Normalized Competitive Index: An Updated Analysis of Trends in Surgical Fellowship Training Over the Past Decade...

The normalized competitive index (NCI) was introduced as a metric describing surgical fellowship competitiveness. Such information has proven useful to prospective candidates, especially as immediate postresidency subspecialty training continues to be common for General Surgery and other surgical residencies. Using the NCI, we provide an updated analysis of the competitiveness of various surgical subspecialities to each other and themselves.

Retrospective cohort study. The competitive index (CI) is defined as the percentage of programs filled divided by the match rate for that subspecialty. For ease of comparison, the NCI normalizes the CI of each subspecialty to a value of 1.

National Resident Matching Program (NRMP), The Fellowship Council, The San Francisco Match (SF Match), and the National Matching Services publicly available match data from the 2015 to 2024 match years.

General Surgery associated fellowship applicants (Abdominal Transplant Surgery, Breast Surgical Oncology, Colon and Rectal Surgery, Complex General Surgical Oncology, Minimally Invasive Surgery, Pediatric Surgery, Plastic and Reconstructive Surgery, Surgical Critical Care, Thoracic Surgery, and Vascular Surgery).

Over the past decade, the match rate for all subspecialties was 75.3% and the percentage of all programs filled was 90.6%. Pediatric Surgery (NCI 1.43, p = 0.0350) and Minimally Invasive Surgery (NCI 1.24, p = 0.0030) were significantly more competitive than other subspecialties, while Surgical Critical Care (NCI 0.64, p < 0.0001) was significantly less competitive. When comparing the NCI within each subspecialty from the prior 5 match years (2015-2019) to the most recent 5 match years (2020-2024), Thoracic Surgery (NCI 1.08 vs 1.34, p = 0.0107) became significantly more competitive while Pediatric Surgery (NCI 1.63 vs 1.25, p = 0.0028) and Complex General Surgical Oncology (NCI 1.17 vs 1.00, p = 0.0218) became significantly less competitive.

The NCI remains a useful metric for prospective applicants and programs, and may be provided annually by organizations sponsoring fellowship matching processes.