Factors Dominating Choice of Surgical Specialty

Reed, Carolyn E.; Vaporciyan, Ara A.; Erikson, Clease; Dill, Michael J.; Carpenter, Andrea J.; Guleserian, Kristine J.; Merrill, Walter H.

doi:10.1016/j.jamcollsurg.2009.11.016

« Previous Next »Journal of the American College of Surgeons
Volume 210, Issue 3 , Pages 319-324, March 2010

Factors Dominating Choice of Surgical Specialty

Presented at the American College of Surgeons 95^th Annual Clinical Congress, Chicago, IL, October 2009.

Carolyn E. Reed, MD, FACS
- Medical University of South Carolina, Charleston, SC
- Correspondence address: Carolyn E Reed, MD, FACS, Medical University of South Carolina, Msc 295 Art 7018, 25 Courtenay Dr, Charleston, SC 29425
Ara A. Vaporciyan, MD, FACS
- University of Texas MD Anderson Cancer Center, Houston, TX
Clease Erikson, MPAff
- Center for Workforce Studies, Association of American Medical Colleges, Washington, DC
Michael J. Dill, MPP
- Center for Workforce Studies, Association of American Medical Colleges, Washington, DC
Andrea J. Carpenter, MD, FACS
- University of Texas Health Center at San Antonio, San Antonio, TX
Kristine J. Guleserian, MD, FACS
- University of Texas Southwestern, Children's Medical Center Dallas, Dallas, TX
Walter H. Merrill, MD, FACS
- University of Mississippi, Jackson, MS

Received 8 October 2009; received in revised form 25 November 2009; accepted 30 November 2009.

Background

There has been much focus on factors influencing medical students' career choice, prompted by such concerns as a sufficient future surgical workforce, declining applicant pool, changing gender composition, and a cultural shift in values and priorities. Once in a surgical residency, there are little data on factors influencing general surgery (GS) residents' final specialty choice.

Study Design

A survey instrument was developed and content validated in conjunction with the Association of American Medical Colleges Center for Workforce Studies. The final instrument was distributed electronically between March 24 and May 2, 2008, through 251 GS program directors to all ACGME-accredited GS residents (n = 7,508).

Results

Response rate was 29% (2,153 residents; 89% programs). Half of GS residents remained undecided about specialty choice through the 2^nd year, declining to 2% by year 5. Of the two-thirds who decided on a specialty, 16.5% chose to remain in GS, 14.6% chose plastics, 9.3% cardiothoracic, and 8.5% vascular. The specialty choice factors most likely to be very important were type of procedures and techniques, exposure to positive role model, and ability to balance work and personal life. Relative importance of factors in specialty choice varied by gender and chosen specialty. Mentors play a key role in specialty choice (66% decided had mentors versus 47% undecided). Work schedule was the most frequently selected shortcoming in every specialty except plastics. Cardiothoracic surgery followed by GS had the highest shortcomings.

Conclusions

The majority of GS residents plan to subspecialize. Three factors dominate specialty choice. Faculty need to understand their impact potential to modify or change perceptions of their specialty.

Abbreviations and Acronyms: APDS, Association of Program Directors in Surgery, CTS, cardiothoracic surgery, GS, general surgery