title: Factors influencing the decision of surgery residency graduates to pursue general surgery practice versus fellowship.
abstract: OBJECTIVE
  Surgery residency serves 2 purposes-prepare graduates for general surgery (GS) practice or postresidency surgical fellowship, leading to specialty surgical practice (SS). This study was undertaken to elucidate factors influencing career choice for these 2 groups.
  
  
  METHODS
  All US allopathic surgery residency graduates from 2009 to 2013 (n = 5512) were surveyed by the American Board of Surgery regarding confidence, autonomy, and reasons for career selection between GS and SS. Surveys were distributed by mail in November 2013, with follow-up mailings to initial nonrespondents.
  
  
  RESULTS
  Sixty-one percent (3354) of graduates completed the survey; 26% pursued GS, and 74% SS. GS expressed greater levels of confidence than SS across the common surgical procedures queried. Confidence increased with each year after completion of residency for GS but not SS. The decision to pursue GS or SS was made during residency by 77% and 74%, respectively. Fifty-seven percent of those who chose GS indicated that a GS mentor significantly influenced their decision. GS rated procedural variety, opportunity for practice autonomy, choice of practice location, and influence of a mentor as reasons to pursue GS practice. SS listed control over scope of practice, prestige, salary, and specialty interest as reasons to pursue SF. Both groups expressed a high degree of satisfaction with their career choice (GS, 94%; SS, 90%).
  
  
  CONCLUSIONS
  Most graduates who pursue GS practice are confident and content. The decision to pursue GS is strongly influenced by a GS mentor. Lack of confidence may be a more significant factor for choosing SS. These findings suggest opportunities for improvements in confidence and mentorship during residency.
authors.affiliation: *Department of Surgery, Washington University in St. Louis, St. Louis, MO †Gundersen Health System, La Crosse, WI ‡Loyola University of Chicago, Stritch School of Medicine, Maywood, IL; and §American Board of Surgery Inc, Philadelphia, PA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Klingensmith
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Cogbill
authors.forename: Frederick
authors.initials: F
authors.lastname: Luchette
authors.forename: Thomas
authors.initials: T
authors.lastname: Biester
authors.forename: Kelli
authors.initials: K
authors.lastname: Samonte
authors.forename: Andrew
authors.initials: A
authors.lastname: Jones
authors.forename: Frank R
authors.initials: FR
authors.lastname: Lewis
authors.forename: Mark A
authors.initials: MA
authors.lastname: Malangoni
mesh_terms: D000328:Adult; D002321:Career Choice; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003657:Decision Making; D004503:Education, Medical, Graduate / Q000458:organization & administration; D005257:Fellowships and Scholarships / Q000706:statistics & numerical data*; D005260:Female; D013502:General Surgery / Q000193:education* / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D010549:Personal Satisfaction; D012307:Risk Factors; D013043:Specialties, Surgical / Q000193:education* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States