How Many Years is General Surgery residency? 5 or '7'?

[Blitz2006]

Ok,

So I thought that Gen surg was 5 years. But now I'm starting to find out that while the residency is 5 years, most programs require '1-2 years' of research.

so really its '7' years...is this true?

If I have an interest in surgery but not so much in research, are there programs out there that do not require any research (Just straight up PGY1-5).

Also, supposing I want to do a fellowship afterwards in Trauma or Surgical Oncology, is research background (1-2 years) required? I'm fairly sure for surgical fellowships research is required, but just want to double check here.

Thanks,

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[JackADeli]

...I thought that Gen surg was 5 years. But now I'm starting to find out that while the residency is 5 years, most programs require '1-2 years' of research.

so really its '7' years...is this true?

If I have an interest in surgery but not so much in research, are there programs out there that do not require any research (Just straight up PGY1-5).

Also, supposing I want to do a fellowship afterwards in Trauma or Surgical Oncology, is research background (1-2 years) required? I'm fairly sure for surgical fellowships research is required, but just want to double check here.

Thanks,

First, I am not sure "most programs require '1-2 years' of research". I think the vast majority of programs are five years in length. I welcome any correction to that statement if I am wrong. A good number will require you conduct some sort of academic/research during residency. This can often be met during the five years with case report publications and participation in on-going clinical research projects.

Second, trauma or trauma/critical care fellowships currently do NOT really require significant "research" activity to be a competitive applicant.

Finally, I am not sure about what is out there now, but, I believe to be competitive for a good surge-onc fellowship, programs do look for eveidence of solid research experience and other such cerebral activity.

JAD

 

[Winged Scapula]

Agree with JAD..."most" programs, even academic ones, do not require research. However, I have noticed a trend amongst academic programs toward this. My assumption is that the scheduling is easier with a set curriculum. Used to be that if you had more people in the lab than coming out, you'd just work the residents harder to make up for the discrepancy. Now with work hour restrictions, its not as easy to cover the call schedule when the resident census is short.

So, while a few outright state that they are required 7 years, a several more are de facto 7 years (there exists a difference of opinion at my former residency program - the former residency director tells me it is now a required 7 years; a current resident there tells me that is not the case), most do not require time in the lab.

Currently trauma is not competitive except at the most highly sought after fellowships: Shock and Ryder (to name a couple).

Surg Onc is probably one of THE most academic of general surgery pursuits and research is expected during residency and fellowship. If this is your goal, you need to be at a program with some opportunities to do research.

 

[Blitz2006]

Thanks guys. Amazing how within 30 minutes I can receive such helpful/informative knowledge.

I just suggested surg onc and trauma as examples...so to cut to the chase, I don't really want to do that much research in my residency (as you could probably already have guesse).

So which surgical fellowships require no or little research during general surg. residency?

I will admit, right now my top choice is trauma. So its encouraging to hear that it does not require any research.

Thx again

 

[Winged Scapula]

Thanks guys. Amazing how within 30 minutes I can receive such helpful/informative knowledge.

I just suggested surg onc and trauma as examples...so to cut to the chase, I don't really want to do that much research in my residency (as you could probably already have guesse).

So which surgical fellowships require no or little research during general surg. residency?

I will admit, right now my top choice is trauma. So its encouraging to hear that it does not require any research.

Thx again

You might want to consider figuring out what you actually enjoy, but here goes:

Research Essentially Required

Pediatric Surgery
Surgical Oncology
Plastics and Reconstruction

Research Not Required

Trauma/Critical Care
Transplant
? CT Surgery

Everything else is in between and depends on the program. For example, Breast doesn't require research but if you wanted to train at MD Anderson or MSK, it probably is. Same goes for Trauma, Txp and CTS.

 

[JackADeli]

You might want to consider figuring out what you actually enjoy, but here goes:

Research Essentially Required

Pediatric Surgery
Surgical Oncology
Plastics and Reconstruction

Research Not Required

Trauma/Critical Care
Transplant
? CT Surgery

Everything else is in between and depends on the program. For example, Breast doesn't require research but if you wanted to train at MD Anderson or MSK, it probably is. Same goes for Trauma, Txp and CTS.

I would update as follows; caveat as per WS statement.....

Formal Research Time Essentially Required

Pediatric Surgery
Surgical Oncology (quite a few PhDs in this field)
Plastics and Reconstruction
colo-rectal +/-
Endocrine +/-
hepatobiliary +/-

Formal Research Time Not Required

Trauma/Critical Care
Minimally Invassive Surgery (bariatric & non-bariatric)
Vascular
CT Surgery
Breast (though some centers would require)
Transplant (though some centers would require)
colo-rectal +/-
Endocrine +/-
hepatobiliary +/-

I would add, not been in GSurgery residency for over a year, generally means not applying/looking at fellowships for over 2-3 years..... thus, my data may be old.

JAD

 

[Winged Scapula]

Colorectal, really?

I've never thought of it as being very competitive.

Endocrine, same...although there aren't many programs.

 

[JackADeli]

Colorectal, really?

I've never thought of it as being very competitive.

Endocrine, same...although there aren't many programs.

I could be wrong on the CRectal. However, it is more popular as most avoid trauma and a good deal of ED general call for cholecystectomy, perf-DU, etc...(xcept ....rhoids, IBD, etc,). It is also increasing popularity with the "lap colons" (i.e. subset of MIS). So, could be wrong but competition is increasing.

As for endocrine, as noted few programs, increased popularity as again, avoid trauma call, and probably all GSurge call after practice established. Becoming quite popular as lap adrenals, thyroids, and parathyroids are generally "fun" cases. Most of these patients go home quickly. Not a large inpatient service and exceedingly low incidence of "wound issues".

I don't think they fall in the categories of Pedes or Plastics....yet. I have adjusted my listing in earlier post.

JAD

 

[Winged Scapula]

I could be wrong on the CRectal. However, it is more popular as most avoid trauma and a good deal of ED general call for cholecystectomy, perf-DU, etc...(xcept ....rhoids, IBD, etc,). It is also increasing popularity with the "lap colons" (i.e. subset of MIS). So, could be wrong but competition is increasing.

As for endocrine, as noted few programs, increased popularity as again, avoid trauma call, and probably all GSurge call after practice established. Becoming quite popular as lap adrenals, thyroids, and parathyroids are generally "fun" cases. Most of these patients go home quickly. Not a large inpatient service and exceedingly low incidence of "wound issues".

I don't think they fall in the categories of Pedes or Plastics....yet. I have adjusted my listing in earlier post.

JAD

Clearly CRS is a popular speciality for the reasons you'ev listed. I would add a highly elective case load (as long as you aren't in the GS call pool), interesting genetics and mostly compliant patients.

Endocrine is the same. The problem with it, IMHO, is the job competition. Many are finding that getting the neck procedures away from GS and ENT difficult, getting the adrenals away from Uro, GS and Surg Onc, tough, etc. I know one Endocrine trained fellow who has said that its hard to find a niche without doing general surgery.

But you are right - that with the exceptions of PRS, Peds and Surg Onc, almost everything else is in the middle of the pack, moving up or down as the fates decide.

 

[Blitz2006]

sweet, thanks for the added responses.

Definitly gives me a better idea of what to expect when I apply for GSurg residency.

Cheers,

 

[Pilot Doc]

Ann Surg. 2009 Jan;249(1):155-61.
Prevalence and cost of full-time research fellowships during general surgery residency: a national survey.


OBJECTIVE: To quantify the prevalence, outcomes, and cost of surgical resident research.

SUMMARY BACKGROUND DATA: General surgery is unique among graduate medical education programs because a large percentage of residents interrupt their clinical training to spend 1 to 3 years performing full-time research. No comprehensive data exists on the scope of this practice.

METHODS: Survey sent to all 239 program directors of general surgery residencies participating in the National Resident Matching Program.

RESULTS: Response rate was 200 of 239 (84%). A total of 381 of 1052 trainees (36%) interrupt residency to pursue full-time research. The mean research fellowship length is 1.7 years, with 72% of trainees performing basic science research. A significant association was found between fellowship length and postresidency activity, with a 14.7% increase in clinical fellowship training and a 15.2% decrease in private practice positions for each year of full-time research (P < 0.0001). Program directors at 31% of programs reported increased clinical duties for research fellows as a result of Accreditation Council for Graduate Medical Education work hour regulations for clinical residents, whereas a further 10% of programs are currently considering such changes. It costs $41.5 million to pay the 634 trainees who perform research fellowships each year, the majority of which is paid for by departmental funds (40%) and institutional training grants (24%).

CONCLUSIONS: Interrupting residency to perform a research fellowship is a common and costly practice among general surgery residents. Although performing a research fellowship is associated with clinical fellowship training after residency, it is unclear to what extent this practice leads to the development of surgical investigators after postgraduate training.

 

[DoctaJay]

I heard that some of these programs that require you to do 2 years of research are now actually allowing their residents to complete a Critical Care Fellowship during that period. I don't recall which programs but if this is true I would definitiely jump on that.

 

[Blitz2006]

Hey Pilot doc,

thanks for that, really useful. So I guess roughly 1/3 of residents do cut out to do some research. Interesting indeed.

Ann Surg. 2009 Jan;249(1):155-61.
Prevalence and cost of full-time research fellowships during general surgery residency: a national survey.


OBJECTIVE: To quantify the prevalence, outcomes, and cost of surgical resident research.

SUMMARY BACKGROUND DATA: General surgery is unique among graduate medical education programs because a large percentage of residents interrupt their clinical training to spend 1 to 3 years performing full-time research. No comprehensive data exists on the scope of this practice.

METHODS: Survey sent to all 239 program directors of general surgery residencies participating in the National Resident Matching Program.

RESULTS: Response rate was 200 of 239 (84%). A total of 381 of 1052 trainees (36%) interrupt residency to pursue full-time research. The mean research fellowship length is 1.7 years, with 72% of trainees performing basic science research. A significant association was found between fellowship length and postresidency activity, with a 14.7% increase in clinical fellowship training and a 15.2% decrease in private practice positions for each year of full-time research (P < 0.0001). Program directors at 31% of programs reported increased clinical duties for research fellows as a result of Accreditation Council for Graduate Medical Education work hour regulations for clinical residents, whereas a further 10% of programs are currently considering such changes. It costs $41.5 million to pay the 634 trainees who perform research fellowships each year, the majority of which is paid for by departmental funds (40%) and institutional training grants (24%).

CONCLUSIONS: Interrupting residency to perform a research fellowship is a common and costly practice among general surgery residents. Although performing a research fellowship is associated with clinical fellowship training after residency, it is unclear to what extent this practice leads to the development of surgical investigators after postgraduate training.

 

[SLUser11]

Colorectal, really?

I've never thought of it as being very competitive.

Endocrine, same...although there aren't many programs.

My opinion is that 2 years of formal research is required only for Pediatrics and Surgical Oncology. I would bet that the majority of plastics spots every year are filled by people after 5 years. At the least, it is not a necessary pre-requisite to get into plastics, as almost everyone I know in plastic surgery did not do 7 years GS.

As for the competitiveness of other subspecialties, the majority of specialties are obtainable from the majority of programs after just 5 years. Things like vascular, transplant, CT, Trauma, are not very competitive, and it is a buyer's market, even at highly desirable places.

Colorectal is sort of in a grey zone. The match rate for US MDs was about 79%, which is relatively low. The match rate for anyone else was pretty bad, I think around 15-30%. Of course, I would guess that the majority of people matching into colorectal did not do 7 years GS.

 

[SLUser11]

My opinion is that 2 years of formal research is required only for Pediatrics and Surgical Oncology. I would bet that the majority of plastics spots every year are filled by people after 5 years. At the least, it is not a necessary pre-requisite to get into plastics, as almost everyone I know in plastic surgery did not do 7 years GS.

As for the competitiveness of other subspecialties, the majority of specialties are obtainable from the majority of programs after just 5 years. Things like vascular, transplant, CT, Trauma, are not very competitive, and it is a buyer's market, even at highly desirable places.

Colorectal is sort of in a grey zone. The match rate for US MDs was about 79%, which is relatively low. The match rate for anyone else was pretty bad, I think around 15-30%. Of course, I would guess that the majority of people matching into colorectal did not do 7 years GS.

Match rates (only including US allopathic grads from US surgery programs):

Transplant: 100% (29% unfilled)

Colorectal: 79% (3% unfilled)

Pediatric: 57% (down from last year) (3% unfilled)

Trauma/cc: 93% (41% unfilled)

thoracic: 91% (28% unfilled)

Vascular: 93% (16% unfilled)


Of course, the match rate for IMGs (training in US programs) is much much lower for almost all of these, so I guess the uneven playing field continues after med school.....



Found plastic surgery match rate: 73% overall (not broken down by IMG vs. US MD)

 

[JackADeli]

Match rates (only including US allopathic grads from US surgery programs):

Transplant: 100% (29% unfilled)

Colorectal: 79% (3% unfilled)

Pediatric: 57% (down from last year) (3% unfilled)

Trauma/cc: 93% (41% unfilled)

thoracic: 91% (28% unfilled)

Vascular: 93% (16% unfilled)


Of course, the match rate for IMGs (training in US programs) is much much lower for almost all of these, so I guess the uneven playing field continues after med school.....



Found plastic surgery match rate: 73% overall (not broken down by IMG vs. US MD)

Just to clarify your posted stats.....
the first percent number represents applicants that successfully matched and the second percent number represents number of programs that successfully matched/filled. Thus, 100% of applicants successfully matched into transplant with an excess of 29% of program slots still remaining unfilled. Therefore, less applicants then available positions.

JAD

 

[SLUser11]

Just to clarify your posted stats.....
the first percent number represents applicants that successfully matched and the second percent number represents number of programs that successfully matched/filled. Thus, 100% of applicants successfully matched into transplant with an excess of 29% of program slots still remaining unfilled. Therefore, less applicants then available positions.

JAD

You're right...I was in a hurry and should have been more clear. Still, pretty interesting numbers....I only included match rates for people who went to US allopathic med schools, then US allopathic residencies.....other "independent applicants," even if from allopathic residencies, tended to have much worse match rates.

My general feeling is that most fellowships are just not that competitive, which to me seems counter-intuitive since around 75% of us are going on to fellowship. I don't know that I've ever heard of someone applying to two different fellowships of varying competitiveness (using one as a backup), but I'd be interested to hear any stories of such adventures.

 

[Winged Scapula]

My general feeling is that most fellowships are just not that competitive, which to me seems counter-intuitive since around 75% of us are going on to fellowship. I don't know that I've ever heard of someone applying to two different fellowships of varying competitiveness (using one as a backup), but I'd be interested to hear any stories of such adventures.

Its fairly common for Plastics. People tend to apply to Breast or Burns and then reapply to Plastics. I know two people who did a Breast fellowship and then matched into Plastics (only 1 here in the US, the other went to France to train with a well known Plastic surgeon there).

 

[JackADeli]

Its fairly common for Plastics. People tend to apply to Breast or Burns and then reapply to Plastics. I know two people who did a Breast fellowship and then matched into Plastics (only 1 here in the US, the other went to France to train with a well known Plastic surgeon there).

It was a common combination that I saw with the oncology side of surgery. Folks would apply to
surge-onc & breast
or
surge onc & colo-rectal.

JAD

 

[filter07]

My general feeling is that most fellowships are just not that competitive, which to me seems counter-intuitive since around 75% of us are going on to fellowship.

The number of fellowship positions are probably increasing as well, if my own institution is any indication. In the past several years we have added new fellowships and increased the number of spots of some existing fellowships.

 

[toxic-megacolon]

Its really not fair to say that 5 years of residency + 2 years of research = a 7 year residency. At most places those 2 years of research are like a vacation. I'm working M-F, 9-5 (though I usually leave by 3 or 4 most days). I take 3 day weekends if I need to. Its 5 years of residency with a break in the middle.

 

[JackADeli]

Its really not fair to say that 5 years of residency + 2 years of research = a 7 year residency. At most places those 2 years of research are like a vacation. I'm working M-F, 9-5 (though I usually leave by 3 or 4 most days). I take 3 day weekends if I need to. Its 5 years of residency with a break in the middle.

That has been my perception as well. Granted there may be some on-call but usually not nearly what clinical residents are doing. Also, research residents often moon-light. I will say, I have seen some that spend a good deal of late night bench research but not the majority. The lab is often a time for home-front & family strengthening.

What I don't get is.... I have seen too many "research" residents consistently do very poor on ABSITE and then go on to barely pass or even fail their written boards
One final note on those considering research.... I think it is an ACGME requirement that you be "financially promoted" based on your research years. Thus a resident returning to clinical PGY4 status after 2 yrs research will be paid as a PGY6. During their pgy5 (chief) year they will be paid as a pgy7. So, during research you continue to be paid commensurate with your years in post-grad training, you can sometimes moonlight, and your work hours can often be markedly less then clinical residents. It would behoove you to make the most of such an opportunity and nail your in-service exams, publish something, and pass your boards.

JAD

 

[badasshairday]

How long is the breast fellowship?

 

[Winged Scapula]

How long is the breast fellowship?

1-2 years depending on fellowship program, desire for research year.

 

[toxic-megacolon]

Many places have no call requirement whatsoever during the research year. I'm still deciding if I'm going to moonlight or not.

 

[badasshairday]

1-2 years depending on fellowship program, desire for research year.

So it would take 6-7 years post medical school to become a BC Breast Surgeon?

I'm guessing tumor removal (lumpectomies/masectomies) is the bread and butter of breast surgery, but what else are common procedures?

 

[Winged Scapula]

So it would take 6-7 years post medical school to become a BC Breast Surgeon?

There is no board of Breast Surgery. You can become a BC General Surgeon after 5 years of training and do an additional 1-2 years of Breast Fellowship training and call yourself a Breast Surgeon, but technically you are not BC in Breast Surgery but rather Gen Surg. Then again you can call yourself a Breast Surgeon without doing the fellowship, as its currently a fashionable term and lots of female general surgeons call themselves that, even as they do a large body of other general surgery cases.

I'm guessing tumor removal (lumpectomies/masectomies) is the bread and butter of breast surgery, but what else are common procedures?

There aren't very many.

Excisional Biopsy; +/- wire or radiation seed localization
Percutaneous Image Guided Needle Biopsies (ie, Stereotactic and US guided); IF you are trained in these
Partial Mastectomy (the oh so vague "lumpectomy")
Mastectomy (with variations on the theme: skin-sparing, nipple-areolar sparing, Simple/Total, Modified Radical), with/without reconstruction
Terminal Duct Excision
Port Removal (I don't put them in anymore - too much hassle for so little reimbursement - but others do)
Nipple Repair (for inversion)
Axillary Staging - Sentinel Node Biopsy, Axillary Node Dissection

Since I tend to get sent everything between the neck and the abdomen, I've also done a fair bit of removing sebaceous cysts, lipomas, skin tags, seborrheic keratoses, diagnosed melanoma, morphea, lymphoma, etc.

Breast Surgery has a LARGE office component. Besides the surgical patients, early in your career you will see patients with non-surgical issues like breast pain, breast feeding problems (and I have NO IDEA why...I don't know jack about BF except what I learned in medical school. Which you could fit on the head of a pin.), benign nipple discharge, "second opinions", reviewing imaging, High Risk Assessment, genetics counseling, etc.

Hope this helps.

 

[Pilot Doc]

I think it is an ACGME requirement that you be "financially promoted" based on your research years. Thus a resident returning to clinical PGY4 status after 2 yrs research will be paid as a PGY6. During their pgy5 (chief) year they will be paid as a pgy7.

That is definitively NOT the case at my institution that has more research residents than almost anyone. If you can give a citation, I'd love to see it.

 

[Winged Scapula]

That is definitively NOT the case at my institution that has more research residents than almost anyone. If you can give a citation, I'd love to see it.

Yeah it was not common at our place either.

 

[JackADeli]

That is definitively NOT the case at my institution that has more research residents than almost anyone. If you can give a citation, I'd love to see it.

Yeah it was not common at our place either.

I have no citation to point to...
However, EVERY institution I have ever trained at, the clinical residents after leaving the lab informed me they were in fact being paid at a higher PGY rate consistent with current clinical year plus the number of years they were in the "lab".
I had an attending explain to me that there is some ACGME bylaw on this.... I could be completely wrong and the attending could be completely wrong; making the residents I spoke to at ALL the residencies I attended quite fortunate.

JAD

 

[Pilot Doc]

ALL the residencies I attended quite fortunate.

how many residencies did you do?

 

[JackADeli]

how many residencies did you do?

Legion
but only one five year GSurgery program

All joking aside, you should look into that salary/stipend promotion thing. The attendings and residents I spoke with on this were fairly straight shooters.

JAD