Career Trajectory After General Surgery Residency: Do Academic Program Graduates Pursue Academic Surgery?

Abstract

To determine the proportion of contemporary U.S. academic general surgery residency program graduates who pursue academic careers and identify factors associated with pursuing academic careers. Many academic residency programs aim to cultivate academic surgeons, yet the proportion of contemporary graduates who choose academic careers is unclear. The potential determinants that affect graduates' decisions to pursue academic careers remain underexplored. We collected program and individual-level data on 2015 and 2018 graduates across 96 U.S. academic general surgery residency programs using public resources. We defined those pursuing academic careers as faculty within U.S. allopathic medical school-affiliated surgery departments who published 2 or more peer-reviewed publications as the first or senior author between 2020 and 2021. After variable selection using sample splitting least absolute shrinkage and selection operator regression, multivariable regression evaluated the association with pursuing academic careers among all graduates, and graduates of top-20 residency programs. Secondary analysis using multivariable ordinal regression explored factors associated with high research productivity during early faculty years. Among 992 graduates, 166 (17%) were pursuing academic careers according to our definition. Graduating from a top-20 ranked residency program [odds ratio (OR; 95% CI): 2.34 (1.40-3.88)], working with a longitudinal research mentor during residency [OR (95% CI): 2.21 (1.24-3.95)], holding an advanced degree [OR (95% CI): 2.20 1.19-3.99)], and the number of peer-reviewed publications during residency as first or senior author [OR (95% CI): 1.13 (1.07-1.20)] were associated with pursuing an academic surgery career, while the number of peer-reviewed publications before residency was not [OR (95% CI): 1.08 (0.99-1.20)]. Among the top 20 program graduates, working with a longitudinal research mentor during residency [OR (95% CI): 0.95 (0.43-2.09)] was not associated with pursuing an academic surgery career. The number of peer-reviewed publications during residency as the first or senior author was the only variable associated with higher productivity during early faculty years [OR (95% CI): 1.12 (1.07-1.18)]. Our findings suggest programs that aim to graduate academic surgeons may benefit from ensuring trainees receive infrastructural support and demonstrate a sustained commitment to research throughout the residency. Our results should be interpreted cautiously as the impact of unmeasured confounders is unclear.