Responding to the Problem of Resident Recruitment

BY MARK S. LESNEY

PHILADELPHIA -- The future of the next generation of vascular surgeons is at stake, with inadequate recruitment, too few women entering the field, and a general perception among medical students and residents that the vascular specialty is not a good "lifestyle" choice, according to speakers at this year's E. Stanley Crawford Critical Issues Forum, at the Vascular Annual Meeting.

The session, "Recruitment Crisis in Vascular Surgery--Defining Solutions Now," was designed and moderated (as per E. Stanley Crawford Forum tradition) by then-SVS president-elect K. Craig Kent as well as New York Presbyterian Hospital, Cornell University, and Columbia University, all in New York, and represents a subject Dr. Kent believes "is critically important to our livelihood--that of recruiting young people to vascular surgery."

The forum was organized to address the issue and to help find some solutions to the recruitment problem. "I believe it is a crisis facing our society," said Dr. Kent, who took over the role of society president during the meeting.

The first speaker, Dr. John Eidt, professor of surgery and radiology at the University of Arkansas, Little Rock, defined the problem, giving a history of the low number of applicants (slightly up this year) over the past decade and especially the dearth of women applicants. This year's match day was May 24; complete match statistics are at www.nrmp.org/fellow/match_name/vascular/stats.html.

The match is conducted yearly by the National Resident Matching Program at the request of the Association of Program Directors in Vascular Surgery, the sponsoring organization for vascular surgery fellowships. These fellowships are for 2 years, and all applicants must have completed a residency in general surgery first. Registration for programs and applicants began in December of last year.

Dr. Eidt highlighted the fact that in this year's match results there were only 129 applicants for 112 positions in 90 active vascular programs, with 106 of these positions being filled (95%). A total of 88% of U.S. applicants were matched.

Although a low number of applicants and a high-percentage match is good news for job seekers, it does not indicate a broad choice for maintaining high quality, Dr. Eidt said, and it does not bode well for the future when the aging population will create far more demand for vascular interventions and for more vascular surgeons. He concluded with the overall message that there were too few individuals entering the specialty now, too few projected for the future, and that there appeared to be a declining interest in the specialty among medical students and residents.

Dr. Julie Freischlag, who is chair of the department of surgery at Johns Hopkins University, Baltimore, continued the discussion, in "Where Have All the Vascular Residents Gone?" She introduced 4th-year medical student Natalie Glebova, also from Johns Hopkins University, and surgical resident Scott Hollenback from Cornell University, who presented their individual perspectives on the problem. Many of their points were reiterated by other speakers, especially the overwhelming importance of personal relationships--meeting and having positive experiences with vascular surgeons at every level.

Vascular Surgery Training Revised

The new Primary Certificate in Vascular Surgery eliminates the requirement for certification in general surgery before certification in vascular surgery. After July 1, 2008, certification in vascular surgery will require a minimum of 2 years of accredited vascular training. There will be several training options available: 7-year track: 5 years of general surgery and general residency plus 2 years of vascular surgery with eventual board certification in both surgery and vascular surgery. 6-year track (“3 + 3”): vascular surgery certification only, for residents who match in initial surgical training. 5-year track: vascular surgery–integrated track for trainees who match during medical school.

For additional information, visit Primary Certificate In Vascular Surgery: What It Means to Medical Students and Junior Residents on VascularWeb.org.

There were several speakers charged with discussing possible solutions, including activities currently being undertaken by SVS as a whole, to address the situation. The critical role of mentoring, as illustrated by the student and resident representatives, was highlighted in a talk by Dr. Myriam J. Curet, director of the minimally invasive surgery program at Stanford (Calif.) University, who discussed "How to Be an Effective Mentor." She urged applying mentorship at every level--from students to residents to junior faculty--to encourage recruitment and retention in the specialty.

Above all, she stressed the need to show the positive face of vascular surgery: the enthusiasm that current practitioners find in their day-to-day activities, including how to balance work and home life and how to enjoy their work. Almost as important was to demonstrate a true concern for the needs of students and residents in this new era by sticking to work-hour restrictions, accommodating personal needs (maternity or paternity leave and child-care issues).

It was also important to let students and residents participate in the actual work of vascular surgery at whatever their competence level. "Let them operate!" she said, to the laughter and applause from an audience who, earlier in the day, had heard a talk in which the resident presenter admitted that he could not answer a particular question because he had not gotten to perform the operations done in the study.

On the curriculum front, one major change addressed the issue of how long it takes to become a vascular surgeon and how quickly students could get access to specialized vascular training. Dr. James Seeger, professor of surgery at the University of Florida, Gainesville, discussed "The New Training Paradigm--the Primary Certificate in Vascular Surgery." He announced that the Primary Care Certificate has now been approved and vascular programs can now be formed to take advantage of the new 3 + 3 plan, which allows 3 years of general surgery, followed by 3 years of vascular specialization. As of June 2006, applications were being accepted to set up primary programs. (See sidebar.)

Dr. Bruce Perler, professor of surgery at Johns Hopkins University, gave the final talk of the session, in which he discussed a new recruitment DVD from SVS. (See p. 10.)