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Fellowship Training After General Surgery Residency: Does it Pay?

Jack F Donaghue1, Daniel J Denson1, Matthew C Carroll2

  • 1Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Tuck School of Business, Dartmouth College, Hanover, New Hampshire.

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|November 8, 2025
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Summary
This summary is machine-generated.

Surgical fellowships significantly impact career earnings, with some offering positive financial returns while others do not. Research years in fellowship training reduce the return on investment for surgeons.

Keywords:
career earningsfellowship traininggeneral surgery residencyopportunity costreturn on investment

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Area of Science:

  • Surgical Oncology
  • Surgical Education
  • Health Economics

Background:

  • Surgical residents increasingly pursue fellowships, incurring opportunity costs and potentially altering career earnings.
  • Fellowship training duration and research involvement can significantly influence a surgeon's long-term financial outcomes.

Purpose of the Study:

  • To quantify the return on investment (ROI) of various surgical fellowships compared to direct entry into general surgery (GS) practice.
  • To analyze the financial implications of fellowship training, considering different specialties, practice types, and training durations.

Main Methods:

  • Employed financial analysis tools such as Net Present Value (NPV) and breakeven analysis.
  • Utilized AAMC academic and MGMA private practice salary data to estimate income over a 35-year career.
  • Modeled both 5-year and 7-year General Surgery (GS) residency training paths, including research time, for academic and private practice scenarios.

Main Results:

  • Academic Cardiothoracic, Plastic, and Pediatric surgery fellowships demonstrated positive NPVs, even with 7 years of training.
  • Private practice Cardiac, Thoracic, Plastic, Vascular, and Pediatric surgery fellowships showed positive NPVs without additional research time.
  • Fellowships in Breast, Surgical Oncology, Trauma, Colorectal, and Transplant generally resulted in negative NPVs, with Trauma surgery showing a positive NPV when adjusted for hours worked.

Conclusions:

  • Fellowship training significantly impacts surgeons' career earnings, with research years reducing the overall financial return.
  • These findings provide a financial analysis to guide surgical residents in career decisions, balancing personal values with financial expectations.