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Fellowship after General Surgery Training: Does it Pay?
Jack F. Donaghue
1, Daniel Denson
1, Kari M. Rosenkranz
2
1. Geisel School of Medicine at Dartmouth College, Hanover, NH, United States. 2. Surgical Oncology - Breast, Dartmouth Hitchcock Medical Center, Hanover, NH, United States.
Background: Surgical residents are increasingly pursuing fellowship after General Surgery (GS) residency. Fellowship and the research years often required for fellowship applicants come at a significant opportunity cost and can alter career earnings. This study aims to quantify the return on investment of surgical fellowships when compared to direct entry into general surgery practice.
Study Design: Using traditional financial analytical tools including net present value (NPV), internal rate of return (IRR) and breakeven analysis, we compared annual salary for a general surgeon to that of surgeons completing one of ten fellowships available to graduating GS residents. Using recent AAMC academic and MGMA private practice salary data we estimated income over a 35-year surgical career, adjusting for weekly work hours and promotion patterns. Modeling for those pursuing fellowship included both a 5-year and a 7-year general surgery residency training path to account for possible research time. GS residency was modeled at 5 years of training. We modeled based on both academic and private practice careers.
Results: Academic Cardiothoracic, Plastic, and Pediatric surgery had a positive NPV when including research years reflecting a positive return on investment (ROI). Those pursuing Vascular surgery fellowship had a positive NPV if they completed training without research time.
Private practice Cardiac, Thoracic, and Pediatric surgeons benefit from a positive NPV irrespective of years of training. Vascular, Transplant, and Plastic surgery enjoy a positive NPV if they complete training without research time.
Breast, Surgical Oncology, Trauma, and Colorectal fellowships confer negative NPVs for both academic and private practice even when modeled without research years. Transplant surgery has negative NPV in academic practice but a positive NPV in private practice.
The overall “cost” of time spent in training can also be expressed as how much more a specialist surgeon needs to earn annually above a GS colleague to see a positive ROI. To breakeven at the end of their career (35 years) the specialist needs to make $23,000 more annually over a GS salary per year of extra training. If a specialist would like to breakeven mid-career (17 years) the figure rises to $37,000 salary benefit annually per year of extra training. For example, a specialist surgeon who spent three years in fellowship would need to make $111,000 more annually than a General Surgeon to breakeven mid-career.
Conclusions: This analysis highlights the significant impact that fellowship training has on career earnings and underscores the opportunity cost of research years. As surgical residents consider the financial impact of their professional choices, we encourage them to utilize the analytical tools outlined here. These data offer a transparent financial analysis to help guide surgical residents in career decisions as they weigh interests, values, financial stress and expectations.
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