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For Love, Not Money: The Financial Implications of Surgical Fellowship Training

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Surgical residents cite “increased income potential” as a motivation for pursuing fellowship training, despite little evidence supporting this perception. Thus, our goal is to quantify the financial impact of surgical fellowship training on financial career value. By using Medical Group Management Association and Association of American Medical Colleges physician income data, and accounting for resident salary, student debt, a progressive tax structure, and forgone wages associated with prolonged training, we generated a net present value (NPV) for both generalist and subspecialist surgeons. By comparing generalist and subspecialist career values, we determined that cardiovascular (ΔNPV = $698,931), pediatric ($430,964), thoracic ($239,189), bariatric ($166,493), vascular ($96,071), and transplant ($46,669) fellowships improve career value. Alternatively, trauma (−$11,374), colorectal (−$44,622), surgical oncology (−$203,021), and breast surgery (−$326,465) fellowships all reduce career value. In orthopedic surgery, spine ($505,198), trauma ($123,250), hip and joint ($60,372), and sport medicine ($56,167) fellowships improve career value, whereas shoulder and elbow (−$4,539), foot and ankle (−$173,766), hand (−$366,300), and pediatric (−$489,683) fellowships reduce career NPV. In obstetrics and gynecology, reproductive endocrinology ($352,854), and maternal and fetal medicine ($322,511) fellowships improve career value, whereas gynecology oncology (−$28,101) and urogynecology (−$206,171) fellowships reduce career value. These data indicate that the financial return of fellowship is highly variable.
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Document Type: Research Article

Affiliations: Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA

Publication date: September 1, 2016

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  • The Southeastern Surgical Congress owns and publishes The American Surgeon monthly. It is the official journal of the Congress and the Southern California Chapter of the American College of Surgeons, which all members receive each month. The journal brings up to date clinical advances in surgical knowledge in a popular reference format. In addition to publishing papers presented at the annual meetings of the associated organizations, the journal publishes selected unsolicited manuscripts. If you have a manuscript you'd like to see published in The American Surgeon select "Information for Authors" from the Related Information options below. A Copyright Release Form must accompany all manuscripts submitted.
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