Most competitive surgical fellowships in 2020

[Dallassurgresident]

Just wanted to get everyone's opinion on the competitiveness various surgical fellowships. I'm a junior general surgical with an open mind to all subspecialties. I have three publications, and come from a descent community program. I looked at the match rates for different surgical specialties and these are the overall match rates i found for them from NRMP website.

- Colorectal surgery - 66%
- Peds surgery - 69.1%
- Thoracic surgery - 70.7%
- Surgical oncology - 74.4%
- Vascular surgery - 91.8%
- Trauma surgery - usually more programs than applicants
- Transplant surgery- usually more programs than applicants

This might sound dumb but why are some of these specialties competitive whereas others aren't. I understand lifestyle might be a big factor but what else determines competitiveness? How do yall think these stats are going to look in 4-5 years?? Thank you. I love our surgical community.

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[mikeGR]

The match rate is an interesting ratio, it doesn't tell you much about the candidates who apply to each fellowship. For example, virtually all applicants to peds/surg onc fellowships have dedicated research time, pubs, etc. From my anecdotal experience, the same does not necessarily apply to colorectal/thoracic, which used to be a bit less competitive, but apparently the tide is turning the past few years. I tried to find more stats to support my hypothesis but I don't think these are publicly available.

In terms of why some specialties are more competitive- there are many reasons, such as differences in lifestyle, compensation, type of practice (academics vs community vs PP), personal interests, job market etc.

 

[Dallassurgresident]

Thank you mikeGR for that insight. Whats your take on the future competitiveness of these specialties? For now Im mainly interested in CRS vs surg onc. Do you think I need to spend a couple of years doing research? We dont have research fellowships in our program but can apply to other programs. Thank you in advance...

 

[mikeGR]

Hard to say about future competitiveness, as one cannot really predict the job market. It seems like thoracic is on the rise, and my totally non-educated guess would be that we are training too many surg oncs/colorectal surgeons. Peds will always be crazy-competitive (few spots). Vascular and transplant will always have a bad lifestyle so they won't be crazy-competitive. Trauma might become a bit more competitive as centers transition to more lifestyle-friendly shift-based ACS models. But this is totally my opinion and I wouldn't count on it for any future decisions.

If you're thinking about any competitive fellowship, you should seriously consider investing a year or two doing research. Big-name places and strong letters from renowned surgeons are often appreciated more in the match.

 

[deleted50541]

Thoracic has definitely been on the raise for the last 4-5 years with this year's match still hovering around 70%. For 2020, there were 140 applicants for 101 spots versus 114 applicants for 96 spots in 2019. 98% of positions were filled this year.

From a jobs perspective, as in many specialties, there are a lot of older CT surgeons who are nearing retirement and will need replacement. The demand is definitely there as well, having recently been on the job market.

I completely agree with investing in research if you're looking at a competitive fellowship. It's essentially a requirement for peds and surg onc, and can only help you stand out in other specialties as well. I didn't initially have much interest in research, but wound up doing a year of dedicated basic science research along with some clinical research at the encouragement of one attending. The work I did garnered a few publications and allowed me to speak at several national conferences. I'm certain it gave me an edge when I applied to CT in 2015 and every program filled.

 

[Dallassurgresident]

Thank you for the insight the negative 1 (cool name btw lol). I had great deal of interest in Cardiac surgery as medical student but a lot of my seniors discouraged me over the last couple of years especially after approval of TAVR for low risk patient that the volume might not be there. Also truth be told I also gravitate more towards GI specialties after starting residency.

Gravitating more towards surg onc vs colorectal vs thoracic only. Someone said that we are training way too many CRS and surg onc.. thoughts?? also where do you think thoracic is going to be in 10 years when i finish training? thank you

 

[deleted50541]

Anecdotally, while I saw TAVR affect some of our AVR volume, there was still plenty of surgical valve work to do. And remember, cardiac surgeons are required for a TAVR program and most are doing them these days in conjunction with the cardiologists. I was never discouraged by the naysayers who previously said cardiac surgery was going away. It's not and I'm sure the other cardiac surgeons here would attest to that.

I can't really comment in much detail on whether or not we're training too many CR or surg onc surgeons. But like most other subspecialties, there's a lot of older surgeons out there nearing retirement. And with the increasing elderly population (the U.S. population over 65 is projected to double in the next 40 years), the need for cancer surgeons will still be there.

As for the future of thoracic surgery, it's in a similar situation. Lung cancer remains one of the most common cancers in the country. With expanded lung cancer screening and detection of more early stage disease, there will be plenty of work in the near future. Newer immunotherapies are definitely a game changer in the world of pulmonary oncology, but surgeons are expanding the indications for intervention in stage III and IV disease, which historically were not considered for surgery. Furthermore, there's a lot of variety in the case load to keep a young thoracic surgeon busy including tracheal, mediastinal, chest wall, and esophageal disease.

 

[dienekes88]

Anecdotally, while I saw TAVR affect some of our AVR volume, there was still plenty of surgical valve work to do. And remember, cardiac surgeons are required for a TAVR program and most are doing them these days in conjunction with the cardiologists. I was never discouraged by the naysayers who previously said cardiac surgery was going away. It's not and I'm sure the other cardiac surgeons here would attest to that.

I can't really comment in much detail on whether or not we're training too many CR or surg onc surgeons. But like most other subspecialties, there's a lot of older surgeons out there nearing retirement. And with the increasing elderly population (the U.S. population over 65 is projected to double in the next 40 years), the need for cancer surgeons will still be there.

As for the future of thoracic surgery, it's in a similar situation. Lung cancer remains one of the most common cancers in the country. With expanded lung cancer screening and detection of more early stage disease, there will be plenty of work in the near future. Newer immunotherapies are definitely a game changer in the world of pulmonary oncology, but surgeons are expanding the indications for intervention in stage III and IV disease, which historically were not considered for surgery. Furthermore, there's a lot of variety in the case load to keep a young thoracic surgeon busy including tracheal, mediastinal, chest wall, and esophageal disease.

There's always the tavr explant... the tavr valve in valve explant... the redo operations after failed bioprostheses too small for valve in valve. Cardiac surgery will never go away; it'll just change.

VAD/transplant will be a good set of skills to have. Also endovascular stuff will be important: TEVAR, Branched endografts. Finally a good repair will always be the best solution to a valve.

 

[Dr.LeoSpaceman]

Someone said that we are training way too many CRS and surg onc.. thoughts??

Not sure we're training too many surgical oncologists overall. But perhaps training too many that want to be an HPB/pancreas surgeon at a tertiary/academic center.

 

[WinslowPringle]

Not sure we're training too many surgical oncologists overall. But perhaps training too many that want to be an HPB/pancreas surgeon at a tertiary/academic center.

That's a really good point. I have seen several community places with large catchment areas and some "small" non Name Brand centers that were looking/would benefit from a surg onc with commensurately high pay and volume; they had a hard time attracting people because many grads wanted 'The Big City."

 

[BovieToMe]

Thank you for the insight the negative 1 (cool name btw lol). I had great deal of interest in Cardiac surgery as medical student but a lot of my seniors discouraged me over the last couple of years especially after approval of TAVR for low risk patient that the volume might not be there. Also truth be told I also gravitate more towards GI specialties after starting residency.

Gravitating more towards surg onc vs colorectal vs thoracic only. Someone said that we are training way too many CRS and surg onc.. thoughts?? also where do you think thoracic is going to be in 10 years when i finish training? thank you

Cardiac surgery will not go away. People who say that it is going to are people with little/no experience in the field. Surgeons are getting on the TAVR train. It's definitely going to play a large role in the treatment of AS for a large portion of patients, but SAVR is still around and if the TAVR population gets younger and healthier, we are going to start seeing more explants, and redos. These cases are only going to get more challenging. You ever see a TAVR go south? You'll find out very fast why you need a cardiac surgeon for every case.

Minimally invasive and endovascular skillsets will be essential for the cardiac surgeon of the future. The field is evolving quite quickly. Thoracic surgery is great if you want to a general surgeon in the chest.

 

[Dallassurgresident]

Thanks for the input guys. Whats yalls take on income potential. Even though that is not my primary motivation it definitely is a huger factor. Is it true that as a colorectal surgeon one can buy into a surgicenter and make bank with scopes and anorectal cases while doing the big cases at the hospital...Do similar opportunities exist in Surg Onc, vasc, cardiac??? and how do they compare

 

[mikeGR]

You can go into PP and "make bank" in any subspecialty. Scopes, mediports, and other quick and lucrative procedures can be done by general surgery or any subspecialty. And as a PP surgeon, you can probably have a combination of surgicenter and hospital-based practice in many places.

The subspecialties you listed are vastly different in every aspect though. You'll be comfortable no matter what you decide to do- but only you know what will keep you happy for 30 years in practice.

Edit: For employed positions (increasingly common), the salaries are generally cardiac>>vascular>>colorectal=surg onc

 

[bluv1212]

Just wanted to get everyone's opinion on the competitiveness various surgical fellowships. I'm a junior general surgical with an open mind to all subspecialties. I have three publications, and come from a descent community program. I looked at the match rates for different surgical specialties and these are the overall match rates i found for them from NRMP website.

- Colorectal surgery - 66%
- Peds surgery - 69.1%
- Thoracic surgery - 70.7%
- Surgical oncology - 74.4%
- Vascular surgery - 91.8%
- Trauma surgery - usually more programs than applicants
- Transplant surgery- usually more programs than applicants

This might sound dumb but why are some of these specialties competitive whereas others aren't. I understand lifestyle might be a big factor but what else determines competitiveness? How do yall think these stats are going to look in 4-5 years?? Thank you. I love our surgical community.

I think that Colorectal and even MIS are becoming more and more competitive. The applicants for these positions commonly have great research and good scores. Better applicants are entering the fellowship pool for these each year. Traditionally, these have been very lifestyle conducive specialties with a long shelf life and people are catching on.

Surgical oncology and HPB have always been very very competitive. Everyone here has taken dedicated research time and has maintained fantastic ABSITES. I think biliopancreatic surgery are brilliant cases and it's easy to fall in love with being the go-to person at an institution for them.

I personally think Vascular is on the rise. The work-life balance is a deterrent for a lot of people. Open vascular surgery is great. endovascular can be divisive.

For Pediatric Surgery and Plastic Surgery, I think one understated aspect is that if you know you are a poor candidate, you are unlikely to even invest in the application process. The pool of applicants is deep and very very qualified. Pediatric surgery is super-selective because there are only so many childrens hospitals with only so many surgeons. The pay is very good, and the scope of practice very broad. Plastic surgery is competitive for so many reasons. It's almost unnecessary to speak on it. The match rate this year was in the 70% range, but again, the population self selects.

Also, for a lot of fellowships, Who you know or who your PD/Chief of Surgery knows can make a huge difference. A few phone calls go a long long way.

I think your strategy should be to present at regional conferences, continue to do research, and figure out who will vouch for your and make phone calls for you for your intended specialty. If your program allows elective rotations, that can be a "make-it" opportunity. The ABSITE scores can be discriminatory as well. I don't think being from a community program necessarily hurts your overall match rate if you have the above strategy in place. It may be harder for more academic, top tier fellowships.

 

[bluv1212]

Not sure we're training too many surgical oncologists overall. But perhaps training too many that want to be an HPB/pancreas surgeon at a tertiary/academic center.

completely agree with this assessment. I considered surg onc but didnt want to risk being relegated to breast and melanoma cases. Everyone wants to do livers and whipples. Its a difficult match, it's 2-3 years, you have to take off time for research, and theres a chance of you not getting to do the case you love most. and extra 5 years to do breast and melanoma is not worth it to me. HPB is different, I guess, but even more competitive.

 

[bluv1212]

Also, Completely my opinion, but don't do transplant. Its a great skill-set, the cases are great, but there are not that many jobs and there are less cases unless you stay at a high volume academic center. Those are already crowded and will always be. The allocations are always changing as well.

 

[deleted697308]

I think that Colorectal and even MIS are becoming more and more competitive. The applicants for these positions commonly have great research and good scores. Better applicants are entering the fellowship pool for these each year. Traditionally, these have been very lifestyle conducive specialties with a long shelf life and people are catching on.

Surgical oncology and HPB have always been very very competitive. Everyone here has taken dedicated research time and has maintained fantastic ABSITES. I think biliopancreatic surgery are brilliant cases and it's easy to fall in love with being the go-to person at an institution for them.

I personally think Vascular is on the rise. The work-life balance is a deterrent for a lot of people. Open vascular surgery is great. endovascular can be divisive.

For Pediatric Surgery and Plastic Surgery, I think one understated aspect is that if you know you are a poor candidate, you are unlikely to even invest in the application process. The pool of applicants is deep and very very qualified. Pediatric surgery is super-selective because there are only so many childrens hospitals with only so many surgeons. The pay is very good, and the scope of practice very broad. Plastic surgery is competitive for so many reasons. It's almost unnecessary to speak on it. The match rate this year was in the 70% range, but again, the population self selects.

Also, for a lot of fellowships, Who you know or who your PD/Chief of Surgery knows can make a huge difference. A few phone calls go a long long way.

I think your strategy should be to present at regional conferences, continue to do research, and figure out who will vouch for your and make phone calls for you for your intended specialty. If your program allows elective rotations, that can be a "make-it" opportunity. The ABSITE scores can be discriminatory as well. I don't think being from a community program necessarily hurts your overall match rate if you have the above strategy in place. It may be harder for more academic, top tier fellowships.

What do you mean by poor candidate? Someone without research?

 

[bluv1212]

What do you mean by poor candidate? Someone without research?

Poor board scores. Little research has or publications. You kind of have to have foresight in building your cv

 

[Lem0nz]

I am applying for jobs coming out of a surg onc fellowship right now (current 2nd yr fellow). There are very few open academic postings that are not just going to end up hiring internally. The few that exist are generally for directorships and expect 10-20 years of experience. The non-directorship academic type jobs seem to be looking for 3-5 yrs experience, or they're hiring their own fellows internally as far as I can tell.

For community type jobs, there are a quite a few. They are also varied. Many want someone to come and start a surgical oncology service line and this is becoming more and more common even for smaller hospitals and systems. They are willing to take someone directly out of fellowship that wants to come and prop up a cancer center which can be quite the undertaking but also pretty rewarding, it seems. You may or may not have a senior partner and be doing big surgery right out of the gate by yourself. This can be cool for some people. For other people, this is *absolutely* not their cup of tea and very intimidating.

I have been actually very surprised that most surg onc jobs are specifically requesting you to be the HPB/HIPEC/sarcoma guy. I was expecting them to have a harder slant towards melanoma/breast/colorectal, and I am finding that while those jobs exist, they are actually more rare. When those jobs do exist, they have a general surgery component that is 25-50% of the job (from what I've seen so far).

Compensation varies wildly. WILDLY. There seems to be absolutely no rhyme or reason to it. I have had "academic" positions from private institutions with residencies that are offering in the mid 200s and trying to pay off the AAMC pay scale, and hospital employed "non-profit" institutions that are paying off the MGMA scale. Somehow, the job all seems to be the same - go start a cancer service line or integrate into one and expand it. I am honestly at a loss in trying to understand how they decide the difference. Geographic location and city density seems to be the only qualifying factor with large cities being "academic" and paid on the AAMC and suburban/smaller (but by no means small, some places we're taking 500k-1mil population) paying MGMA scale. Many MGMA type non-academic jobs are still offering dedicated professional time for research or administration.

So I legitimately have no idea how they're coming up with these jobs or deciding the difference. My boots on the ground, first person experience and educated guess is that places that are hiring their first surgical oncologist (which is about half, surprisingly) do not know how to craft or advertise these positions and are making it up to their best knowledge, which, is not great.

I would actually like to hear others opinions as I continue my job search. I think I'll do a consolidative post on my experience and what I learned once I finally sign a contract because I've been lurking for a couple years now and this is a recurring theme on SDN with not a lot of information.

 

[Lem0nz]

I am applying for jobs coming out of a surg onc fellowship right now (current 2nd yr fellow). There are very few open academic postings that are not just going to end up hiring internally. The few that exist are generally for directorships and expect 10-20 years of experience. The non-directorship academic type jobs seem to be looking for 3-5 yrs experience, or they're hiring their own fellows internally as far as I can tell.

For community type jobs, there are a quite a few. They are also varied. Many want someone to come and start a surgical oncology service line and this is becoming more and more common even for smaller hospitals and systems. They are willing to take someone directly out of fellowship that wants to come and prop up a cancer center which can be quite the undertaking but also pretty rewarding, it seems. You may or may not have a senior partner and be doing big surgery right out of the gate by yourself. This can be cool for some people. For other people, this is *absolutely* not their cup of tea and very intimidating.

I have been actually very surprised that most surg onc jobs are specifically requesting you to be the HPB/HIPEC/sarcoma guy. I was expecting them to have a harder slant towards melanoma/breast/colorectal, and I am finding that while those jobs exist, they are actually more rare. When those jobs do exist, they have a general surgery component that is 25-50% of the job (from what I've seen so far).

Compensation varies wildly. WILDLY. There seems to be absolutely no rhyme or reason to it. I have had "academic" positions from private institutions with residencies that are offering in the mid 200s and trying to pay off the AAMC pay scale, and hospital employed "non-profit" institutions that are paying off the MGMA scale. Somehow, the job all seems to be the same - go start a cancer service line or integrate into one and expand it. I am honestly at a loss in trying to understand how they decide the difference. Geographic location and city density seems to be the only qualifying factor with large cities being "academic" and paid on the AAMC and suburban/smaller (but by no means small, some places we're taking 500k-1mil population) paying MGMA scale. Many MGMA type non-academic jobs are still offering dedicated professional time for research or administration.

So I legitimately have no idea how they're coming up with these jobs or deciding the difference. My boots on the ground, first person experience and educated guess is that places that are hiring their first surgical oncologist (which is about half, surprisingly) do not know how to craft or advertise these positions and are making it up to their best knowledge, which, is not great.

I would actually like to hear others opinions as I continue my job search. I think I'll do a consolidative post on my experience and what I learned once I finally sign a contract because I've been lurking for a couple years now and this is a recurring theme on SDN with not a lot of information.

Also, sorry. To answer some of your original questions OP - surg/onc almost impossible to match into without 2 years dedicated research in a lab. There are exceptions. They are VERY few and far between. I matched without dedicated research time and it was a very difficult road and I had to bolster my CV with some very weird stuff that made me stand out very much from the usual crowd - and even then, many heavily academic programs were not interested in me because I didn't put in the research time. If you're seriously considering it, I highly recommend deciding to do it early, throwing yourself at it completely, and doing the research time. As others have said, the match statistics are misleading. *Nearly* every candidate is wildly qualified. (Excellent board scores, 2 years research, multiple first author publications, and meetings). Not having those things is not a death sentence, but the odds of matching without them are very long shot, and even having them is no longer a guarantee.

 

[TypeADissection]

I am applying for jobs coming out of a surg onc fellowship right now (current 2nd yr fellow). There are very few open academic postings that are not just going to end up hiring internally. The few that exist are generally for directorships and expect 10-20 years of experience. The non-directorship academic type jobs seem to be looking for 3-5 yrs experience, or they're hiring their own fellows internally as far as I can tell.

For community type jobs, there are a quite a few. They are also varied. Many want someone to come and start a surgical oncology service line and this is becoming more and more common even for smaller hospitals and systems. They are willing to take someone directly out of fellowship that wants to come and prop up a cancer center which can be quite the undertaking but also pretty rewarding, it seems. You may or may not have a senior partner and be doing big surgery right out of the gate by yourself. This can be cool for some people. For other people, this is *absolutely* not their cup of tea and very intimidating.

I have been actually very surprised that most surg onc jobs are specifically requesting you to be the HPB/HIPEC/sarcoma guy. I was expecting them to have a harder slant towards melanoma/breast/colorectal, and I am finding that while those jobs exist, they are actually more rare. When those jobs do exist, they have a general surgery component that is 25-50% of the job (from what I've seen so far).

Compensation varies wildly. WILDLY. There seems to be absolutely no rhyme or reason to it. I have had "academic" positions from private institutions with residencies that are offering in the mid 200s and trying to pay off the AAMC pay scale, and hospital employed "non-profit" institutions that are paying off the MGMA scale. Somehow, the job all seems to be the same - go start a cancer service line or integrate into one and expand it. I am honestly at a loss in trying to understand how they decide the difference. Geographic location and city density seems to be the only qualifying factor with large cities being "academic" and paid on the AAMC and suburban/smaller (but by no means small, some places we're taking 500k-1mil population) paying MGMA scale. Many MGMA type non-academic jobs are still offering dedicated professional time for research or administration.

So I legitimately have no idea how they're coming up with these jobs or deciding the difference. My boots on the ground, first person experience and educated guess is that places that are hiring their first surgical oncologist (which is about half, surprisingly) do not know how to craft or advertise these positions and are making it up to their best knowledge, which, is not great.

I would actually like to hear others opinions as I continue my job search. I think I'll do a consolidative post on my experience and what I learned once I finally sign a contract because I've been lurking for a couple years now and this is a recurring theme on SDN with not a lot of information.

Knowing nothing about the Surg Onc job market, this was a really good read and provides a lot of insight and value.. Please keep us updated and how things turn out, if you want to of course. Good luck. Cheers.

 

[mikeGR]

I am applying for jobs coming out of a surg onc fellowship right now (current 2nd yr fellow). There are very few open academic postings that are not just going to end up hiring internally. The few that exist are generally for directorships and expect 10-20 years of experience. The non-directorship academic type jobs seem to be looking for 3-5 yrs experience, or they're hiring their own fellows internally as far as I can tell.

For community type jobs, there are a quite a few. They are also varied. Many want someone to come and start a surgical oncology service line and this is becoming more and more common even for smaller hospitals and systems. They are willing to take someone directly out of fellowship that wants to come and prop up a cancer center which can be quite the undertaking but also pretty rewarding, it seems. You may or may not have a senior partner and be doing big surgery right out of the gate by yourself. This can be cool for some people. For other people, this is *absolutely* not their cup of tea and very intimidating.

I have been actually very surprised that most surg onc jobs are specifically requesting you to be the HPB/HIPEC/sarcoma guy. I was expecting them to have a harder slant towards melanoma/breast/colorectal, and I am finding that while those jobs exist, they are actually more rare. When those jobs do exist, they have a general surgery component that is 25-50% of the job (from what I've seen so far).

Compensation varies wildly. WILDLY. There seems to be absolutely no rhyme or reason to it. I have had "academic" positions from private institutions with residencies that are offering in the mid 200s and trying to pay off the AAMC pay scale, and hospital employed "non-profit" institutions that are paying off the MGMA scale. Somehow, the job all seems to be the same - go start a cancer service line or integrate into one and expand it. I am honestly at a loss in trying to understand how they decide the difference. Geographic location and city density seems to be the only qualifying factor with large cities being "academic" and paid on the AAMC and suburban/smaller (but by no means small, some places we're taking 500k-1mil population) paying MGMA scale. Many MGMA type non-academic jobs are still offering dedicated professional time for research or administration.

So I legitimately have no idea how they're coming up with these jobs or deciding the difference. My boots on the ground, first person experience and educated guess is that places that are hiring their first surgical oncologist (which is about half, surprisingly) do not know how to craft or advertise these positions and are making it up to their best knowledge, which, is not great.

I would actually like to hear others opinions as I continue my job search. I think I'll do a consolidative post on my experience and what I learned once I finally sign a contract because I've been lurking for a couple years now and this is a recurring theme on SDN with not a lot of information.

This is an excellent post and would make an excellent separate topic. Happy to share my impressions/experience as I was in your shoes last year, once we have an appropriate, on-topic space.