOI: 10.1016/j.transproceed.2016.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 06/17/2016] [Accepted: 07/05/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND The training of surgeons that perform renal transplantations can be diverse. For example, the training profile can vary greatly, involving urologists to general surgeons. The efficacy of training programs directed at transplantation surgeons is influenced by numerous factors, including the specialist profile who is trained, the number of procedures available to trainees in a given teaching hospital, and the duration of training. Here we determine the number of procedures necessary to consolidate and contribute to proficiency in renal transplantation technique. METHODS We used a canine model, comparing 32 renal transplantations performed by a urologist and by a general surgeon who had completed their respective training in renal transplantation. RESULTS Our results demonstrated that with 12 surgical procedures, surgeons were able to consolidate their skills in renal transplantation, regardless of their educational background. CONCLUSIONS This is an initial effort in the establishment of a system for targeted training of transplantation surgeons directed specifically at correcting deficiencies and consolidating skills acquired during training programs. These efforts should contribute to the improvement of patient safety in public and private health systems.
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Silver MP, Hamilton AD, Biswas A, Warrick NI. A systematic review of physician retirement planning. HUMAN RESOURCES FOR HEALTH 2016; 14:67. [PMID: 27846852 PMCID: PMC5109800 DOI: 10.1186/s12960-016-0166-z] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 11/01/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Physician retirement planning and timing have important implications for patients, hospitals, and healthcare systems. Unplanned early or late physician retirement can have dire consequences in terms of both patient safety and human resource allocations. This systematic review examined existing evidence on the timing and process of retirement of physicians. Four questions were addressed: (1) When do physicians retire? (2) Why do some physicians retire early? (3) Why do some physicians delay their retirement? (4) What strategies facilitate physician retention and/or retirement planning? METHODS English-language studies were searched in electronic databases MEDLINE, Web of Science, Scopus, CINAHL, AgeLine, Embase, HealthSTAR, ASSA, and PsycINFO, from inception up to and including March 2016. Included studies were peer-reviewed primary journal articles with quantitative and/or qualitative analyses of physicians' plans for, and opinions about, retirement. Three reviewers independently assessed each study for methodological quality using the Newcastle-Ottawa Scale for quantitative studies and Critical Appraisal Tool for qualitative studies, and a fourth reviewer resolved inconsistencies. RESULTS In all, 65 studies were included and analyzed, of which the majority were cross-sectional in design. Qualitative studies were found to be methodologically strong, with credible results deemed relevant to practice. The majority of quantitative studies had adequate sample representativeness, had justified and satisfactory sample size, used appropriate statistical tests, and collected primary data by self-reported survey methods. Physicians commonly reported retiring between 60 and 69 years of age. Excessive workload and burnout were frequently cited reasons for early retirement. Ongoing financial obligations delayed retirement, while strategies to mitigate career dissatisfaction, workplace frustration, and workload pressure supported continuing practice. CONCLUSIONS Knowledge of when physicians plan to retire and how they can transition out of practice has been shown to aid succession planning. Healthcare organizations might consider promoting retirement mentorship programs, resource toolkits, education sessions, and guidance around financial planning for physicians throughout their careers, as well as creating post-retirement opportunities that maintain institutional ties through teaching, mentoring, and peer support.
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Affiliation(s)
- Michelle Pannor Silver
- Department of Anthropology/Health Studies, University of Toronto Scarborough Campus, 1265 Military Trail, Toronto, Ontario, M1C 1A4, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Angela D Hamilton
- Department of Anthropology/Health Studies, University of Toronto Scarborough Campus, 1265 Military Trail, Toronto, Ontario, M1C 1A4, Canada
| | - Aviroop Biswas
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Natalie Irene Warrick
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Rosati CM, Ekser B, Kaafarani HMA, Gaudino M, Koniaris LG. International medical graduates among top US transplant surgeons. Int J Surg 2016; 35:19-20. [PMID: 27619016 DOI: 10.1016/j.ijsu.2016.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Carlo Maria Rosati
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Burcin Ekser
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Leonidas G Koniaris
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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26
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Hoyer DP, Kaiser GM, Cicinnati V, Radunz S, Braun F, Greif-Higer G, Schulze M, Schmidt HJ, Paul A, Beckebaum S. Training, work, and lifestyle of transplant physicians and surgeons in Germany. Clin Transplant 2016; 30:1046-52. [PMID: 27291870 DOI: 10.1111/ctr.12786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND International data on training, work, and lifestyle of transplant physicians and surgeons are scarce. Such data might help in development of uniform education paths and provide insights for young clinicians interested in this field. This study aimed at the evaluation of these data in all transplant-associated medical disciplines. METHODS A survey on professional and academic training, workload, and lifestyle was generated. The questionnaire was distributed to all members of the German Transplant Association (DTG), utilizing the tool SurveyMonkey(®) . RESULTS A total of 127 members of the DTG responded (male/female 66.1%/33.9%, 45.8±10.3 years). The majority had been working in transplant medicine for more than 10 years (61.9%). Fifteen respondents (11.8%) obtained an official European certification (European Union of Medical Specialists). A total of 57 (48.3%) respondents worked full time on research during training. The research focus was clinical for most respondents (n=72, 61.5%). An average working time of 62±1.5 h/wk was reported. Fifty-eight percent of all respondents complained of inadequate remuneration and 50% reported inadequate acknowledgment of their professional performance. CONCLUSION This is the first study reporting characteristics of training, work, and lifestyle in an interdisciplinary cohort of German transplant physicians and surgeons. Enormous efforts in clinical and research work were reported, associated with high rates of professional and financial dissatisfaction.
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Affiliation(s)
- Dieter P Hoyer
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.
| | - Gernot M Kaiser
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Vito Cicinnati
- Department of Transplantation Medicine, University Hospital Münster, Münster, Germany.,Department of Internal Medicine, Gastroenterology and Hepatology, St. Josef-Krankenhaus, Essen, Germany
| | - Sonia Radunz
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Felix Braun
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Gertrud Greif-Higer
- Department of Psychosomatics and Psychotherapy, University Hospital Mainz, Mainz, Germany
| | - Maren Schulze
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Hartmut J Schmidt
- Department of Transplantation Medicine, University Hospital Münster, Münster, Germany
| | - Andreas Paul
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Susanne Beckebaum
- Department of Transplantation Medicine, University Hospital Münster, Münster, Germany.,Department of Internal Medicine, Gastroenterology and Hepatology, St. Josef-Krankenhaus, Essen, Germany
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Letters to the Editor Regarding Dr. Laskin's Perspectives Article. J Oral Maxillofac Surg 2015; 73:1025-6. [DOI: 10.1016/j.joms.2015.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/07/2015] [Indexed: 11/23/2022]
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Cabello-Benavente R, González-Enguita C. Residency in urology and training in kidney transplantation. Results of a national survey. Actas Urol Esp 2015; 39:303-9. [PMID: 25449295 DOI: 10.1016/j.acuro.2014.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/04/2014] [Accepted: 09/05/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To determine the current state of kidney transplantation (KT) training in a country that is leader in organ donation and transplantation. MATERIAL AND METHODS We conducted an online survey by e-mail to 138 urology residents. The survey contained 5 sections: affiliation, training in KT, interest in KT, residents of transplant centers and residents of nontransplant centers. RESULTS Sixty-five residents responded, 47.1% of the urologists in training surveyed, representing 28 cities and 15 provinces. Fifty-five percent (n=36) of the respondents deemed the KT training offered during their residency as insufficient, and 85% (n=55) demanded more resources. More than half were not confident in their abilities to perform transplantation surgery over the course of their residency (n=35). Nineteen percent of the residents considered KT an important discipline in their residency, with a mean score of 56.2 (1-100). Among the residents of the transplant centers (69.2%, n=45), 73% (n=33) considered KT when choosing a center for their residency. Of the surveyed residents from nontransplant centers (30.7%, n=20), 45% (n=9) do not perform an external rotation in KT. CONCLUSIONS The surveyed residents demand more training in KT. The most common situation is to end a residency without having performed a complete KT. KT is considered an asset when selecting a resident medical intern position and commonly they are part of the transplantation team. The majority of residents are trained in centers with less than 75 transplants/year. External rotations in KT are not the rule in centers where transplantation is not performed.
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Thomas MN, Nadalin S, Schemmer P, Pascher A, Kaiser GM, Braun F, Becker T, Nashan B, Guba M. A German survey of the abdominal transplantation surgical work force. Transpl Int 2015; 28:849-56. [PMID: 25800065 DOI: 10.1111/tri.12556] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 08/27/2014] [Accepted: 02/27/2015] [Indexed: 11/30/2022]
Abstract
This manuscript reports the results of a nationwide survey of transplant surgeons in Germany, including the demographics, training, position, individual case loads, center volumes, program structure, professional practice, grade of specialization, workload, work hours, salary, and career expectations. We contacted all 32 German transplant centers that perform liver, kidney, and pancreas transplantation. Surgeons engaged in transplantation were asked to reply to the survey. Eighty-five surgeons responded, with a mean age of 44 ± 8 years, 13% of whom were female. The median transplant frequency per active transplant surgeon was relatively low, with 16 liver transplants, 15 kidney transplants, and three pancreas transplants. The median reported center volumes were 45 liver transplants, 90 kidney transplants, and five pancreas transplants per year. Most of the surgeons reported a primary focus on hepato-pancreato-biliary surgery, and only 10% of effective work time was actually dedicated to perform transplant surgeries. The majority of respondents estimated their weekly work hours to be between 55 and 66 h. When asked about their career satisfaction and expectations, most respondents characterized their salaries as inappropriately low and their career prospects as inadequate. This survey provides a first impression of the transplant surgery work force in Germany.
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Affiliation(s)
- Michael N Thomas
- Department of General-, Visceral-, Transplantation- Vascular- and Thoracic Surgery, University of Munich, Munich, Germany.,Transplant Center Munich, Munich, Germany
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Peter Schemmer
- Department of General and Transplant Surgery, Ruprecht Karls University, Heidelberg, Germany
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Gernot M Kaiser
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Felix Braun
- Department of General and Transplantation Surgery, University of Kiel, Kiel, Germany
| | - Thomas Becker
- Department of General and Transplantation Surgery, University of Kiel, Kiel, Germany
| | - Björn Nashan
- Department of Hepatobiliary Surgery and Visceral Transplantation, University Medical Center Eppendorf, Hamburg, Germany
| | - Markus Guba
- Department of General-, Visceral-, Transplantation- Vascular- and Thoracic Surgery, University of Munich, Munich, Germany.,Transplant Center Munich, Munich, Germany
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Englesbe MJ, Lynch RJ, Sung RS, Segev DL. Time-trends in publication productivity of young transplant surgeons in the United States. Am J Transplant 2012; 12:772-8. [PMID: 22176745 DOI: 10.1111/j.1600-6143.2011.03878.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
To further clarify whether the transplant surgical research workforce is adequately poised to further scientific achievement, we have investigated the publication productivity of young transplant surgeons. Our hypothesis is that recent young transplant surgeons write fewer academic manuscripts than their senior colleagues did when they were young surgeons. We compared the number of first and senior author publications in the first 5 years after completion of fellowship among recent transplant surgeons (completed fellowship 2000-2004) and former young surgeons (completed fellowship 1990-1994). Recent young surgeons wrote fewer overall manuscripts (0.94 vs. 1.67, p < 0.05), as well as basic science manuscripts (0.21 vs. 0.54, p < 0.05) and clinical manuscripts (0.73 vs. 1.14, p < 0.05). Adjusting for the number of trainees, we note that recent young surgeons published 59% fewer basic science publications (IRR 0.41, 95% CI 0.29-0.57, p < 0.001) and 33% fewer clinical publications (IRR 0.67, 95% CI 0.56-0.82, p < 0.001). Among fellows in the 2000-2004 cohort, there was a 32% lower chance of publishing at least one paper compared with fellows in the 1990-1994 cohort (IRR 0.68, 95% CI 0.51-0.89, p = 0.006). These findings raise concerns about the future place of transplant surgeons within the science that shapes our own field.
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Affiliation(s)
- M J Englesbe
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
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Affiliation(s)
- David W Rattner
- Department of Surgery, Massachusetts General Hospital, 15 Parkman St., Boston, MA 02114, USA.
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Affiliation(s)
| | - Raj Prasad
- St James University Hospital, Leeds LS9 7TF
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