Starting a Vascular Surgery Fellowship at a Rural Healthcare Center

Area of Science:

• Vascular Surgery
• Surgical Education
• Healthcare Access

Background:

• Anticipated shortage of vascular surgeons in the U.S., particularly in rural areas.
• Rising cardiovascular disease incidence in rural, underserved populations.
• Existing infrastructure at a rural institution supports a vascular surgery fellowship.

Purpose of the Study:

• Analyze institutional vascular caseload to assess feasibility of establishing a 2-year vascular fellowship.
• Determine if the institution and similar centers can support fellowship training.
• Evaluate alignment of case volumes with Accreditation Council for Graduate Medical Education (ACGME) requirements.

Main Methods:

• Retrospective review of vascular cases (July 2016 - June 2021).
• Categorization of procedures per ACGME guidelines (abdominal, cerebrovascular, complex, EVAR, etc.).
• Comparison of institutional 2-year case estimates against ACGME minimums and national averages.

Main Results:

• 6100 total procedures; 2578 met ACGME criteria.
• Institutional volume exceeded ACGME requirements in most categories, except abdominal.
• No significant difference found between institutional and national average case volumes per category (P >= 0.05).

Conclusions:

• Insufficient open abdominal cases to support vascular fellowship training at this rural institution.
• Declining open aortic volumes nationally may hinder fellowship establishment in similar rural centers.
• Recommendations include flexibility in ACGME abdominal requirements or specialized fellowships to train rural vascular surgeons.