The rise of gastrointestinal surgical fellowships

Gastrointestinal (GI) and abdominal wall surgical procedures are core components of general surgery. Increasingly, residents are pursuing fellowship after completing general surgery residency for reasons, including desired subspecialty and/or perceived readiness for practice. This study aimed to determine what proportion of graduating general surgery residents pursue fellowships related to the GI tract and abdominal wall.

Publicly available data from the American Board of Surgery (ABS) were used to quantify the rates of ABS-certified surgeons with fellowship training. Data were categorized by the degree of fellowship-level GI-specific training: (i) no fellowship, (ii) all GI (advanced GI, bariatric, colon and rectal, endoscopy, hepatobiliary, and minimally invasive), (iii) most GI (acute care, complex general surgical oncology, and oncology), (iv) some GI (pediatric, thoracic, and transplantation), and (v) non-GI (breast, critical care, endocrine, hand, other, plastic, trauma burns, and vascular). Trends were statistically analyzed using Mann-Kendall tests and 2-sample proportion t tests.

In 1980, 5.8% of applicants for initial ABS fellowship certification were made up of GI-related surgeons (ie, all GI + most GI + some GI), whereas 84.5% of surgeons did not pursue any fellowship training. By 2023, the number of surgeons applying for initial ABS fellowship certification had substantially increased to 39.6%, whereas the number of surgeons pursuing no fellowship had fallen to a mere 18.2%. There were statistically significant increasing trends over time for each fellowship, and a significant decreasing trend for no fellowship (P <.0001). When comparing all, most, and some GI training, all GI training demonstrated the largest increase of fellowships between 1980-1980 (3.2%) and 2014-2023 (20.3%) (P <.0001). The largest increases in enrollment in individual GI fellowships between 1980-1989 and 2014-2023 were in colon and rectal surgery (CRS: 1.7% in 1980-1989 vs 7.5% in 2014-2023; P <.0001) and minimally invasive surgery (MIS: 0.3% in 1980-1989 vs 7.4% in 2014-2023; P <.0001) fellowships.

Over time, there has been a significant increase in surgeons pursuing additional training in GI-related fields, especially CRS and MIS. Additional investigation is necessary to determine whether this is secondary to exposure in residency and/or increasing complexity of operations. However, our data suggest that even with the increase in fellowships, general surgery residents continue to seek careers focused on the GI tract, which remains at the core of the surgical field.