Vascular Match Statistics Still Disappointing

By Janice Rosenberg

CHICAGO -- The number of applicants for fellowships in vascular surgery is at an all-time low, reported Pamela M. Zimmerman, M.D., at the Vascular Annual Meeting.

In order to improve the situation, vascular specialists need to work hard at establishing the specialty's identity, actively recruiting applicants, and increasing their mentoring of students and residents, according to Dr. Zimmerman of the Kaleida Health-Millard Fillmore Gates Hospital, University of Buffalo, New York.

A record low number of applicants for active fellowship positions in vascular surgery resulted in unfilled matches in 2004 (for 2005 appointments), and in 2005 (for 2006 appointments), said Dr. Zimmerman. In 2004, there were 100 active applicants for 110 active positions, and in 2005, 108 applicants for 117 positions. By comparison, in 1997, 124 applicants competed for 86 positions, creating a 35% surplus in applicants.

To investigate why the new millennium has seen increasing vacancies, Dr. Zimmerman and colleagues sent surveys electronically to vascular surgery program directors, who forwarded them to vascular fellows. The survey comprised 16 questions related to vascular career decisions and experiences during residency. The survey asked about factors that affected career decisions and the timing of those decisions. In addition, the researchers obtained data from the National Resident Matching Program.

Of the 90 fellows who responded, 16% decided during medical school to pursue vascular surgery. The other 84% committed to vascular surgery during residency. Broken down by postgraduate year (PGY), 18% chose vascular surgery during PGY-1, 54% decided by the end of PGY-2, 84% in PGY-3, and 95% of the students had chosen by the end of PGY-4. One issue that affected the time of decision making was the number of vascular cases performed by residents, since routine exposure often did not occur until later in their training.

Several reasons were reported for not choosing a career as a vascular specialist. Medical students stated lifestyle and length of training concerns, along with negative influences from mentors. Residents noted that the operations were too long and that they had had unfavorable experiences with the field until their senior year of medical school. They also were concerned about the loss of potential patients to other specialties.

Dr. Zimmerman and colleagues recommended several ways to build the applicant pool. Practitioners should work to enhance the specialty's identity by better defining the term "vascular specialist," by identifying areas of turf concern, and by promoting the ways that the endovascular component of the field has improved their lifestyles.

Members of the specialty should increase their interactions with medical students to allow more opportunities to recruit and mentor them, as well to offer the students earlier exposure to endovascular and open surgeries. The researchers also encouraged active recruitment of women. Currently, more than 50% of medical students and 25% of surgery residents are women, yet for the 2004 match, 92 of the applicants were male and 18 ( less than 20%) were female.

"We need global education concerning what we do," Dr. Zimmerman said. "We can start by talking to medical students."

New training paradigms were accepted in spring 2005 by the American Board of Surgery. The logistics of how they will be implemented into current training programs is yet to be determined.