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Passion in the gut – Will your General Surgery search meet the cut?

By Cliff Zeller, MD
- Vice President, Rocky Mountain Medical Search

Of the upcoming shortage of physicians predicted for the next 20 years, perhaps most critical of all will be the shortage of General Surgeons. General Surgery will be one of the most difficult recruits to fill as fewer graduating medical students are choosing this specialty. 

In 1981, 12 percent of graduating US medical students chose General Surgery, while in 2002, only 5 percent chose General Surgery as their career. 

Why are students not choosing General Surgery? And what does that mean if you are recruiting General Surgeons?

According to the American Medical Association's 2007 Medical Student Graduation Questionnaire, students viewed onerous work hours with perceived lack of controllable lifestyle, inadequate compensation for time spent in training, and the stress of dealing with life-threatening illness as important barriers for specializing in General Surgery.

AMA data also shows there are approximately 32,600 General Surgeons with nearly 1,000 retiring or dying each year. In addition, about 7,000 of the total are over age 60. An approximate 50 percent increase in surgical workload needs is being forecasted over the next 30 years due to aging of the population. There are about 1,100 new board eligible General Surgeons graduated per year with about 600 choosing to stay with General Surgery and enter the workforce. 

These numbers indicate a significant shortage looming.

Ladies first
There is evidence that some residency slots are being filled by international medical graduates but a more important trend is the increased percentage of women going into General Surgery. Currently, approximately 24 percent of newly certified General Surgeons are women, with almost a third of PG1 surgical residency slots being filled by women. 

According to Dr. Bruce Stabile in an article published in the Archives of General Surgery 2008, there are several critical factors important to attracting new surgeons. In the past, women tended to perceive surgery as a macho specialty with an "old boys club" attitude.  Therefore, a sense of connectedness to other surgeons, especially among  female surgeons to other female surgeons, has ranked particularly important to those choosing a surgical career.

A 2002 article in the American Journal of Surgery indicated that extroversion and conscientiousness were two important traits found in young surgical candidates. However, according to Dr. Stabile, the most critical personality trait in the attraction of young surgeons to their specialty is passion – the special willingness to invade the human body in order to heal it.

Geoff Lawton, Vice President of Business Development for Littleton Adventist Hospital in Denver, believes that General Surgery is an important component within a hospital's infrastructure, especially in conjunction with trauma and oncology teams.

"General Surgery just touches so many service lines," Lawton said. "General Surgeons are extraordinarily valuable to the whole hospital."

Looking ahead
What does this mean in the recruitment of General Surgeons? During the recruitment process, the team should demonstrate an understanding of the character traits of conscientiousness and extroversion by showing the candidate that they would be quickly integrated into the social stream of the hospital and the mainstream of hospital politics.

Describing the opportunities to join volunteer clinical faculty with recognition and promotion of honors, as well as monetary stipends to support attendance at scientific meetings (the opportunity to connect with other surgical colleagues), would be important in the recruiting process. Administration should demonstrate an acceptance and empathy for the strong passion of these physicians for their career choice.

About one third of new recruits will be female, so it is particularly important to introduce the candidate to other female surgical colleagues on staff during the recruitment process. It would be important to demonstrate a sense of welcoming collegiality, particularly from the male surgeons – "no old boys clubs here" should be the recruitment mantra.

The surgeon's need for connectedness and extroversion may indicate that the final year of residency is too far along to begin the recruitment process. This would necessitate projecting physician staff surgical needs several years earlier than usual.

The use of recruiters (in-house and external) to identify target residents in specifically desired residency programs will be critical to get a jump on the competition. Recruiters may begin working with appropriate candidates several years before the completion of their full training program. Initial recruitment contact could take place earlier in the candidate's training at seminars and medical conferences. The recruiter needs to facilitate personal contact between key hospital physicians and identify early candidates. The implementation of a mentoring relationship would help as well.

In summary, quality-of-life issues, a sense of connectedness to other medical staff, fostering a sense of control over the workload, and the recognition of the unique special surgical passion, will all be critical factors in the competition to attract General Surgeons in the upcoming decades.