Shrinking Applicant Pool for Surgery Residency Programs
As 2002 draws to a close, it seems fitting to reflect on events that have shaped opinion, policy, and practice in the field of surgery this year and will likely continue to do so in 2003. There have been numerous scientific and clinical advances in all surgical subspecialties this year, many of them reported, reviewed, and debated in both the professional and lay media around the world.
I asked members of the Medscape Surgery editorial advisory board to think about these developments and give me their sense of which among them had the greatest impact on the field in the past 12 months. It wasn't an easy assignment. But perhaps the most significant occurrence, according to Albert B. Lowenfels, MD, Professor of Surgery, New York Medical College, Valhalla, New York, is the dramatic decline in the applicant pool seeking surgical training in the United States. Once the most competitive and highly coveted positions by medical students, surgery residencies are being passed over for residencies in subspecialties that afford a more controllable lifestyle, particularly during the family-raising years, and more competitive salaries.
The backdrop of this situation is dramatic. Applications to medical school have decreased by 20% over the past 5 years. The percentage of medical students interested in a residency in surgery has decreased from 12.1% in 1981 to 6.1% in 2001. For the first time, surgery residency programs have vacant positions; it is projected that, by 2005, only 76.6% will be filled.
There appear to be several reasons for this palpable shift. Considering that approximately 50% of graduating medical students are women and that graduates are older and more ethnically diverse, the very process of becoming a general surgeon in the rigid and inflexible environment of many residency programs is excessively difficult. To make matters worse, mean salaries of medical graduates are decreasing at a time when 83% are in considerable debt. Their average debt is $95,000, for which repayment must begin immediately; average salaries of first-year house staff are lower than $36,000. Furthermore, surgery residencies can last 5-10 years, compounding the indebtedness issue.
Dr. Lowenfels, and many others within the surgical community, suggest that it's not just trainees that suffer, but the specialty and the profession as a whole. If current trends are not reversed, not only will general surgery be affected, but so will the various specialties, all of which require preliminary training in general surgery. The impact will be disproportionately felt by teaching hospitals with residency programs, where some of the most interesting and complex cases often are seen and where major surgical advances develop as a result. Looking ahead, there could also be a shortage of young surgeons with an interest or training in surgical research. The bottom line: scientific advances, clinical excellence, and, as a result, patient care may all be compromised.
It's a daunting challenge that should be of concern to every physician, not just surgeons. At a minimum, it offers us a significant agenda for change in graduate surgical education as we look to 2003 and beyond.
As always, if you have any questions, comments, or concerns, please feel free to email me at surgeryeditor@webmd.net. If you are experiencing technical difficulties, please contact our customer support staff at medscapecustomersupport@ms.medscape.com.
Happy New Year.