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Outline

The Surgical Resident’s Perception of the 2001 Match Joseph Jensen, M.D., Mina Johnson, M.A. and Robert W. Barnes, M.D. Department of Surgery University of Arkansas for Medical Sciences Little Rock, Arkansas Surgery Education Week 2001

Problem 70 Categorical surgery positions were unfilled in the 2001 match This is the most in recent history and ten times the yearly average from 1989-1999 (Barone, unpublished communication) We provided this information to our categorical surgery residents and asked for their impressions regarding this major change in residency program recruitment.

The UAMS Surgery Residency Program A typical southern University-based program 21 Categorical Residents Affiliated with state-supported medical school Residency applicants primarily from the east and south

Demographics 7 Female, 14 Male 6 Single without children 1 Single (non-custodial) parent 9 Married without children 5 Married with children 16/21 (76%) participated in survey

Methods Categorical residents completed a survey regarding their experiences, attitudes and advice to medical students regarding surgery residency training

Results

Results

Results

Most important factors in the decision to enter a General Surgery residency Enjoyed the “hands-on” aspect of General Surgery Intellectual challenge of a General Surgery residency Enjoyed “camaraderie” of  General Surgery housestaff team Physical Challenge of a General Surgery residency Medical School Faculty or Resident role model

Least important factors in the decision to enter a General Surgery residency Difficult lifestyle of a general surgery resident “get used to it” Financial expectations of a Surgery Practice Family or friend surgical role model

5/16 (31%) of UAMS Surgery Residents Have Seriously Considered Changing to Another Specialty Anesthesia, Pathology, Emergency Medicine, Psychiatry “Turned Off” by political battles between faculty Surgical Faculty role models “turned me off” Lifestyle during residency training Perceived lifestyle after completion of training

Other Results 5/16 (31%) of our residents were previously employed in another career field Average expected entry-level salary = $170,000.00 3/16 (19%) report difficulty of spouse or significant other in dealing with lifestyle

Resident Comments “Medicine in general is becoming less attractive because of the paperwork, Managed Care hassles, etc.  People are less likely to make a big sacrifice for this and since training in the surgical specialties requires the greatest sacrifice, they will be the hardest hit. Medical students are always exhausted on MS III rotations…they see residents work long hours with lack of sleep, food, social contacts - would you be impressed with that?

Resident Comments “This is too hard to do if you are not committed and enjoy the fun parts enough to make the bad parts worth it. Some if not all students have the perception that “The surgeons have difficult personalities” and they don’t want to live with that for five or more years.  Other specialties seem better given this and the long training time of surgery”

Resident Comments “Some exposure to real-world medicine in the non-academic setting might improve the reputation of surgery” (comments about specialties encroaching on General Surgery) ...General Surgery is an exciting field, but I hope it is not a dying field.  I do enjoy my training, but it is putting stress on my family.  To sum it all up in a few short words, Lifestyle, Lifestyle and Lifestyle are the reasons why students are not considering general surgery.”

Resident Comments “To cut is to cure” Hypertension - no cure Diabetes - no cure Cholecystitis - cure Appendicitis - cure Ulcerative colitis - cured with surgery, controlled? with medicine Cancer 3% cure with chemotherapy alone 40% cure with surgery alone, more with combination

Conclusions Most UAMS Surgery residents are happy with their career choice and would make that choice again Most UAMS Surgery residents would recommend General Surgery to a student already interested in surgery, but not to an undecided student. Surgical Lifestyle likely is a major factor in our decreased attractiveness to students as a career We individually are on pedestals and must understand our personal responsibilities as  role models for our residents