From the Society for Vascular Surgery
Choice of vascular surgery as a specialty: Survey of
vascular surgery residents, general surgery chief
residents, and medical students at hospitals with
vascular surgery training programs
Keith D. Calligaro, MD,aMatthew J. Dougherty, MD,aAnton N. Sidawy, MD,band
Jack L. Cronenwett, MD,cPhiladelphia, Pa; Washington, DC; and Lebanon, NH
Purpose: Under the direction of the Association of Program Directors in Vascular Surgery, a survey was mailed to vascular
surgery residents (VSRs), general surgery chief residents (GS-CRs), and fourth-year medical students (MSs) to better
define reasons why trainees do and do not choose vascular surgery as a career.
Methods: Questionnaires were mailed to all accredited VSR programs and their associated GS programs in the United
States and Canada in 2001 (survey 1) and in 2003 (survey 2) and to 2 medical schools with VSR programs in 2001. A
total of 197 VSRs, 169 GS-CRs, and 78 MSs responded (overall program response rate of 78% for VSRs, 46% for GSRs,
20% for MSs). A scoring system was assigned, with 1.0 the least important and 5.0 the most important reasons to choose
or not choose vascular surgery.
Results: Technical aspects, role of mentors, and complex decision making involved in vascular surgery were the most
important reasons that VSRs, GS-CRs, and MSs would choose vascular surgery as a specialty (average scores >4.0 for
VSRs and GS-CRs; >3.5 for MSs). Responses of GS-CRs and VSRs did not vary significantly between surveys 1 and 2,
except endovascular capabilities of vascular surgeons had a more important role in choosing vascular surgery, and future
loss of patients to other interventionalists had a more important role in not choosing this specialty in the more recent
survey of GS-CRs and VSRs. MSs identified lifestyle as a surgical resident (4.3) and as a surgeon (4.2) as the most
important negative factors. A training paradigm consisting of 4 years general surgery ? 2 years vascular surgery with a GS
certificate was favored by 64% of GS-CRs and 48% of VSRs, compared with a paradigm of 5 years ? 2 years with a general
surgery certificate, which was favored by 29% of GS-CRs and 25% of VSRs, or 3 years ? 3 years without a general surgery
certificate, favored by 7% of GS-CRs and 27% of VSRs. Of note, 86% of MSs favored 3 years general surgery ? 3 years
vascular surgery or 2 years general surgery ? 4 years vascular surgery compared with longer general surgery training
Conclusion: These findings may help vascular surgery program directors devise strategies to attract future trainees. The
importance of mentorship to general surgery junior residents and medical students in choosing vascular surgery cannot
be overestimated. Endovascular capabilities of vascular surgeons have an increasingly positive role in career choice by
GS-CRs and VSRs, but these residents express increasing concerns about potential loss of patients to other specialists.
Lifestyle concerns are the most important reasons why medical students do not choose vascular surgery as a career.
(J Vasc Surg 2004;40:978-84.)
Members of the Association of Program Directors in
Vascular Surgery (APDVS) were concerned that the num-
residency programs had decreased in recent years. We pre-
viously suggested strategies to improve outpatient educa-
service, because of our concern about this issue.1Possible
reasons suggested for the decreasing number of applicants
to vascular surgery training programs include lifestyle, poor
mentorship, financial considerations, and a diminishing
applicant pool for general surgery residencies.2-7Of sub-
stantial concern is a decreasing interest in vascular surgery
residency by finishing general surgery residents. The pool
of US-trained medical students vying for positions in vas-
cular surgery has decreased substantially.2,3,8Since 1997
the number of training positions available in vascular sur-
gery programs accredited by the Accreditation Council for
Graduate Medical Education has increased by 34% (82 in
1997 to 110 in 2004 for the vascular surgery residency
match), but the total number of active applicants to these
decreased by 36% (107 in 1997 to 68 in 2004) during this
time.8Only 68 US medical graduates were available for
110 vascular surgery residency positions in 2004.
Previous surveys addressing different vascular issues
have proved helpful in providing pertinent information
regarding vascular training and experience.9Under the
From the Section of Vascular Surgery,aPennsylvania Hospital, Philadelphia,
The Surgical Service,bVeterans Affairs Medical Center, Washington, DC,
and the Section of Vascular Surgery,cDartmouth-Hitchcock Medical
Center, Lebanon, NH.
Competition of interest: none.
Presented at the Fifty-seventh Annual Meeting of the Society for Vascular
Surgery, Anaheim, Calif, Jun 3, 2004.
PA 19106 (e-mail: firstname.lastname@example.org).
Copyright © 2004 by The Society for Vascular Surgery.
General surgery has fixed their problem. This year there were only
3 unfilled spots in the county for general surgery. And it was dismal
a few years ago. So I think we can come up with some things to do
to fix this quickly.
Third, there’s the women issue. If you look around this room,
there are not many women here. How do we solve this problem? If
you look at who is in college right now, 62% of college students are
women. And so for the next 10 years over half of medical students
are going to be women. So what are we going to do to get them to
be vascular surgeons? I think we’re going to have to work hard to
get them into surgery. But how are we going to get them out of
general surgery and to become vascular surgeons?
So I appreciate your comments. Keith, you’ve been a great
mentor to many students, women and men, and certainly many in
this room have done a lot to try to attract people to our specialty.
I actually think we’re in an emergency situation, and this is the year
to work on it.
Dr Keith D. Calligaro. I think the results of this year’s match
show that the situation is an emergency. We’re facing a crisis in
terms of producing reasonable numbers of vascular surgeons.
In answer to your questions, I think we need to apply similar
strategies, not only for medical students and junior residents but
for women also. All program directors and all of us who work with
students and junior residents need to assume this as a personal
responsibility. We have to show interest in junior residents and
In particular, a strategy that I use is to allow students or
residents to evaluate new patients first and present them to you,
whether as a consult in the hospital or a new patient in the clinic.
This simple approach gets them interested. Students really like our
rotation because they get involved in taking care of patients, and
they like office hours for that reason. Also, allowing students or
junior residents to do part of an operation or part of an endovas-
underestimate how important this can be. There may be many of
you in the audience who were allowed to do a little bit of an
anastomosis as a fourth-year student or junior resident, and you
didn’t forget it, and it greatly stimulated your interest. I would
recommend the formation of a task force developed by the SVS or
the APDVS to address this issue.
Dr Peter Pappas (Newark, NJ). I think the issue with the
medical students is a little bit more complex than that. Depending
on what medical school you’re in and what part of the country
days where you were exposed to general surgery for 12 weeks are
very few and far between. At our institution the medical students
rotate for 7 weeks on general surgery, and the last week is totally
devoted to lectures. We have medical students on our service for
only 1 week at a time. So the other ways to get involved with the
medical students is to be involved in their core lecture series. Also,
I applaud your efforts at getting them more involved with the
clinic, because I think that’s absolutely right on the money what
needs to be done.
I think, also, in terms of the general surgery residents, one of
the things that we’ve done is we’ve gone back to them in our
residency program and asked them what they would like to see
done differently. We have actually changed our approach a little
bit. There used to be a fourth-year and a second-year resident
rotation, and now we’ve changed to a third-year and a second-year
rotation. And they enjoy it more, because they get to do that
vascular anastomosis you just talked about.
The other thing is, we’ve also changed our conferences a little
bit. They used to be directed more at the fellow, and the residents
would sit in the back of the room and fall asleep. We now have the
fellows, who run the conference, direct all of the questions toward
the general surgery residents, and it’s much more interactive.
We’ve moved the chairs so that they’re in the front of the room.
And it goes back to the whole point about mentoring. I think
colleagues, the Association of Academic Surgery has for years put
money and effort into mentorship. And I think with the new SVS
council we should make mentorship and education a top priority.
Dr Calligaro. We have also recently adopted having our
and that has been received very well.
You mentioned one of the biggest problems we face, and
that’s the length of time that medical students are exposed to a
vascular rotation. We used to have students for at least 1 month.
Now it’s been cut down to 2 weeks, actually 8 days. It is difficult to
convince someone to choose your specialty when you have them
for such a short time. We’re going to have to consider what we can
do about it, whether it’s going to the dean of the medical school or
have the chairman of the surgery department try to help. It’s going
to be a difficult problem.
JOURNAL OF VASCULAR SURGERY
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