The dying field of general surgery: when do we intervene?

Background: Although the number of residents choosing general surgery continues to decline, few studies have examined the factors that influence surgical residents to pursue general surgery as a career. Using a survey of former graduates, we evaluated factors that influenced residents' decisions to enter their chosen area of surgery. We then compared those residents who pursued general surgery with those that decided to subspecialize.

Methods: A 32-item web survey was sent to 99 graduates of a university general surgery program, all of whom matriculated between 1985 and 2006. Results were then analyzed using Fisher's exact test with significance determined as P<or=0.05.

Results: A total of 83 (84%) survey recipients replied. Of the respondents, 35 (42%) were general surgeons, 46 (55%) subspecialized, and two (3%) did not specify their field. Those that entered general surgery practices were significantly less likely to rank research opportunities and the ability to teach medical students and residents as important in choosing their current field. They were, however, more likely to rank duration of training as important compared with those who subspecialized. General surgeons were significantly more likely than those who specialized to have chosen their career paths prior to entering residency, 60% versus 4% (P<0.0001). They were also significantly more likely to be in private practice and not associated with a University/Academic institution, 66% versus 36% (P=0.013).

Conclusion: In our survey, surgical residents who pursue general surgery were more likely to have chosen their career path prior to beginning residency, and to rank duration of training as an important factor in that decision. These findings suggest that the response to the decreasing numbers of general surgeons needs to happen prior to residency, and that a restructuring of surgical education may need to involve concentrating the training of general surgeons into a shorter time frame.