The market for pediatric surgeons: a survey of recent graduates

The aim of this study was to identify the demand for pediatric surgeons as perceived and experienced by recent graduates of North American training programs.

A survey questionnaire was mailed to every pediatric surgeon who had completed a certified training program in the United States or Canada between 1992 and 1997; 84% of the 165 responded. The data were then analyzed using univariate and bivariate statistics and content analysis.

The number trained has risen since 1992 from 21 to 35 per year, exceeding previous definitions of need. However, recently trained pediatric surgeons found positions, and their first-year incomes had risen oven the 6-year period. In contrast, just 54% found first positions in the type of hospital desired, and the percent working in a children's hospital dropped from 65% in 1992 to 32% in 1997; 34% cover between four and ten hospitals. The majority of those in practice for more than 2 years expressed the perception of a decline in market demand with just 30% of those 1996 to 1997 graduates perceiving a strong market. The clinical scope of practice was less than that for which they were trained. Three specified complex cases were managed by fewer than 30% of recent graduates during practice despite more than 60% having had fellowship experience. The scope of practice, as measured by variables of index procedures, was strongly associated with hospital type (children's or general) and by practice region. Although satisfaction with practice is lower for each successive class, 96% of the graduates were satisfied with their training programs, and 98% believed they had been well prepared, although 46% indicated they desired some additional training. Sixty-one percent believed the role of pediatric surgeons will change over the next 5 years.

The market demand was strong as measured by employment and income. This was in contrast to the striking recent changes in the market for new pediatric surgeons, including a migration of practice from children's to general hospitals, a reduced scope of practice, a more negative perception of the pediatric surgery market, and concerns for narrowing of the specialty.