The Impact of Non-Fellowship Trained General Surgeon Faculty on Resident Career Plans at Graduation

Despite the shortage of general surgeons in the United States, >80% of general surgery residents pursue fellowship training at graduation. Surgeon mentors can influence a resident's career choice. The number of non-fellowship trained general surgeons on faculty at each general surgery residency program within the United States is unknown. We hypothesize that as the proportion of non-fellowship trained general surgeons on faculty increases within a program, so too does the proportion of residents who enter full-time practice at graduation.

We conducted an observational study by reviewing websites of general surgery residency programs (n = 348) in the United States from July 2024 to February 2025 to determine the total number of faculty within each department and each faculty's training history. We obtained program characteristics, including percentage of residents who entered full-time practice upon graduation, from the Association of American Medical Colleges' Residency Explorer™ tool. Analysis of variance was used to analyze relationships between various program characteristics and resident career plans at graduation.

An average of 20% of faculty within a department of surgery were non-fellowship trained general surgeons. As the proportion of non-fellowship trained general surgeons on faculty increased, there was an increase in the proportion of residents who entered full-time practice upon graduation (p < 0.0001). When adjusting for institutional setting, this relationship was observed at university (p = 0.00348) and affiliated hospital (p < 0.001) programs, but not independent academic medical center programs (p = 0.371). The presence of a community hospital rotation, or its rural track, within a program did not significantly correlate with resident career plans to enter full-time practice at graduation.

Exposure to non-fellowship trained general surgeons during residency can increase the number of residents who enter full-time practice at graduation. This finding highlights the importance of general surgeons as faculty mentors and their impact on resident career plans. This finding also points to the role general surgeons play in workforce development and the importance of recruiting general surgeons as faculty at university and affiliated hospital residency programs.