You’ve heard the drumbeat – in years to come we won’t have nearly enough vascular surgeons to treat an aging population.
“Folks, we need more of us,” Dr. Anton Sidawy announced at a recent vascular surgery symposium hosted by Northwestern University. That’s not just because in 2010 some 40 percent were over age 55, but because the elderly U.S. population will double by 2030.
Plus, vascular surgery has the distinction of having the largest ratio of people per active physician for all medical subspecialties in the country. In 2010, the U.S. had 108,325 patients per vascular surgeon.
While Dr. Sidawy is correct, the Society is making some genuine progress with recruitment and programming.
Thanks to a multipronged endeavor –
• 33 new fellowship and 0+5 programs are in development.
• The number of 0+5 programs has risen dramatically, from three in 2007 to 44 in 2014.
• The number of 0+5 positions accepted has risen equally, from four in 2007 to 51 in 2014.
• While some fellowship programs have closed (primarily those that have started a 0+5 program) during that same time period, the number of fellowship positions has stayed flat. In 2007, 106 fellowship positions were offered, and in 2014, the number was 115.
The profession has done some soul searching in recent years, since med students, residents and fellows are showing the same values as the rest of the Millennial generation. Millennials, researchers note, tend to want a better work/life balance than their parents had.
They are socially oriented, mission-driven and tech-savvy. Having grown up with technology, they expect to get information fast and often – as an example – will review an online video of a procedure just before going into the operating room.
The Society, along with the Resident Student Outreach Committee-Recruitment and the ADPDVS Ad Hoc Committee on Recruitment of Surgical Residents and Students, has developed a number of strategies, including:
• Identifying which schools are sending students into surgical programs and developing best practice guidelines.
• Offering student and resident scholarships to attend the Vascular Annual Meeting where they get encouragement, ideas, and mentoring.
• Creating the Fellowship Development Task Force with the goal of increasing total training programs, currently totaling 151 at 113 institutions with 455 vascular surgery trainees.
These efforts will take time and some success has already been seen with vascular surgery experiencing a 54 percent increase in the number of first-year ACGME residents and fellows between 2005 and 2010. The reasons for the shortage, Dr. Sidawy believes, are multiple. For example:
• Young doctors want a work/life balance; those 80-hours-plus residencies over five years don’t lead to life quality. The prevailing mindset, says Dr. Sidawy, is that work is not an end in itself, but what they do in order to have a life, family, and children.
• Mentors and residents may have a disconnect. Older mentors have a belief that young residents don’t want to work hard, while 55 percent of residents believe their mentors have a negative attitude.
More interaction, such as after-work get-togethers, may help, he suggested. Additional efforts to encourage more female and minority residents into the specialty are important.
• Older specialists may have learned by default, but Millennials want specific instruction.
• Meanwhile, it’s now common knowledge that the shortage of open surgery opportunities is leading to a generation of doctors without that skill set, and that is worrisome to both residents and mentors.
The 80-hour limit has compounded that issue, he said.
“We need to find a way to produce surgeons like we used to,” Dr. Sidawy said.
One effort that is underway to help address these gaps, is a collaborative project by the SVS Young Surgeons Committee and the Education Council to assess the training needs of vascular surgeon members at all career levels, with a special emphasis on identifying training gaps and needs for young surgeons. An online list of experts and useful links should be completed later this year.