Careers of women in academic surgery]

AIM: The aim of our national survey was to determine personal, working, and career conditions of women in academic surgery in Germany. METHODS: A questionnaire with 47 items was sent to 261 female surgeons working in 36 departments of general, abdominal, trauma, and vascular surgery. A total of 134 (51.3%) from all 36 surgical departments responded with completed surveys. RESULTS: The mean age of the women was 35.1 years (range 27 to 54). Seventy-eight percent of the surgeons worked in departments for general or abdominal surgery, 17% in trauma, and 5% in vascular surgery. 45% of the women had finished residency and 19% were in faculty positions. Eighty percent of those asked were mostly or always content with their working conditions. However, 79% perceived career obstacles in academic surgery. The most frequently addressed obstructions were: predominant male structures (80%), the absence of mentoring programs (70%), too few operative cases per month (67%), and no equality of career opportunities compared to male surgeons (60%). CONCLUSIONS: To reduce career obstructions, which were reported by 79% of the female surgeons, and to encourage those 33% who wanted to leave academic surgery, it seems necessary to improve cooperation between female surgeons, department chairs, and governmental institutions.     

Karriere im Gegenwind

Aim

The aim of our national survey was to determine personal, working, and career conditions of women in academic surgery in Germany.

Methods

A questionnaire with 47 items was sent to 261 female surgeons working in 36 departments of general, abdominal, trauma, and vascular surgery. A total of 134 (51.3%) from all 36 surgical departments responded with completed surveys.

Results

The mean age of the women was 35.1 years (range 27 to 54). Seventy-eight percent of the surgeons worked in departments for general or abdominal surgery, 17% in trauma, and 5% in vascular surgery. 45% of the women had finished residency and 19% were in faculty positions. Eighty percent of those asked were mostly or always content with their working conditions. However, 79% perceived career obstacles in academic surgery. The most frequently addressed obstructions were: predominant male structures (80%), the absence of mentoring programs (70%), too few operative cases per month (67%), and no equality of career opportunities compared to male surgeons (60%).

Conclusions

To reduce career obstructions, which were reported by 79% of the female surgeons, and to encourage those 33% who wanted to leave academic surgery, it seems necessary to improve cooperation between female surgeons, department chairs, and governmental institutions.     

Comparison of private versus academic practice for general surgeons: a guide for medical students and residents

BACKGROUND: Medical students and residents often make specialty and practice choices with limited exposure to aspects of professional and personal life in general surgery. The purpose of this study was to portray practice composition, career choices, professional experiences, job satisfaction, and personal life characteristics specific to practicing general surgeons in the United States. STUDY DESIGN: A 131-question survey was mailed to all female members (n = 1,076) and a random 2:1 sample of male members (n = 2,152) of the American College of Surgeons in three mailings between September 1998 and March 1999. Respondents who were not actively practicing general surgery in the United States and both trainees and surgeons who did not fit the definition of private or academic practice were excluded. Detailed questions regarding practice attributes, surgical training, professional choices, harassment, malpractice, career satisfaction, and personal life characteristics were included. Separate five-point Likert scales were designed to measure influences on career choices and satisfaction with professional and personal matters. Univariate analyses were used to analyze responses by surgeon age, gender, and practice type. RESULTS: A response rate of 57% resulted in 1,532 eligible responses. Significant differences between private and academic practice were noted in case composition, practice structure, and income potential; no major differences were seen in malpractice experience. Propensity for marriage and parenthood differed significantly between men and women surgeons. Overall career satisfaction was very high regardless of practice type. Some differences by surgeon gender in perceptions of equal career advancement opportunities and of professional isolation were noted. CONCLUSIONS: This study offers a comprehensive view of general surgery to enable more informed decisions among medical students and residents regarding specialty choice or practice opportunities.     

Workforce patterns of rural surgeons in West Virginia

Rural general surgeons perform a wide variety of procedures and have practices different from those of surgeons in larger communities. Because of this residents completing a classical general surgery training program may not be prepared for the rural setting. The 219 licensed physicians in West Virginia who list general surgery as their practice specialty with the State Board were surveyed to determine the nature of the rural surgery workforce and to examine the caseload of these surgeons. The majority of rural surgeons were satisfied with their current situation; however, 22 per cent stated that they would leave the practice of medicine if financially able. One-third of these surgeons regarded the rural setting as having an adverse impact on their practice. More than half of those surveyed stated that they would not encourage a young person to pursue a career in medicine. For one-third of rural surgeons general medicine was part of daily practice. The caseload varied by community size. Surgeons in communities of fewer than 10,000 people performed a lower percentage of general surgical procedures than surgeons in urban areas. They listed obstetric and gynecologic (9%), urologic (5%), otolaryngologic (9%), and orthopedic (4%) procedures as part of their regular cases. Endoscopic procedures comprise 17 to 24 per cent of total procedures regardless of community size. We conclude that resident surgeons planning to pursue a career in rural general surgery should broaden their operative and general medicine experiences to meet the needs of the communities in which they will serve.     

Perceived gender-based barriers to careers in academic surgery

BackgroundWomen represent roughly 50% of US medical students and one third of US surgery residents. Within academic surgery departments, however, women are disproportionately underrepresented, particularly at senior levels. The aim of this study was to test the hypothesis that female surgeons perceive different barriers to academic careers relative to their male colleagues.MethodsA modified version of the Career Barriers Inventory–Revised was administered to senior surgical residents and early-career surgical faculty members at 8 academic medical centers using an online survey tool. Likert-type scales were used to measure respondents' agreement with each survey item. Fisher's exact test was used to identify significant differences on the basis of gender.ResultsRespondents included 70 women (44 residents, 26 faculty members) and 84 men (41 residents, 43 faculty members). Women anticipated or perceived active discrimination in the form of being treated differently and experiencing negative comments about their sex, findings that differed notably from those for male counterparts. Sex-based negative attitudes inhibited the career aspirations of female surgeons. The presence of overt and implicit bias resulted in a sense that sex is a barrier to female surgeons' career development in academic surgery. No differences were observed between male and female respondents with regard to career preparation or structural barriers.ConclusionsFemale academic surgeons experience challenges that are perceived to differ from their male counterparts. Women who participated in this study reported feeling excluded from the dominant culture in departments of surgery. This study may help guide transformative initiatives within academic surgery departments.     

Does protected research time during general surgery training contribute to graduates' career choice?

A number of general surgery training programs offer a dedicated research experience during the training period. There is much debate over the importance of these experiences with the added constraints placed on training surgeons including length of training, Accreditation Council of Graduate Medical Education limitations, and financial barriers. We seek to quantify the impact of a protected research experience on graduates of a university-affiliated general surgery training program. We surveyed all graduates of a single university-affiliated general surgery training program who completed training from 1989 to 1999. Data was obtained for 100 per cent of the subjects. Most graduates (72/73; 98.6%) completed a dedicated research experience (range: 1-5 years). Presently, 72.6 per cent (53/73) are practicing academic surgery and 82.5 per cent (60/73) are engaged in research activities. Fifty-one of 73 graduates (69.5%) have current research funding including 32.9 per cent (24/73) with National Institutes of Health funding. Of all graduates, 42.5 per cent (31/73) have become full professors with 20.2 per cent (15/73) division/section chiefs and 14.3 per cent (10/73) department chairmen or vice chairmen. Those trainees achieving a career in academic surgery were statistically more likely to have committed 2 or more years to a protected research experience during training (P < 0.05), fellowship training after general surgery residency (P < 0.01), and a first job at an academic institution upon completion of training (P < 0.001). Understanding the importance of resident research experiences while highlighting critical factors during the formative training period may help to ensure continued academic interest and productivity of future trainees.     

Career pathways of graduates of general surgery residency programs: an analysis of graduates from 1983 to 1990.

BACKGROUND: Approximately 1,000 individuals complete graduate surgical education in general surgery each year. Their subsequent career pathways have not been described but may have relevance to the supply of general surgeons available to provide a broad range of surgical care to the population of the USA. STUDY DESIGN: Data for this study were obtained from the American College of Surgeons's Surgery Resident Masterfile, developed for the annual Longitudinal Study of Surgery Residents, and the American Board of Medical Specialties's Official Directory of Board Certified Medical Specialists. For verification purposes, the American Medical Association's Physician Masterfile and the American Board of Surgery's certified database were searched. Yearly analyses of certified general surgery graduates from 1983 to 1990 were conducted, and rates of certification between US or Canadian medical school graduates and international medical school graduates (IMG) were compared. RESULTS: Ten to 18 years after completion of a residency program in general surgery, 93.6% of graduates had been certified in general surgery or by another American Board of Medical Specialties board. A total of 43.7% of the 8,068 graduates were certified, in addition, in a general surgery-based specialty. Overall, evidence of certification was not available for 6.4% of graduates. The certification rate for US or Canadian graduates was 95.8% of general surgeons and increased for IMG surgeons from 69.4% for 1983 graduates to 94.7% for 1990 graduates. The number of IMGs in general surgery residency programs declined from 19.7% of 1983 graduates to 7.8% of 1990 graduates. The rates of American Board of Surgery certification are 96.1% for male and 93.6% for female US or Canadian graduates; 79.2% of male IMG graduates and 83.7% of female IMG graduates became certified. CONCLUSIONS: Most surgeons who completed a general surgery residency program from 1983 to 1990 are certified and presumably have met high standards for knowledge and experience. More than half of the graduates specialize further.     

National criteria for academic appointment in vascular surgery

ObjectiveAdvancement in academic medicine is multifactorial. Our objectives were to characterize academic appointments in vascular surgery and to investigate what factors, particularly publications, influenced academic appointment.MethodsAcademic vascular surgeons at Accreditation Council for Graduate Medical Education vascular training programs or at primary sites of U.S. allopathic medical schools were included. Those with qualified titles, such as “adjunct” or a “clinical” prefix, were excluded. Sex, education, region, board certification, and affiliation details were recorded. Web of Science was queried for publication details and h-index. The h-index is a “personal impact factor” defined as “x” number of publications cited at least “x” number of times. After surgeons' information was deidentified, univariate and multivariable analyses were completed for academic appointment and appointment as division chief.ResultsThere were 642 vascular surgeons who met criteria: 297 (46.3%) assistant professors, 150 (23.4%) associate professors, and 195 (30.4%) professors. There were 96 (15%) division chiefs and 10 (1.6%) chairs of surgery, and 83.2% were male. Surgeons worked in the Northeast (33.5%), Southern (32.6%), Central (20.1%), and Western (13.9%) United States. The mean (±standard deviation) number of publications was 13.7 ± 15.4 for assistant professors, 33.9 ± 28.8 for associate professors, and 86.8 ± 63.6 for professors (P < .001). Mean number of first or last author publications was 5.3 ± 6.4 for assistant professors, 12.2 ± 12.7 for associate professors, and 38.7 ± 35.3 for professors (P < .001). Mean h-index was 5.9 ± 5.4 for assistant professors, 12 ± 7.7 for associate professors, and 24.9 ± 12.6 for professors (P < .001). In multivariable analysis, vascular surgery board certification (adjusted odds ratio [OR], 6.08; 95% confidence interval [CI], 1.15-32.2; P = .03), academic appointment at a public medical school (OR, 1.99; 95% CI, 1.18-3.37; P = .01), years since medical school graduation (OR, 1.13; 95% CI, 1.09-1.18; P < .001, per year), and number of publications (OR, 1.05; 95% CI, 1.03-1.06; P < .001, per publication) were independently associated with associate professor. Factors independently associated with professor were years since medical school graduation (OR, 1.18; 95% CI, 1.12-1.24; P < .001, per year) and number of first or last author publications (OR, 1.05; 95% CI, 1.02-1.09; P = .003, per publication). Appointment as division chief was independently associated with h-index (OR, 1.04; 95% CI, 1.01-1.08; P = .016, per point).ConclusionsTotal number of publications was independently associated with associate professor, with number of first or last author publications particularly important for professor. The h-index was not independently associated with academic appointment, but it was for appointment as division chief. This study provides relevant data for promotional guidance in academic vascular surgery.     

How to become a researcher and the role of the academic specialist registrar

This article outlines the recent changes to the academic clinical training pathway and provides insights from the direct experiences of two academic surgeons, at different stages of their careers. The role of academic surgeons is to bridge the gap between research and/or teaching and clinical practice, with the ability to translate challenges from the bedside into meaningful research that informs practice. Surgery remains a craft speciality and undoubtedly the critical challenge remains the need to balance academia with developing the specific skills required of surgeons. This is often offset by the opportunity for training with greater continuity, resulting from longer periods in a specialist department. The practical nature of surgery creates great opportunities in translational research and technological innovation. Changes to research funding and academic clinical training have formalized the opportunities available at every stage, and the benefits of a career in academic surgery are vast.     

The initial examination for a Certificate of Added Qualifications in Surgery of the Hand

A total of 510 candidates took the 1989 Examination for Added Qualifications in Surgery of the Hand, including 412 diplomates of the American Board of Orthopaedic Surgery and ninety-eight diplomates of the American Board of Surgery. Most candidates reported that they had intensive practices in hand surgery and large annual case-loads, and most had taken a hand fellowship. However, there were significant differences between diplomates of the American Board of Orthopaedic Surgery and diplomates of the American Board of Surgery regarding these variables. The psychometric characteristics of the examination were very good. The average difficulty value was 77.6 per cent correct. The average item-discrimination value was high, and the total test reliability coefficient was 0.89. In general, the candidates' performance was very good, although there was a wide range in scores. A passing score of 66.3 per cent correct was selected, resulting in an over-all failure rate of 7.6 per cent, with 471 candidates passing and thirty-nine failing the examination. There were significant relationships between performance on the examination and several background variables, such as percentage of practice in hand surgery, having taken a hand fellowship, and size of the annual case-load.     

Psychologic well-being of surgery residents after inception of the 80-hour workweek: a multi-institutional study

BACKGROUND: The 80-hour workweek was adopted by US residency programs on July 1, 2003. Our published data from the preceding year indicated significant impairment in psychologic well-being among surgery residents. The purpose of this study was to determine whether psychologic well-being and academic performance of surgery residents improved after inception of the 80-hour workweek. METHODS: A single-blinded survey of general surgery residents (n=130) across 4 US training programs was conducted after July 1, 2003, with the use of validated psychometric surveys (Symptom Checklist-90-R and Perceived Stress Scale) and the American Board of Surgery In-Training Examination; comparison was done with preceding year and societal data. Primary outcomes were "psychologic distress" and "perceived stress." Secondary outcomes were "somatization," "depression," "anxiety," "interpersonal sensitivity," "hostility," "obsessive-compulsive behavior," "phobic anxiety," "paranoid ideation," "psychoticism." and "academic performance." The impact of demographic variables was assessed. RESULTS: Mean psychologic distress improved from the preceding year (P < .01) but remained elevated, compared with societal norms (P < .001). The proportion of residents meeting the criteria for clinical psychologic distress (>or=90th percentile) decreased from 38% before, to 24% after, July 2003. Mean perceived stress remained elevated, compared with norms (P < .0001) without improvement from the preceding year. Overall academic performance was unchanged. Previously elevated secondary psychologic outcomes improved after July 2003 (P < .05), although obsessive-compulsive behavior, depression, interpersonal sensitivity, hostility, and anxiety failed to normalize. Male gender and single status were independent risk factors for psychologic distress. CONCLUSIONS: Inception of the 80-hour workweek is associated with reduced psychologic distress among surgery residents. The perception of stress and academic performance remains unchanged.     

How to become a researcher and the role of the academic specialist registrar

This article outlines the current academic clinical training pathway and provides insights from the personal experiences of two academic surgeons, at different stages of their careers. The role of academic surgeons is to bridge the gaps between research, teaching and clinical practice, with the ability to translate issues from the bedside and operating theatre into meaningful research that informs practice. Surgery remains a craft speciality and undoubtedly the critical challenge for academic training remains the need to balance academia with developing the specific skills required of surgeons. This is often offset by the potential for training with a greater continuity, as a result of longer periods in a specialist department. The practical nature of surgery creates great possibilities in translational research and technological innovation. Changes in recent years to research funding and academic clinical training have formalized the potential opportunities at every stage. The benefits of a career in academic surgery are vast.     

Career development of residents in university and independent training programs: the influence of special training fellowships, type of practice, specialization, and research

General surgical chief residents in all approved training programs were surveyed to evaluate the influence of fellowships, specialization, and research. Respondents represented 76% of programs and 60% of residents. Most chief residents plan to take post-residency fellowships. This is most common among those from university training programs and residents planning an academic career. Vascular surgery and cardiothoracic surgery represent half of all fellowships. Sixty-two percent of residents plan to enter private practice compared with 28% who plan to join a medical school faculty. More than one third of university trainees plan an academic career. More than 90% plan fellowships. The practice of general surgery alone or combined with a specialty was more common among trainees from independent training programs. Practice of a subspecialty was more common among university trainees. More than 80% of residents did research during training. Research leading to publication was more common among university trainees planning academic careers and least common among future general surgeons. This survey suggests that general surgery is predominant among residents in independent training programs who then enter private practice. University programs produce subspecialists who are predominant among future academic surgeons. This trend has vital implications for the future of academic general surgery.     

The Economics of Private Practice versus Academia in Surgery

Objective

Residents often make career decisions regarding future practice without adequate knowledge to the realities of professional life. Currently there is a paucity of data regarding economic differences between practice models. This study seeks to illuminate the financial differences of surgical subspecialties between academic and private practice.

The importance of vascular surgery training in a general surgery practice

The aim of this report was to document the practice of vascular surgery for graduates of 4 general surgery training programs.Graduating residents from 1991 to 1995 were surveyed by phone to document the number of reconstructive vascular and dialysis access procedures that they performed during the most recent 12 months. Those who pursued additional training beyond general surgery or who did not successfully complete the certifying examination of the American Board of Surgery (ABS) were excluded. In addition, the Resident Review Committee for Surgery (RRC-S) defined category report for these same general surgeons during their residency was examined.Fifty-five percent (26 of 47) of the board-certified general surgeons do either reconstructive or dialysis access vascular surgery. The average number of procedures in the RRC-S defined category for this cohort was 76. During the focused 12 months, 1986 vascular procedures were done by these 26 surgeons (76 cases per surgeon).In certain regions of this country, a significant volume of vascular surgery is done by general surgeons who have an ABS primary certificate alone. The technique of control and repair of major arteries and veins, the consequences of distal organ ischemia, reperfusion injury, thrombosis, and embolization are important anatomic and physiologic principles that must be taught in the curriculum to general surgeons, regardless of their future surgical careers. (Curr Surg 57:381-383. Copyright 2000 by the Association of Program Directors in Surgery.)     

Gender differences in general surgical careers: results of a post-residency survey

BACKGROUND: This study's purpose was to gain perspective regarding general surgery career choices while examining gender differences. METHODS: Graduates of a general surgery residency (n = 189) received surveys addressing fellowship training, practice type, case composition, work hours, academic involvement, income, residency, and career satisfaction. RESULTS: Several gender differences were identified. Most men (64%) listed general surgery as their primary work type, whereas women most commonly reported breast surgery (38%, P < .001). More women worked <40 hours per week (25% versus 9%, P = .049). There was no gender difference in income for fellowship-trained surgeons, but a disparity in income >200,000 dollars favored non-fellowship-trained men (74% versus 36%, P = .0031). Both genders reduced work hours. Women reduced them exclusively for personal/family demands. Both genders reported satisfaction with their surgical careers (93%). CONCLUSIONS: Some gender differences in surgery were identified. However, both genders maintain a high level of satisfaction with their career choice.     

Keys to career satisfaction: insights from a survey of women pediatric surgeons

Background/purpose

Declining interest in the field of surgery is attributed to lifestyle issues, more women per class, high debt, and long residency. To maintain surgery as a premier career choice, female students must find surgery to be professionally and personally rewarding.

Methods

A 35-item questionnaire was mailed to 95 women pediatric surgeons (WPS), assessing multiple professional and personal factors. Responses were entered into a confidential database and analyzed by χ² or t tests.

Results

Seventy-nine percent of surveys were returned; practice was identified as academic (60%) and private (40%). Respondents were grouped by age: A, less than 44 years (41%); B, 45 to 54 years (37%); and C, greater than 55 years (22%). For academic WPS, 81% are on timeline for promotion. Insufficient protected time was a significant obstacle for a successful academic career in groups A and B (P = .001). Clinical load, on-call responsibilities, lack of mentorship, and departmental support were major obstacles in all groups (P = .05). Seventy-three percent of WPS in private practice were satisfied with their role in practice management; poor practice conditions were cited as the most frequent reason for job relocation. Sixty-one percent of WPS are married, and 46% are raising children. WPS had statistically significant more responsibilities for child care and household tasks in comparison with their partners. Eighty-three percent report career satisfaction but desire more time with family and for personal interests. Part-time and flexible work schedules were identified as attractive ways to achieve career-family balance. Eighty-four percent believe that quality-of-life issues are the dominant reason that fewer medical students choose surgical fields.

Conclusions

WPS express career satisfaction but share the concerns of their female colleagues in other surgical disciplines. Quality of life is viewed as central to career choice for the current generation of medical students; female role models are key to recruiting women into pediatric surgery.     

Samuel D. Gross: pioneer academic trauma surgeon of 19th century America

It is appropriate on the 50th anniversary of the American Association for the Surgery of Trauma to recall the most influential trauma surgeon in 19th century America: Samuel D. Gross. Gross was an innovative surgeon whose 50-year career as a surgeon caring for injured patients encompassed orthopedics, thoracic surgery, abdominal surgery, and ophthalmology. The dominant influence of Gross over contemporary surgical doctrine was a consequence of his prolific scholarship which included six superbly written texts that passed through a combined total of 15 editions. Gross was a teacher, occupying for 42 years Chairs of Surgery at three medical schools. Gross wore the mantle of political leadership, founding medical societies that continue today as forums for the presentation and review of new treatments for injured patients. Modern academic trauma surgeons could do no better than to emulate the career of Samuel David Gross, the Patriarch of American trauma surgeons.     

Relevance of basic laboratory and clinical research activities as part of the vascular surgery fellowship: an assessment by program directors and postfellowship surgeons

INTRODUCTION: Decreased federal monies for graduate medical education, increased clinical training demands, and a decreased pool of general surgery trainees applying to vascular surgery fellowships have brought into question the relevance of the fellowship research experience. This study sought to describe the recent laboratory experience of the fellows, the value of this experience to program directors (PDs) and the trainees, and what factors related to this experience contributed to the trainee entering an academic career versus a private practice career. METHODS: A survey regarding the relevance of research experience during fellowship training was mailed in 2001 to all Accreditation Council for Graduate Medical Education-approved vascular surgery fellowship PDs and vascular surgery fellows (VSFs) from 1988 to 2000 applying for the American Board of Surgery Certificate of Added Qualification in General Vascular Surgery. RESULTS: Survey responses were received from 89% of the PDs (74/83) and 69% of the VSFs (259/378). Among the PDs, 70% had completed an approved fellowship, and current bench research was performed by 46%. The PDs afforded protected research time to 69% of the VSFs (with a mean duration of 12 months). This research was in the basic science laboratory 34% of the time. Only 42% of the PDs considered basic laboratory research to be an important part of the fellowship, whereas 99% believed that clinical research was important. Among the PDs, 42% believed that more practice-oriented fellowships with no basic research were needed, whereas 35% believed that basic research should remain an integral component of the fellowship. VSF basic science productivity was significantly greater from those programs that offered protected research time as compared with those that did not (mean basic science paper published, 1.7 +/- 0.1 versus 0.3 +/- 0.6 per VSF; P <.001). At the time of the survey, 99 VSFs had entered academic careers and 136 were in private practice. Basic science research had been undertaken by 56% of the VSFs during medical school and by 53% during general surgery residency. Research during the fellowship was performed by 65% of the VSFs. This experience was considered helpful in choosing an academic or private practice career by 44% of the VSFs. A greater proportion of academic surgeons had research experience as VSFs when compared with VSFs who became private practitioners (71% versus 57%; P <.05). VSFs who entered academic careers had a more productive publication record in fellowship than did those who chose private practice (mean paper, 2.4 versus 1.5; P <.05). Overall, 78% of the VSFs believed that their research experience was maturing beyond the technical skills learned. CONCLUSION: This report provides a benchmark of the vascular surgery fellowship research experience. Most VSFs considered the research experience as it now exists to be worthwhile, and less than half of the PDs believed that it should remain as it is. Research experience in fellowship seemed more influential than that in medical school or general surgical residency in promoting an academic career.