Should I ever complete a similar mental exercise, the title of my autobiography will begin, “[name removed]: Surgeon”. My first year in medical school exposed me to a handful of specialties and dozens of subspecialties. Finding and choosing a specialty was daunting as many appeared to peak my interests. In an attempt to gain better perspective, I decided to spend as much time in the hospital as possible in the summer between my 1st and 2nd years. I contacted several departments at Northwestern Memorial Hospital (NWM) in Chicago about shadowing their physicians. My schedule started me on the Trauma Surgery and Critical Care service and rotated between different departments every week. I never ended up leaving the Trauma Surgery service.
Though I spent time in other department’s clinics and floors, I would always gravitate back to the Trauma service. I was fortunate to be at NWM in June when there is a traditional break between 3rd and 4th year for medical students, leaving me the sole medical student in the entire hospital and the only student on a surgical service. This gave me an unparalleled opportunity to explore my interest in surgery. The residents tried to direct me to what they thought would be interesting cases as well as those that I would be of use. My transforming experience that summer, in particular the 200 or so hours in the hospital those two weeks being the only medical student, exposed me to three aspects of surgery that convinced me that I was destined to be a surgeon: the surgical problems, surgical patients and surgeon characteristics.
Surgical problems and patients are difficult, complex and unique. Surgery is an assault on the human body. A surgeon must contend not only with the patient’s natural decline in health, but also the infliction that we cause trying to help. They must deal with three distinct, but complicated problem areas; pre-operative: whether or not to operate, operative: the marriage of medical knowledge and the technical skill and post-operative: management of wounds, infections and a whole host of potential complications. These problems represent the pinnacle of intellectual challenges and are life altering for patients. I cannot imagine anything more rewarding than dedicating my life to solving them.
The uniqueness of surgical problems requires surgeons to not only be intelligent, diligent physicians, but also creative, good with their hands, work well under pressure, decisive and good team leaders. These are all characteristics that throughout my life I have aspired to. I am eager to realize these aspirations as I continue my medical education as a surgical resident.
Based on the significant number of unfilled vascular fellowship positions in the 2004 National Residency Matching Program (NRMP) and the perception of program directors that the quality of candidates is deteriorating, the Issues Committee of the Association of Program Directors in Vascular Surgery (APDVS) explored the characteristics and the trend of the applicant pool to develop recommendations for improvement.
The Electronic Residency Application Service (ERAS) database was queried for the total number of applicants, medical school, gender, and age, among other characteristics. The vascular surgery applicant pool was compared to the applicant pool for general surgery; the applicant pool for all fellowship positions, including a variety of medical subspecialties; the applicant pool for all residency positions; and the applicant pool for colorectal surgery, the only other surgical subspecialty participating in ERAS in 2004. NRMP data was used prior to 2004. The χ2 test was used for statistical analysis, with significance set at P < .05.
In the 2004 match for June 2005 positions, there were 100 applicants for 110 first-year vascular surgery positions in 90 programs. In 1989, there were 123 applicants for 56 positions in 49 programs. In 1989, 55% of vascular surgery applicants did not match; whereas in 2004, only 7% were unmatched. Although the overall number of vascular surgery applicants has remained relatively stable, the number of United States applicants has decreased from 89% in 1990 to 68% in 2004 (P < .01). There was a significant geographic variation: 34% of those in the applicant pool came from the state of New York, but 23 states did not contribute a single applicant to the pool. In addition, vascular surgery, like other fellowships, attracts fewer female applicants.
The data from the ERAS database support the impression held by many in the vascular surgery education community that the size of the applicant pool for vascular surgery fellowship positions has remained stagnant, while the number of positions has significantly increased. Strategies to increase the size and quality of the applicant pool are needed.