Session 21

General Surgery is gaining popularity as a residency choice, which shows in the high competition for spots. It’s generally understood that you need to be at the top of your game to match into a surgical residency. Similarly to internal medicine, general surgery is also the gateway to a lot of subspecialties.

As we’re presenting the data here, remember that this is not just for those looking to be general surgeons their whole life but also those who are looking into other subspecialties such as Surgical Oncology, Colorectal Surgery, Surgical Critical Care, Minimally Invasive Surgery, and so on. There are certainly a lot of things you can do after your general surgery residency.

Here is the link to the 2017 NRMP Main Match Data. Feel free to open it up and follow along.

[01:45] Total Number of Residency Programs and Applicants

For General Surgery, there are a lot of residency spots available with 267 programs. Just to compare, there are 236 programs in Psychiatry, 204 in Pediatrics, and 241 in OB/GYN, so comparatively speaking there are more surgical residencies.

General surgery has both categorical and prelim residency programs. A categorical program is one where you apply to the program from medical school and that’s where you’re going to do all five years of your General Surgery residency. Then there are prelim surgery positions, where you’re only attending that program for part of your overall residency training. There are more prelim surgery positions than categorical. In this episode, I will only tackle the full five-year categorical surgery programs, consisting of 267 programs.

In those 267 programs, there are 1,281 spots. That’s an average of almost 5 spots at each program. Interestingly, there were only 1,383 U.S. Seniors applying for these spots out of 2,388 total applicants. For the purposes of this data, “U.S. Seniors” are only current Seniors at allopathic (MD) medical schools.

[06:55] Types of Applicants Who Matched Into General Surgery

By looking at Table 2 of the 2017 NRMP Match Data we can see that, out of the 1,276 positions filled in general surgery, 1,005 were U.S. Seniors (again this is current MD seniors only), while 74 were U.S. Grads (MD students who didn’t match the first time or didn’t apply because they were doing research or something else), 64 osteopathic (DO) students, 62 U.S.-citizen international medical graduates (IMGs), and 71 non-U.S.-citizen IMGs.

Something often debated in the premed world is whether it’s better to go to DO school in the U.S. or an international MD school, specifically Caribbean schools. Well, if General Surgery is something you’re interested in, there were 64 students who matched from U.S. osteopathic schools and 62 from international medical schools.

[13:25] How Many Osteopathic Students Match Into MD General Surgery Residencies?

Looking at Table 11, we see how many osteopathic (DO) students matched into the various PGY-1 spots. As expected, general surgery has a lot fewer osteopathic students, percentage-wise, compared to other specialties. With all specialties adding up to 100%, Surgery only made up 2.2% of the PGY-1 programs attended by osteopathic students.

Students may look at this data and think, It must be harder to get accepted to an MD general surgery residency as a DO student. So then they think, if they’re considering surgery, they should only apply to MD programs. My different perspective on this is that osteopathic schools are specifically targeting students with an “osteopathic” philosophy and students interested in primary care, so of course there are going to be fewer DO students matching into surgical programs.

[Related post: MD vs DO: What are the Differences (And Similarities)?]

The Competitiveness of Matching into General Surgery

For this year’s data, General Surgery had one of the higher unmatched rates at 20.7%. “Unmatched U.S. Seniors” was only 9.6%, but this is still high compared to a lot of the other specialties. It seems that general surgery is becoming more and more competitive as there are more options available for subspecialties and fellowships afterward.

[Related post: 8 Things to Think About When Choosing a Specialty]

Osteopathic (DO) General Surgery Residency Programs

Looking at the National Matching Service Data for 2016 for the different program types, there were 49 programs for General Surgery for osteopathic students and 155 positions. 149 positions were filled, and 6 went unfilled. The data given is not as robust as that given by the NRMP, so I’m uncertain if there were a lot more applicants than these 155 spots and a lot went unmatched or if there just weren’t too many applicants.

[17:43] How Many Residency Programs Should You Apply To?

If we move to the 2016 Charting the Outcomes for the NRMP document, Chart 4 shows, for both matched and unmatched applicants, how many programs they applied to. Those who successfully matched ranked 13 programs as a median number, while those who did not match only ranked 5. If you are picky about where you go or if you can’t apply or interview many places, you have less chance of matching.

What Percentage of General Surgery Residents Were AOA Members?

Chart 12 shows the percentage of matched U.S. Seniors who are members of AOA (the Honor Society for medical students, showing academic success in medical school). For those who matched into general surgery, only 17% of U.S. Seniors were AOA. This compares to 52% for Plastic Surgery and 53% for Dermatology. So General Surgery is in the lower end for a surgical specialty.

Step Scores for Students Who Match Into General Surgery

Looking at the Summary Statistics (Table GS-1) for General Surgery, those who matched have a decent Step-1 score at 235. Those who applied and did not match had a mean Step-1 score of 218, which is a big difference. The mean Step-2 score was 247 for those who matched and 231 for those who did not.

This is one of those areas where you need to be very realistic about your chances of matching. If you don’t match, why? Could it be that your Step scores are not high enough?

[21:20] How Burned Out are General Surgeons? Are They Happy?

The Medscape Lifestyle Report reports on burnout and happiness in physicians every year. The numbers are not necessarily the best data-wise because it’s a survey, so just take this with a grain of salt.

When it comes to burnout, general surgery is lower on the list at 49%, which is more than halfway down the list. This is good. But looking at how severe is the burnout is, surgery is higher up on the list at 4.3 on a scale of 0-4.5.

In terms of happiness, general surgery is ranked higher up on the list with 35% happiness at work and 69% happiness outside of work. So it’s on the higher end of the scale.

How Much Money Do General Surgeons Make?

Moving on to the Medscape Physician Compensation Report 2017, General Surgery is higher up on the list with an average annual salary of $352,000. You make a decent living as a general surgeon, although if you think about the lifestyle, it’s harder. So you’re compensated for that harder lifestyle.

Looking at the rate of increase year over year, general surgery had a 9% increase in salary, which is pretty decent. The number of general surgeons who feel fairly compensated is lower at only 48%.

How Many General Surgeons Would Choose Medicine Again?

In terms of whether they would choose medicine again, general surgery is right in the middle at 77%, while only 82% said they would choose the same specialty, which is slightly into the lower half of all the specialties listed.

Links & Resources:

• 2017 NRMP Match Data
• Supplemental Offer and Acceptance Program (SOAP)
• National Matching Service Data for 2016
• 2016 Charting the Outcomes (from NRMP)
• Medscape 2017 Lifestyle Report and Physician Compensation Report
• Related episode: A Community Plastic Surgeon Gives Us a Look at His Job
• Related episode: Important Details About (Almost) Every Medical Specialty
• More Match Data Deep Dives:
  anesthesiology, dermatology, emergency medicine, family medicine, neurosurgery, OB/GYN, ophthalmology, orthopedic surgery, pathology, pediatrics, physical medicine & rehabilitation, psychiatry.