by Chris Emery

Single and childless surgical residents in the U.S. are more likely to pursue specialized surgical fellowships, and a majority of surgical residents believe a successful career depends upon specialty surgical training, a new survey found.

Of residents who responded to the survey, 28.7% believed general surgery is becoming an obsolete career path (30.1% of men and 25.9% of women, P=0.004), and 55.1% believed specialty training is necessary for career success (56.4% of men and 52.7% of women, P=0.02), according to the report published online May 17 in the Archives of Surgery.

Single residents were more likely to plan for a specialty surgical fellowship, with 59.1% of singles versus 51.9% of married residents (P<0.001) planning fellowships. Similarly, 57.0% of residents with no children versus 50.1% of those with children were planning fellowships (P<0.001).

“When deciding whether to pursue a postresidency fellowship, trainees must balance the immediate time and financial burdens of additional training (which can be even more acute if the resident already has children) against future potential salary and lifestyle benefits that stem from becoming a specialty-trained surgeon,” Julie Ann Sosa, MD, of the Yale School of Medicine, and colleagues wrote. “It appears that commitment to a spouse, partner, and/or children may dissuade residents from seeking specialty training, possibly because of time constraints of additional training or prioritization of family commitment.”

In their report, Sosa and colleagues wrote that graduate surgical education has changed significantly in recent decades, with elimination of the pyramidal training system and the institution of the Accreditation Council for Graduate Medical Education core competencies and the 80-hour work week. In addition, the number of fast-track residencies and specialty fellowships has grown, particularly in minimally invasive surgery, reflecting a growing interest in tailoring traditional general surgery to meet residents’ desire for specialty training.

“Specialization is a growing trend that might jeopardize the future of general surgery,” the authors wrote. “Research has demonstrated that it likely results from multiple factors, including the changing demographics of medical schools and surgery residency programs, residency type (academic versus community setting) and early exposure through research performed during residency.”

In January 2008, Sosa and colleagues conducted a national survey of general surgery residents in 248 general surgery programs around the U.S., of which 4,586 responded (75%). The mean age of the respondents was 30.6 years, and of the respondents 31.7% were women, 51.3% were married, and 25.4% had children.

The survey asked participants why they pursued surgery as a career, about the role of specialty training in relation to anticipated income and lifestyle, and about their predictions for general surgery as a career path.

The researchers noted their findings were based on survey results, and could have been biased by respondents’ tendency to give socially desirable answers or avoid expressing negative opinions.

In addition to finding that unmarried and childless residents were more likely to pursue specialty surgery, the researchers found that men were more likely to worry that general surgery is becoming obsolete (P=0.003) and that female residents who were single or had no children tended to identify lifestyle rather than income as a motivator for specialty training.

“Ultimately, all trainees seek a pathway in graduate surgical education that will provide the skill set necessary for optimizing patient care, receiving adequate compensation, and achieving a flexible lifestyle within an appropriate time frame,” the authors concluded. “Understanding how these factors influence this large subgroup of physicians is critical to identifying, recruiting, and retaining the best and brightest candidates in graduate surgical education.”

Chris Emery is a MedPage Today contributing writer.

Originally published in MedPage Today. Visit MedPageToday.com for more health policy news.