Small but substantial proportion of surgeons interested in part-time training

Medical students expressed increased interest in a career in surgery if part-time training options were available, and some residents, fellows and practicing surgeons would be interested in flexible training options as well, according to the results of a web-based survey published in the October issue of Archives of Surgery, one of the JAMA/Archives journals.

Current surgical residencies are a minimum of five years long; new regulations limit workweeks to 80 hours. As many as one-fifth of surgical residents leave their programs before finishing, most often citing lifestyle concerns, according to background information in the article. "Many of today's medical students have more diverse interests and, when they apply for postgraduate training, may prefer specialties in which a more flexible approach to training (i.e., part-time, reduced hours or extended periods of time off) is an option to allow them to integrate other professional and family interests," the authors write. Because about half of medical school graduates are now women, who comprise only 24 percent of general surgery residents, the field must devise methods to attract and retain female surgeons.

Alison R. Saalwachter, M.D., of the University of Virginia Health System, Charlottesville, and colleagues assessed interest in part-time training options among 482 medical students, 789 surgical residents, 179 surgical fellows and 2,858 fully trained surgeons using a web-based survey. The respondents were asked to rate, on a scale of one to five, how interested they would be in a general surgery training program that lasted longer but featured shorter workweeks (between 40 and 80 hours).

Of the 4,308 physicians and students who responded to the survey, 76 percent were male, and 20 to 30 percent would accept a residency that lasted longer than five years in exchange for the opportunity to train part-time (although few would accept an extension to more than seven years). Thirty-six percent of female and 24 percent of male medical students indicated that the availability of a more flexible approach to training would positively affect the decision to choose a career in surgery. At all levels of training, women were more likely than men to express interest in a program longer than five years and were also more likely to accept a reduction in salary during those years.

Of the survey respondents who were physicians, 9.1 percent had taken time off from their residency for reasons other than doing medical research. The authors suggest that even though not all residents would be interested in part-time training options, such programs could greatly benefit those who desire flexibility for personal, financial or health reasons. "Flexible options should be available for those who need it who might otherwise feel unable to pursue or continue in a surgical career," they write. "For example, the availability of protected time off could permit a surgeon in training to tend to a personal crisis or a family emergency, whereas, without this option, he or she may have to resign from a program with no guarantee of being able to finish training."

Although women were more likely than men to express interest in flexible options, lifestyle issues are not solely woman- or family-related, the authors continue. "In light of recent concerns about decreasing applications to general surgery training programs and a need to appeal to students with greater interest in controllable lifestyle careers, a more flexible approach to surgical training could boost interest and improve applicant caliber," they write. "Because the upcoming generation is less willing than previous ones to sacrifice quality of life, academic medicine will lose both women and men if greater work balance is not achievable."

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(Arch Surg. 2006;141:977-982. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.


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