RESULTS Graduates of 1994-1995 and 1995-1996 residency programs in surgery In 1995, 4,228 residents graduated from the core surgical specialties; in 1996 this number was 4,154. An additional 359 and 369 residents completed residency programs in the advanced general surgery-based specialties in 1995 and 1996, respectively, for a total of 4,587 graduates in 1995 and 4,523 in 1996 (Table 1). These numbers are essentially unchanged from those reported in prior years, varying from the 15 -year average by less than 1% each year (Fig. 1). In 1995 and 1996 the largest number of graduates of core surgical programs, 1,188 (28%) and 1,194 (29%), respectively, were in the specialty of obstetrics and gynecology; 1,011 (24%) and 998 (24%) of the graduates were in general surgery. Although it appears that there has been an increase in graduates in thoracic surgery (138 in 1995 and 148 in 1996), this represents residents in programs admitting 2 residents in one year and 1 the next. With the exception of neurological surgery, which had 131 graduates in 1995 and 143 in 1996, core and advanced programs graduates remained the same or decreased slightly (Table 2). Table 1. Graduates of Surgical Residencies, 1995 and 1996   1995 Graduates 1996 Graduates   Residencies n % n % Core Surgical*     General surgery  1,011 23.9 998 24.0    Obstetrics and    gynecology  1,188 28.1 1,194 28.7    Orthopaedic surgery† 635 15.0 607 14.6    Ophthalmology† 506 12.0 484 11.6    Otolaryngology† 282 6.7 273 6.6    Urology‡ 256 6.1 249 6.0    Plastic surgery§ 219 5.2 206 5.0    Neurological surgery† 131 3.1 143 3.4 Subtotal 4,228 100 4,154 100 Advanced Surgical||            Thoracic surgery  138 38.3 148 40.1    Vascular surgery  79 21.9 76 20.6    Colon and rectal surgery  54 15.0 54 14.6    Surgical critical care¶ 62 17.2 65 17.6    Pediatric surgery  26 7.2 26 7.0 Subtotal  359 100 369 100 Total  4,587   4,523   * Core Surgical Specialties offer primary certification by an American Board of Medical Specialties board. † One prerequisite year of graduate medical education is required before entering specialty. ‡ Two years of prerequisite general surgery residency is required before entering urology. § A minimum of three prerequisite years of general surgery or completion of an otolaryngology residency is required before entering plastic surgery. || Successful completion of a general surgery residency is required before entering these surgical specialties. ¶ Three or more years of general surgery residency are required before entering a residency program in surgical critical care; completion of a general surgery residency is required to be eligible for certification in surgical critical care. From the American College of Surgeons Surgical Resident Masterfile and the Medical Education Research and Information Database, 1996, American Medical Association, Chicago, IL, with permission. Figure 1. Graduates from core surgical residency programs, 1987 to 1996. The total number of graduates each year varies from the 15-year average by less than 1%. Core surgical residency programs offering primary certification by an American Board of Medical Specialties member board include general surgery, neurological surgery, obstetrics and gynecology, ophthalmology, orthopaedic surgery, otolaryngology, plastic surgery, and urology. (From the American College of Surgeons Surgical Resident Masterfile and the Medical Education Research and Information Database, 1995-1996 American Medical Association, Chicago, IL with permission.) Table 2. Graduates of Surgical Residencies, 1983 to 1996 Specialty 1983  1985  1987  1989  1991  1993  1994  1995  1996  General surgery  996 1,024 1,023 994 995 979 1,001 1,011 998 Obstetrics and gynecology NA NA 1,175 1,104 1,133 1,175 1,177 1,188 1,194 Orthopaedic surgery 613 639 620 598 653 630 655 635 607 Ophthalmology NA NA 512 504 461 465 507 507 484 Otolaryngology 252 223 257 259 268 271 273 282 273 Urology  264 260 254 237 254 247 252 256 249 Neurological surgery 90 127 118 129 110 127 126 131 143 Plastic surgery 186 205 187 191 204 212 209 219 206 Thoracic surgery 139 141 135 132 133 144 147 138 148 Colon and rectal surgery 50 46 48 49 58 53 54 54 54 Vascular surgery 0* 10 61 69 74 72 78 79 76 Pediatric surgery  17 17 17 17 22 21 21 26 26 Total  2,607 2,692 4,407 4,283 4,365 4,396 4,500 4,587 4,521 * Vascular surgery first accredited in 1984. NA, not available until 1987. From the American College of Surgeons Surgical Resident Masterfile and the Medical Education Research and Information Database, 1996, American Medical Association, Chicago, IL, with permission. By the beginning of the 1997-98 academic year, 446 (44%) of the 1995 general surgery graduates have continued in advanced general surgery-based accredited GME (Table 3). In addition, graduates entered formal specialty fellowship programs in transplantation and surgical oncology that are not accredited through the ACGME system, leaving fewer than half of the graduates of general surgery residency programs who enter broad-based general surgery practice. Although numbers of 1996 general surgery graduates continuing in advanced programs appear lower, we have found that some residents enter advanced programs one to two years after graduation from the core general surgery program; we anticipate that the number of 1996 general surgery graduates who eventually enter accredited advanced surgical residency programs will be the same as in prior years. One hundred thirty of the 1995 general surgery graduates entered plastic surgery in 1995, 1996, or 1997; the number of 1996 general surgery graduates entering plastic surgery in 1996 and 1997 was 87, although followup of this group has been insufficient to detect some of the graduates who begin plastic surgery programs after a hiatus of one to two years. Table 3. General Surgery Graduates Continuing in Accredited General Surgery Based Residency Programs Specialty 1995 general surgery graduates*   1996 general surgery graduates†   Colon and rectal surgery 50 38 Plastic surgery  130 87 Surgical critical care  39 47 Pediatric surgery  24 21 Vascular surgery  74 74 Thoracic surgery  129 116 Total  446 383 * 1995 general surgery graduates identified in 1995/96, 1996/97, or 1997/98 advanced residency programs. † 1996 general surgery graduates identified in 1996/97 or 1997/98 advanced residency programs. From the American College of Surgeons Surgical Resident Masterfile and the Medical Education Research and Information Database, 1996, American Medical Association, Chicago, IL, with permission. Graduates of core surgical residency programs were 33 years old on average; graduates of the advanced general surgery-based programs were, as expected, at least 2 years older (35 to 36 years old) (Table 4). Women were slightly, though significantly, younger than men. IMG graduates were older than US and Canadian graduates when graduating either from core programs (36.5 years versus 33 years) or from advanced programs (38 years versus 35 years). Osteopathic graduates of core programs were, on average, 1.8 years older than allopathic graduates from US and Canadian medical schools. Table 4. Average Age of 1995 and 1996 Graduates of Surgical Residencies*   1995 graduates† 1996 graduates†   Specialties Age (y) n Age (y) n Core Surgical‡    All core specialties  33.0 + 3.1 4,062 33.1 + 3.7 4,12    Men  33.1 + 3.0 3,087 33.2 + 3.4 3,056    Women  32.7 + 3.5 || 975 32.8 + 4.3 || 1.071    Graduates of US/Canadian    allopathic medical schools  32.8 + 2.9 3,806 32.9 + 3.4 3,808    Graduates of international    medical schools  36.5 + 4.4 205 36.7 + 4.7 261    Graduates of osteopathic    medical schools  34.1 + 3.2 51 34.8 + 4.3 58 Advanced surgical§             All advanced specialties  35.4 + 3.2 306 36.0 + 5.8 358    Men  35.4 + 3.2 277 36.0 + 5.9 329    Women  34.8 + 3.1 29 35.3 + 4.5 29    Graduates of US/Canadian    allopathic medical schools  35.1 + 2.8 272 35.7 + 5.9 325    Graduates of international    medical schools  37.7 + 4.7 34 38.2 + 3.7 32    Graduates of osteopathic    medical schools  0 0 33.0 + 4.3 1 *Ages are reported as mean plus or minus one standard deviation. † Data were missing for 4.8% of the 1995 graduates and 0.8% of the 1996 graduates. ‡ Core surgical specialties offer primary certification by an American Board of Medical Specialties board. § Successful completion of a general surgery residency is required before entering these surgical specialties. || Women are significantly younger than men at graduation from a surgical residency (p <.005). From the American College Surgeons Surgical Resident Masterfile and the Medical Education Research and Information Database, 1996, American Medical Association, Chicago, IL, with permission. Residents entering surgical GME in 1994 and 1995 Twice as many residents enter general surgery as graduate, reflecting the preliminary category of residency appointments in general surgery (Table 5). "Designated" preliminary residents (those fulfilling a prerequisite general surgery experience for 1 or 2 years before beginning specialty GME) have been identified by longitudinal followup of the 1994 and 1995 entry cohort, and have been arbitrarily assigned to their specialty at the postgraduate year (PGY) 1 level for the purposes of this study. The excess of general surgery residents, therefore, represent the "undesignated" preliminary cohort. In contrast, the number entering the other core surgical specialties closely resembles the number of graduates, as is typical of categorical resident positions. Approximately 5,000 individuals enter a surgical residency program each year. Table 5. Specialty of Surgical Residents Beginning a Residency Program, 1994-1995 and 1995-1996   Residents     1994-1995 1995-1996   Core surgical residencies* n % n % General surgery 2,094 40.5 1,927 38.3 Obstetrics and gynecology  1,220 23.6 1,211 24.1 Orthopaedic surgery† 553 10.7 583 11.6 Ophthalmology† 475 9.2 467 9.3 Otolaryngology† 213 4.1 261 5.2 Urology‡ 261 5.0 223 4.4 Plastic surgery§ 207 4.0 211 4.2 Neurological surgery† 152 2.9 144 2.9 Total  5,175 100 5,027 100 * Core Surgical Specialties offer primary certification by an American Board of Medical Specialties board. † One prerequisite year of graduate medical education is required before entering specialty. ‡ Two years of prerequisite general surgery residency is required before entering urology. § A minimum of 3 prerequisite years of general surgery or completion of an otolaryngology residency is required before entering plastic surgery. In 1995, the Accreditation Council for Graduate Medical Education (ACGME) began accrediting programs to offer a 5- to 6-year program in plastic surgery, called the Integrated Educational Model. From the American College of Surgeons Surgical Resident Masterfile and the Medical Education Research and Information Database, 1996, American Medical Association, Chicago, IL, with permission. Most who enter surgical residency programs are male (73.4% in 1994 and 73.8% in 1995), Caucasian (67.5% in 1994 and 62.3% in 1995), and graduates of US or Canadian allopathic medical schools (89.4% in 1994 and 89.6% in 1995). Twenty-seven percent are women, 16% are Asian, 5% are African American or Native American, and approximately 4% are from Hispanic backgrounds (Tables 6 and 7). Approximately 9% of entering residents are graduates of international medical schools (IMG), and 1.2 to 1.3% are graduates of US osteopathic medical schools. Graduates of surgical residency programs are even more homogenous: 77% of graduates in 1995 and 75.6% in 1996 are male; 77.5% in 1995 and 78.2% in 1996 are Caucasian. Only 6% of graduates in both 1995 and 1996 are IMGs and 1% are osteopathic graduates (Tables 8 and 9). Table 6. Surgical Residents Beginning a Residency Program, 1994-1995 and 1995-1996: Gender, Ethnic Background, and Medical School Attended   Residents     1994-1995 1995-1996   Characteristic n % n % Gender    Male 4,069 73.4 3,982 73.8    Female 1,472 26.6 1,415 26.2 Ethnic background    Caucasian 3,738 67.5 3,364 62.3    Asian* 910 16.4 865 16.0    African-Ameican and    Native American 301 5.4 305 5.7    Hispanic† 218 3.9 226 4.2    Other/unknown 374 6.7 637 11.8 Medical school attended            US/Canadian allopathic 4,955 89.4 4,837 89.6    US osteopathic 69 1.2 70 1.3    International medical graduate 492 8.9 481 8.9    Unknown medical school 25 0.5 9 0.2 Total residents 5,541 100 5,397 100 * Asian, Pacific Islander, Indian, Middle Eastern (1995). † Mexican American, Puerto Rican, or other Hispanic. From the American College of Surgeons Surgical Resident Masterfile and the Medical Education Research and Information Database, 1996, American Medical Association, Chicago, IL, with permission. Table 8. 1995 and 1996 Graduates of Surgical Residencies: Gender, Ethnic Background, and Medical School Attended   Graduates     1995 1996   Characteristic n % n % Gender    Male 3,530 77.0 3,418 75.6    Female 1,057 23.0 1,105 24.4 Ethnic background    Caucasian 3,553 77.5 3,537 78.2    Asian* 497 10.4 432 9.6    African-Ameican and    Native American 218 4.8 213 4.7    Hispanic† 193 4.2 202 4.5    Other/unknown 144 3.1 139 3.1 Medical school attended            US/Canadian allopathic 4,276 93.2 4,165 92.1    US osteopathic 55 1.2 60 1.3    International medical graduate 253 5.5 298 6.6    Unknown medical school 3 0.1 0   Total graduates 4,587 100 4,523 100 * Asian, Pacific Islander, Indian, Middle Eastern (1995). † Mexican American, Puerto Rican, or other Hispanic. From the American College of Surgeons Surgical Resident Masterfile and the Medical Education Research and Information Database, 1996, American Medical Association, Chicago, IL, with permission. The predominant ethnic minority group represented in surgical GME is Asian (10% of graduates). African-American and Hispanic individuals make up 5% and 4% of graduates from surgical residency programs, respectively, in both the 1995 and 1996 graduating classes (Tables 7 and 9 and Fig. 2). Figure 2. Ethnic backgrounds of graduates of all surgical residency programs in 1996. (From the American College of Surgeons Surgical Resident Masterfile and the Medical Education Research and Information Database, 1995-1996 American Medical Association, Chicago, IL, with permission.) Women make up 27% of entering residents and 23% to 24% of graduates of surgical GME programs (Tables 6 and 8). Most women are registered in obstetrics and gynecology residency programs where they represent the majority of the entering class (59% in 1994 and 60% in 1995) and of graduates (53% in 1995 and 55% in 1996). In all other surgical specialties combined, women made up 17% of the entering class in 1994 and 16% in 1995; in 1995, 13% of graduates from surgical specialties other than obstetrics and gynecology were women and in 1996 this number was 14%. Women represented 19% of entering general surgical residents in 1994 and 1995, and 15% and 16% of general surgery graduates in 1995 and 1996, respectively.   Introduction | Methods | Results | Discussion | References JACS menu

This page and all contents are Copyright © 1996-2000
by the American College of Surgeons, Chicago, IL 60611-3211