title: General surgery vs fellowship: the role of the Independent Academic Medical Center.
abstract: OBJECTIVE
  To compare career choices of residency graduates from Independent Academic Medical Center (IAMC) and University Academic Medical Center (UAMC) programs and evaluate program directors' perceptions of residents' motivations for pursuing general surgery or fellowships.
  
  
  METHODS
  From May to August 2011, an electronic survey collected information on program characteristics, graduates' career pursuits, and career motivations. Fisher's exact tests were calculated to compare responses by program type. Multivariate logistic regression was used to identify independent program characteristics associated with graduates pursuing general surgery.
  
  
  METHODS
  Data were collected on graduates over 3 years (2009-2011).
  
  
  METHODS
  Surgery residency program directors.
  
  
  RESULTS
  Seventy-four program directors completed the survey; 42% represented IAMCs. IAMCs reported more graduates choosing general surgery. Over one-quarter of graduates pursued general surgery from 52% of IAMC vs 37% of UAMC programs (p = 0.243). Career choices varied significantly by region: over one-quarter of graduates pursue general surgery from 78% of Western, 60% of Midwestern, 40% of Southern, and 24% of Northeastern programs (p = 0.018). On multivariate analysis, IAMC programs were independently associated with more graduates choosing general surgery (p = 0.017), after adjustment for other program characteristics. Seventy-five percent of UAMC programs reported over three-fourths of graduates receive first choice fellowship, compared with only 52% of IAMC programs (p = 0.067). Fellowships were comparable among IAMC and UAMC programs, most commonly MIS/Bariatric (16%), Critical Care/Trauma (16%), and Vascular (14%). IAMC and UAMC program directors cite similar reasons for graduate career choices.
  
  
  CONCLUSIONS
  Most general surgery residents undergo fellowship training. Graduates from IAMC and UAMC programs pursue similar specialties, but UAMC programs report more first choice acceptance. IAMC programs may graduate proportionately more general surgeons. Further studies directly evaluating surgical residents' career choices are warranted to understand the influence of independent and university programs in shaping these choices and to develop strategies for reducing the general surgeon shortage.
authors.affiliation: Inova Fairfax Hospital, Falls Church, VA, USA.
authors.forename: Souheil W
authors.initials: SW
authors.lastname: Adra
authors.forename: Amber W
authors.initials: AW
authors.lastname: Trickey
authors.forename: Moira E
authors.initials: ME
authors.lastname: Crosby
authors.forename: Scott H
authors.initials: SH
authors.lastname: Kurtzman
authors.forename: Mark L
authors.initials: ML
authors.lastname: Friedell
authors.forename: H David
authors.initials: HD
authors.lastname: Reines
mesh_terms: D000046:Academic Medical Centers; D002321:Career Choice; D005257:Fellowships and Scholarships; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires; D014481:United States