Association of Program Directors Vascular Surgery

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Association of Program DirectorsVascular Surgery
Choice of Vascular Surgery as a Specialty

• Anton N. Sidawy, M.D.
• The Issues Committee
• April 3, 2004

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The Appeal of Surgery
Newsweek May 25, 2002
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Factors Affecting Recruitment

• Lifestyle issues
• Inability to attract women
• Diminished reimbursement
• Malpractice crisis
• Long residency and Debt accumulation
• Discouraging medical students from entering
  surgery

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2002-03 Vascular Match
National Resident Matching Program, 2002-03
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Objectives of Survey

• To define why trainees are not choosing Vascular
  Surgery as a specialty
• To find out whether there has been any change
  since the last survey performed in 2001
• To help devise strategies to improve the situation

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Trainees

• Medical students
• Two groups of chief surgical residents -those
  who chose Vascular Surgery -those who did not
• Vascular Surgery residents (fellows)

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Scoring of Surveys

• Trainees were asked to score various statements
  from 1-5
• 1, least important and 5, most important
• Responses are reported in two categories
• Important, includes 45
• Unimportant, includes 12
• Therefore, responses may not add to 100

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Surveys

• Survey 1 (2001) Medical students, chief
  residents, and fellows
• Survey 2 (2003) Chief residents and fellows

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Medical Students Survey (MS2001)

• Two programs responded
• University of Pennsylvania
• University of Florida
• A total of 78 students responded
• 51 U. Penn
• 27 U. Florida

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Reasons VS Was Appealing (MS2001)
Important Unimport. Score High quality
of V. rotation 60 16 3.7 Endovasc
capabilities of VS 71 24 3.5 Technical
aspect of VS 68 21 3.5 Positive
mentors 67 24 3.5 Higher income
than GS 58 37 3.2 Complex decision
in VS 43 40 3.2 Better job
opportunities 50 39 2.9 Academic
nature of VS 42 44 2.9
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Reasons VS Was Not Appealing
Important Unimport. Score Lifestyle of
surgery residents 91 7 4.3 Lifestyle of
V. surgeons 92 6 4.2 Negative
mentors 55 24 3.7 Length of
training 45 22 3.1 Poor quality of
V. rotation 51 30 3.1 Patients too
sick 45 45 3.0 V. operation
stressful 57 40 2.9 Loss of cases to
IR, cardio. 45 41 2.9 Too much debt
35 56 2.7
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Training Paradigms (MS2001)

• 5 yr GS 1 or 2 yr VS with GS certificate 4
• 4 yr GS 2 yr VS with GS certificate 10
• 3 yr GS 3 yr VS without GS certificate 45
• 2 yr GS 4 yr VS without GS certificate 41

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Chief Resident Survey (CR2003)

• Survey mailed to 95 (81) programs
• A total of 37 (43) programs responded
• A total of 68 (101) CR responded
• 18 (15) chose vascular residency
• 50 (86) did not choose vascular residency
• ( )results of 2001 survey

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Reasons VS Was Chosen (CR2003)
Important Unimport. Score Technical
aspect of VS 100 (100) 0 (0)
4.7 (5, 1) Positive mentors 100
(100) 0 (0) 4.6 (4.9, 2) Complex
decision in VS 100 (100) 0 (0)
4.3 (4.7, 3) Endovasc. capabilities
78 (40) 6 (0) 4.1 (3.6, 6) Better job
opportunities 78 (60) 12 (33) 4.0 (3.5,
5) Academic nature of VS 78 (80) 12 (0)
3.8 (4.2, 4) Higher income than GS 45 (13)
34 (47) 3.1 (2.4, 7) ( )Results of 2001
survey
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Reasons VS Was Not Chosen
Important Unimport. Score Liked VS
but chose other 56 (72) 22 (17) 3.6
(3.8, 1) Loss of surgery endovasc 50 (16)
34 (66) 3.1 (2.1, 6) Vasc. patients too sick
37 (45) 28 (34) 3.0 (3.0, 2) Too many
endovasc 28 (15) 48 (74) 2.6
(1.9, 7) Lifestyle of VS 20 (24) 52 (53)
2.4 (2.8, 3) Too much AV access 14 (22) 68
(64) 2.1 (2.1, 4) Negative mentors 12 (12)
78 (76) 1.8 (1.7, 10) VS operations
stressful 6 (14) 80 (74) 1.7 (1.9,
9) Training too long 6 (5) 80 (84)
1.7 (1.5, 13) Too much debt 4 (7) 80
(86) 1.6 (1.4, 11) ( )Results of 2001 survey
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Training Paradigms (CR2003)

• If you chose VS as a career how many years of GS
  you prefer to do before Vascular fellowship?
• 5 yr GS 56
• 4 yr GS 38
• 3 yr GS 6
• Whether you chose VS as a career or not, what
  training paradigm seems more appealing?
• 5 yr GS 1 or 2 yr VS with GS certificate 29
• 4 yr GS 2 yr VS with GS certificate 64
• 3 yr GS 3 yr VS without GS certificate 7

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Vascular Residents Surveys (VR2003)

• Survey mailed to 95 (81) programs
• A total of 61 (74) programs responded
• A total of 93 (104) VR responded
• ( )results of 2001 survey

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Reasons VS Was Chosen (VR2003)
Important Unimport. Score Technical
aspect of VS 97 (100) 0 (0)
4.7 (4.8, 1) Endovasc. capabilities
88 (66) 3 (16) 4.2 (3.7, 4) Positive
mentors 83 (87) 4 (5) 4.2
(4.3, 2) Complex decision in VS 80 (83)
9 (2) 3.9 (4.2, 3) Better job
opportunities 56 (50) 17 (23)
3.5 (3.3, 6) Academic nature of VS 47
(60) 20 (10) 2.9 (3.6, 5) Higher income
than GS 38 (29) 26 (38) 2.9
(2.8, 7) ( )Results of 2001 survey
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Reasons Peers Did Not Choose VS
Important Unimport. Score VS
operations stressful 82 (68) 10 (15) 4.1
(3.7, 1) Loss of surgery endovasc. 49 (26)
34 (44) 3.1 (2.7, 3) Liked VS but chose
other 34 (36) 20 (21) 3.1 (3.2,
2) Negative mentors 29 (15) 41 (49) 2.8
(2.5, 5) Too much AV access 23 (21) 43
(55) 2.7 (2.5, 4) Too much debt 22 (10)
44 (51) 2.7 (2.4, 6) Importance of GS
certificate 73 (70) 15 (14) 3.9 (3.9)
( )Results of 2001 survey
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Training Paradigms (VR2003)

• 5 yr GS 1 or 2 yr VS with GS certificate 25
• 4 yr GS 2 yr VS with GS certificate 48
• 3 yr GS 3 yr VS without GS certificate 27
  (25)
• What percent of practice do you plan to devote to
  GS?
• 0 49 (48)
• 10 16 (15)
• 25 26 (26) ( )Results of 2001 survey
• 50 9 (11)
• 75 and above 0 (0)

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In Conclusion.

• Lifestyle issues are very important
• We should all be involved in mentoring medical
  students and junior surgical residents
• We should reflect a positive attitude after all
  vascular surgery is an exciting specialty
• Generation-Y is showing the same characteristics
  as Xers, so the problem is not going away. This
  is a real issue for us to deal with.

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In Conclusion.

• As we are thinking about the training paradigms,
  we need to keep in mind that 75 of Chief
  Residents and 52 of current Vascular Fellows in
  our 2003 survey still want to do General Surgery.
  At least we need to explore this issue further.