Changing Demographics of Residents Choosing Fellowships: Longterm Data from The American Board of Surgery

BACKGROUND: After completing general surgery residency, surgeons may seek focused additional education or fellowships. Longterm data describing the characteristics of residents selecting fellowships are lacking. Credible data could inform decisions about surgical education paradigms and workforce planning. STUDY DESIGN: From 1993 to 2005, residents taking the American Board of Surgery In-Training Examination were queried about fellowship plans. Individual and residency program data were collected: gender, postgraduate year level (PGY), medical school location (US/international), residency type (academic/community), residency size, and residency location (Northeast, Southeast, Midwest, Southwest, West). The data were examined for changes in the numbers and characteristics of residents seeking fellowships. RESULTS: Responses from 11,080 postgraduate year level-5 residents were analyzed. The number of women nearly doubled and the number of international medical graduates (IMG) almost tripled. Residency program demographics were static. The percentage choosing fellowships increased from 67% to 77%. Patterns of change from "No Fellowship" to "Any Fellowship" were spread heterogeneously across individual and residency subsets. Increases were greatest for Midwest, Southeast, women, community, small program, and US medical graduates. Temporal patterns of change were also heterogeneous. Specialty top choice patterns varied, leading to disproportionate demographic subgroup representation within some specialties. CONCLUSIONS: More general surgery residents are pursuing fellowships. The increase has originated disproportionately from resident and residency demographic subsets and has varied temporally across subgroups. The heterogeneity of change suggests a multifactorial etiology. Future directions in surgical education and workforce planning should reflect these findings.