Original Article
Canadian vascular surgery residents’ perceptions regarding future job opportunities
Vascular 2015, Vol. 23(3) 253–259 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1708538114541112 vas.sagepub.com
Joel A Cooper1, Luc Dubois1, Adam H Power1, Guy DeRose1, Kent S MacKenzie2 and Thomas L Forbes1
Abstract The objective was to determine the employment environment for graduates of Canadian vascular surgery training programs. A cross-sectional survey of residents and graduates (2011–2012) was used. Thirty-seven residents were invited with a response rate of 57%, and 14 graduates with a response rate of 71%; 70% of graduates felt the job market played an important role in their decision to pursue vascular surgery as a career compared to 43% of trainees. The top three concerns were the lack of surgeons retiring, the overproduction of trainees, and saturation of the job market. The majority (62%) of trainees see themselves extending their training due to lack of employment. All of the graduates obtained employment, with 50% during their second year (of two years) of training and 30% after training was completed. Graduates spent an average of 12 10.6 months seeking a position and applied to 3.3 1.5 positions, with a mean of 1.9 1.3 interviews and 2 1.2 offers. There was a discrepancy between the favorable employment climate experienced by graduates and the pessimistic outlook of trainees. We must be progressive in balancing the employment opportunities with the number of graduates. Number and timing of job offers is a possible future metric of the optimal number of residents.
Keywords Human resources, education, training
Background With an increasingly competitive surgical job market in Canada, some graduates have extended their training before gaining employment. Cardiac surgery has been particularly affected, with the average graduating resident extending his or her six-year residency training by a further three years due to the lack of employment opportunities.1 This trend has dampened the interest of medical students in applying to cardiac surgery residency programs and could lead to a significant shortage of cardiac surgeons in the future.1 As the competitiveness of employment reaches other surgical subspecialties, graduates may find it difficult to gain employment. Currently, there is a lack of data regarding employment for recent graduates of Canadian vascular surgery training programs. Recently, training of vascular surgeons in Canada has shifted from a subspecialty program (completion of general surgery or cardiac surgery training followed
by two years of vascular surgery subspecialty training) to a direct entry five-year residency program, which trainees enter directly from medical school. With this shift in training regimen, it is important that the specialty be progressive in balancing employment opportunities with the number of graduates in order to avoid saturation of the job market. By surveying recent graduates and current residents of Canadian vascular surgery training programs, we 1 Division of Vascular Surgery, London Health Sciences Centre & Western University London, Canada 2 Division of Vascular Surgery, Royal Victoria Hospital & McGill University, Canada
Corresponding author: Thomas L Forbes, Division of Vascular Surgery, London Health Sciences Centre, 800 Commissioners Road East, Room E2-119, London, ON, Canada, N6A5W9. Email: [email protected]
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sought to determine the availability of vascular surgery positions, the factors that lead to obtaining employment, and whether current trainees have been influenced by the competitiveness of the surgical job market. The results of this survey could be used to guide future enrollment decisions for the direct-entry residency program, and help both current and future trainees have realistic expectations and successfully gain employment. In addition, we sought to explore the applicability of numerical metrics for evaluating the employment climate, namely number of jobs sought, number of job offers, and time spent seeking employment.
Methods This study consists of a descriptive, cross-sectional survey of residents currently training in Canadian vascular surgery programs, as well as recent (2011–2012) graduates (Online Appendix 1 and 2). The Tailored Design Method with multiple contacts was employed, following the methodology described by Dillman.2 We generated a list of all current trainees by contacting program administrators and directors of the 10 training programs in Canada. Program directors were also contacted for a list of graduates from their program for the years 2011 and 2012. The residents and graduates were contacted via email and asked to complete a survey with an online survey tool (Online Appendix 1 and 2). Survey responses were kept confidential, and no markers were used to identify respondents. All respondents were removed from the survey link to avoid duplicate responses. This study was approved by the Ethics Board for Research Involving Human Subjects at Western University. In order to assess the potential effect, the job market may have had in both the trainees’ and the graduates’ decisions to pursue vascular surgery; we asked how important employment opportunities were in deciding on vascular surgery training. The answers were recorded using a five-point Likert scale: 1, not important; 2, somewhat important; 3, important; 4, very important; and 5, most important. To compare the responses between graduates and trainees, we dichotomized the responses by considering answers to be not important (not important, somewhat important) or important (important, very important, most important). In a similar fashion, we recorded how important certain factors (publications/grants/research, extra-training, efforts by program director, individual efforts, serendipity, obtaining a graduate degree) were or would be to finding employment in vascular surgery, and again compared the results between graduates and trainees. We also explored graduates’ and trainees’ perceptions regarding barriers to finding employment
(lack of a strong research profile, competition from other specialists, oversaturation of the job market, overproduction of trainees, lack of surgeons retiring, fee-for-service remuneration). These were recorded using a four-point Likert scale: 1, extremely detrimental; 2, detrimental; 3, somewhat detrimental; and 4, inconsequential. In order to compare the results between trainees and graduates, we dichotomized the results by considering answers to be detrimental (extremely detrimental, detrimental) or not detrimental (somewhat detrimental, inconsequential). In addition to demographic data, we also collected data on the nature of recent graduate’s practices (academic, allocation of time, type of operative cases, advanced degrees). The answers to the questionnaires were coded using Microsoft Excel (version 2010; Microsoft, Mountain View, CA) and analyzed using SPSS (IBM version 20, Chicago, IL). Categorical variables were analyzed using Pearson Chi-squared test or Fischer’s exact test where appropriate with significance set at p ¼ 0.05.
Results Thirty-seven current trainees and 14 recent graduates were invited to participate in the study (Table 1). Completed surveys were submitted by 21 current trainees and 10 graduates, with a response rate of 57% and 71%, respectively. The majority of respondents were male, 57% of trainees and 67% of graduates. Average age of respondents was 27 years for trainees and 35 years for graduates. Ten percent of trainees and 40% of graduates had obtained a Masters or PhD. All of the recent graduates had completed a general surgery residency prior to completing a two-year vascular surgery residency. Only 43% of current trainees felt that the job market played an important role in their decision to pursue vascular surgery as a career, whereas 70% of recent graduates felt it played an important or very important role in their decision (Figure 1, p ¼ 0.25). A greater
Table 1. Demographics of Canadian vascular surgery trainees and recent graduates participating in survey.
Invites Participants Male Average age (years) Advanced education (Masters/PhD)
Downloaded from vas.sagepub.com by guest on November 15, 2015
Trainees, n (%/SD)
Recent graduates, n (%/SD)
37 21 (57%) 12 (57%) 27.6 (2.9) 2 (9%)
14 10 (71%) 6 (43%) 35 (1.3) 4 (40%)
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proportion of current trainees anticipated having difficulty finding a job compared with recent graduates, although this was not statistically significant (50% vs. 33%, p ¼ 0.45; Figure 2). The most detrimental factors, ranked by both trainees and graduates, included lack of surgeons retiring, overproduction of trainees, saturation of the job market, lack of strong research profile, competition from interventional radiologists, and fee-for-service remuneration (Figure 3). Trainees perceived competition from other specialties as more detrimental to obtaining employment than did graduates (37% vs. 10%, p ¼ 0.2). Otherwise, both groups had similar concerns regarding factors detrimental to finding employment. Graduates and trainees indicated that efforts by their home program, individual efforts, and serendipity were all important in finding employment (Figure 4). Trainees placed greater importance on publications/research experience (90% vs. 40%, p ¼ 0.01), extra-training following residency (86% vs.
40%, p ¼ 0.02), and efforts by the home program/program director (100% vs. 30%, p ¼ 0.001) than recent graduates. The majority of trainees felt that they would begin to pursue employment opportunities in their senior years with 5% as PGY1, 5% as PGY2, 24% as PGY3, 38% as PGY4, and 29% as PGY5 (Figure 5). The majority (62%) of current trainees foresee themselves extending their residency due to a lack of job opportunities (Figure 6). One-third (30%) of recent graduates were offered a staff position after completing a two-year vascular surgery residency, 50% during the second year, 10% during the first year, and 10% during their general surgery residency (Figure 7). Recent graduates spent an average of 12 10.6 months seeking employment in vascular surgery. The average number of staff positions applied for was 3.3 1.5, and the average number of job interviews received was 1.9 1.3. All graduates had obtained
Figure 1. Graduates’ and Trainees’ decision to pursue vascular surgery training based on employment opportunities assessed using a 5-point Likert scale (p ¼ 0.25).
Figure 2. Graduates and Trainees anticipating difficulty finding employment once completing their training, assessed using a 4-point Likert scale (p ¼ 0.45).
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Figure 3. Graduates and Trainees rank most detrimental factors affecting employability.
employment with an average of 2 1.2 job offers. Graduates had been practicing for an average of 14.9 8.3 months at the time survey completion (Table 2). The majority (60%) of graduates are employed in academic and 40% in community positions. The vast majority (89%) are remunerated feefor-service and 11% salary-based. Seventy percent are employed as an attending surgeon – full partner, 10% as an attending surgeon – junior partner, and 20% as attending surgeon – on contract. Most (90%) graduates live and practice in Canada and 10% in the United States (Table 3). When asked whether graduates received the job they wanted, 50% replied definitely yes, 40% mostly yes, and 10% mostly no (Figure 8).
Discussion The results of this survey highlight a disparity between the favorable employment situation of all recent vascular surgery graduates and the concern expressed by current residents. This likely reflects what is happening with other surgical specialties and highlights the need for due diligence in preventing an oversupply of vascular surgeons and unemployed graduates of our training programs. The United States 0 þ 5 (direct entry) vascular surgery training program graduated its first cohort in 2012. Recently, Colvard et al.3 performed a similar study of
this initial cohort of graduates of the 0 þ 5 training program as well as vascular surgery fellows (5 þ 2, which is analogous to Canada’s two-year vascular surgery residency following a general surgery residency). Similar to our findings, they demonstrated a positive job market with 100% of the graduates from both the 0 þ 5 training program and the fellowship program finding employment. Most (61%) graduates from American fellowship programs were offered one to two jobs and 39% offered three or more. Although these results are similar to our findings regarding Canada, it appears there are currently more job opportunities for graduates in the United States. This may suggest that if the Canadian market were to become saturated, graduates of Canadian vascular surgery programs may find a more favorable market in the United States. Despite the current favorable job market, current Canadian vascular surgery residents share a pessimistic outlook on their future employment possibilities, and over 60% foresee themselves extending their training specifically due to a lack of job availability. In our survey, current residents and recent graduates felt that the lack of surgeons retiring and an overproduction of trainees were the biggest issues threatening the workforce. In order to address these issues, objective metrics should be in place to balance the optimal number of
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Figure 4. Graduates and Trainees rank most helpful factors affecting employability.
Figure 5. Trainees estimate what post-graduate year (PGY) they will begin to pursue employment.
Figure 6. Trainees asked if they foresee themselves extending residency due to a lack of jobs.
residents. Although not tested in our survey, the average number of job interviews and job offers could serve as a metric for current employability of graduates, and a fluctuation of these numbers over subsequent years could be used to predict the number of graduates needed to populate the workforce. Currently, job opportunities for newly trained Canadian vascular surgery positions are favorable, with an average of two job offers per graduate; however, with the small number of graduates in Canada, this average could be rapidly decreased with only a small increase in the number of
graduates, leading to a surplus of graduates, and potential unemployment. Vanderby et al.4 published a model to predict the number of cardiac surgeons required to meet the increasing surgical demand from an aging population. Extrapolating their data, the aging population will subsequently increase the number of cardiovascular interventions required, and vascular surgeons should continue to be in high demand. However, currently no model exists to predict the exact number of vascular surgeons that will be required in Canada. In 1998,
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Figure 7. Time graduates were offered staff position as vascular surgeon.
Table 2. Employment opportunities for recent Canadian vascular surgery graduates. Job market
Recent graduates, mean (SD)
Staff positions applied for Job interviews Job offers Time seeking a position (months) Length of time in practice (months)
3.3 1.9 2 12 14.9
(1.5) (1.3) (1.2) (10.6) (8.3)
Table 3. Employment characteristics of recent Canadian vascular surgery graduates. Type of employment
Recent graduates, n (%)
Academic position Community position Fee-for-service Salary Attending surgeon – full partner Attending surgeon – junior partner Attending surgeon – on contract Practicing in Canada Practicing in United States
6 4 9 1 7 1 2 9 1
(60%) (40%) (89%) (11%) (70%) (10%) (20%) (90%) (10%)
Harris et al.5 predicted an increasing demand of for vascular surgeons, based on an aging population and the number of graduating vascular surgeons, which at that time was eight per year. However, models only looking at disease and population projections can be impractical when it comes to hospital-based positions in Canada. As in most western countries, Canada’s population continues to age with an increasing incidence of cardiovascular disease. With these metrics, one would easily surmise a growing need for vascular
Figure 8. Graduates asked if they got the job they wanted.
specialists. The reality, however, is that projection of vascular surgeon needs is more in keeping with hospital budgets rather than population projections. Therefore, we propose an ongoing evaluation of graduating residents’ job prospects as a metric for the optimum supply of vascular surgeons, until that point when hospital budgets, population and disease projections are better aligned. Models used to predict surgical workforce needs would also need to take into account a shift in trainees’ expectations regarding work hour restrictions. Although not assessed in this study, Maruscuk et al.6 did show that current surgical trainees plan to adopt more work hour restrictions in their future practice, and may require larger surgical groups to replace those retiring. Modeling future surgical workforce needs is a complex problem; however, if vascular surgery, as a specialty, is not progressive in balancing supply and demand, Canadian graduates may be forced to find employment in other countries, and attracting candidates to the specialty could become difficult. Having a more competitive job market, however, may have some positive effects. The direct entry vascular surgery residency program has quickly become one of the most competitive post-graduate training streams for Canadian medical graduates. In 2012, there were 28 applicants for eight available training positions, and in 2013, there were 28 applicants for 10 available training positions.7 This competitiveness may lead to better trained and more academically productive vascular surgeons. In our study, trainees placed more importance on research and publications as well as extratraining than did recent graduates. Lee et al. published an interesting study surveying applicants to the 0 þ 5 direct entry and the 5 þ 2 fellowship program in the United States. They found that applicants to the 0 þ 5 direct entry program were more likely to have an additional degree (PhD/Masters), have a higher number of publications, have higher United States Medical Licensure Examination test scores, and are more likely to be in the top quartile of their medical school
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class, compared to those applying to the 5 þ 2 fellowship program.8,9 With a more competitive job market in mind, current trainees are already developing their academic portfolios in order to secure a residency position, and also foresee this being an important step in attaining future employment. This parallels the changing nature of vascular surgery practice in Canada, with a move away from community-based, mixed vascular and general surgery, to solely vascular surgery in academic health care centers. Although adequate, our response rate of current trainees was 57%, and the views of the non-respondents were not captured in this data. With busy schedules and exposure to a number of surveys and evaluations, surgical residents can be a difficult group to survey. However, a systematic review of surveys published in medical journals revealed a mean response rate of 54% among surveys of physicians, and our response rates were comparable to this.10 Regardless, a limitation of our study is this response rate which could limit the generalizability of the study’s findings. Other limitations of this study include the inherent biased selfreporting that survey data relies on. Non-respondents among the recent graduates are more likely to have been unhappier with their employment status and potentially unemployed which may have led to an overestimation of the favorable employment climate among these graduates. With other surgical specialties in Canada faced with a surplus of well-trained graduates who are unable to obtain positions, vascular surgery currently has a favorable job market, but there is uncertainty about the future, particularly amongst current trainees. If this climate is to continue, regulatory bodies must be proactive in continually re-evaluating the need and output of trainees in vascular surgery. Ultimately, if proper oversight can be developed, then allocation of training position can potentially match need. Use of the metrics described here (number of job interviews, number of job offers, time spent seeking employment) may emerge as ways to track the employment climate in Canada.
Acknowledgment This article was presented as a poster at the Annual Meeting of the Canadian Society for Vascular Surgery, 13–14 September 2013, Edmonton, Alberta.
Conflict of interest None declared.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References 1. Ouzounian M, et al. The cardiac surgery workforce: a survey of recent graduates of Canadian training programs. Ann Thorac Surg 2010; 90: 460–466. 2. Dillman DA. Tailored design of mail and other self-administered surveys, New York, NY: Wiley-Interscience, in press. 3. Colvard M, et al. Survey of initial cohort of graduating integrated 0 þ 5 residents and vascular surgery fellows: experiences during the job hunt. J Vasc Surg 2013; 68: 559. 4. Vanderby SA, et al. Modeling the cardiac surgery workforce in Canada. Ann Thorac Surg 2010; 90: 467–473. 5. Harris KA, et al. Canadian human resource needs in vascular surgery. Can J Surg 1998; 41: 39–45. 6. Maruscak A, et al. Implications of current resident workhour guidelines on the future practice of surgery in Canada. J Surg Educ 2012; 69: 487–492. 7. Canadian Residency Matching Service, http:// www.carms.ca (2013, accessed November 2013). 8. Lee JT, et al. A survey of demographics, motivations, and backgrounds among applicants to the integrated 0 þ 5 vascular surgery residency. J Vasc Surg 2010; 51: 496–503. 9. Zayed MA, et al. A comparison of 0 þ 5 versus 5 þ 2 applicants to vascular surgery training programs. J Vasc Surg 2012; 57: 1448–1452. 10. Asch DA, Jedrziewski MK and Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol 1997; 50: 1129–1136.
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Canadian vascular surgery residents’ perceptions regarding future job opportunities
Vascular 2015, Vol. 23(3) 253–259 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1708538114541112 vas.sagepub.com
Joel A Cooper1, Luc Dubois1, Adam H Power1, Guy DeRose1, Kent S MacKenzie2 and Thomas L Forbes1
Abstract The objective was to determine the employment environment for graduates of Canadian vascular surgery training programs. A cross-sectional survey of residents and graduates (2011–2012) was used. Thirty-seven residents were invited with a response rate of 57%, and 14 graduates with a response rate of 71%; 70% of graduates felt the job market played an important role in their decision to pursue vascular surgery as a career compared to 43% of trainees. The top three concerns were the lack of surgeons retiring, the overproduction of trainees, and saturation of the job market. The majority (62%) of trainees see themselves extending their training due to lack of employment. All of the graduates obtained employment, with 50% during their second year (of two years) of training and 30% after training was completed. Graduates spent an average of 12 10.6 months seeking a position and applied to 3.3 1.5 positions, with a mean of 1.9 1.3 interviews and 2 1.2 offers. There was a discrepancy between the favorable employment climate experienced by graduates and the pessimistic outlook of trainees. We must be progressive in balancing the employment opportunities with the number of graduates. Number and timing of job offers is a possible future metric of the optimal number of residents.
Keywords Human resources, education, training
Background With an increasingly competitive surgical job market in Canada, some graduates have extended their training before gaining employment. Cardiac surgery has been particularly affected, with the average graduating resident extending his or her six-year residency training by a further three years due to the lack of employment opportunities.1 This trend has dampened the interest of medical students in applying to cardiac surgery residency programs and could lead to a significant shortage of cardiac surgeons in the future.1 As the competitiveness of employment reaches other surgical subspecialties, graduates may find it difficult to gain employment. Currently, there is a lack of data regarding employment for recent graduates of Canadian vascular surgery training programs. Recently, training of vascular surgeons in Canada has shifted from a subspecialty program (completion of general surgery or cardiac surgery training followed
by two years of vascular surgery subspecialty training) to a direct entry five-year residency program, which trainees enter directly from medical school. With this shift in training regimen, it is important that the specialty be progressive in balancing employment opportunities with the number of graduates in order to avoid saturation of the job market. By surveying recent graduates and current residents of Canadian vascular surgery training programs, we 1 Division of Vascular Surgery, London Health Sciences Centre & Western University London, Canada 2 Division of Vascular Surgery, Royal Victoria Hospital & McGill University, Canada
Corresponding author: Thomas L Forbes, Division of Vascular Surgery, London Health Sciences Centre, 800 Commissioners Road East, Room E2-119, London, ON, Canada, N6A5W9. Email: [email protected]
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sought to determine the availability of vascular surgery positions, the factors that lead to obtaining employment, and whether current trainees have been influenced by the competitiveness of the surgical job market. The results of this survey could be used to guide future enrollment decisions for the direct-entry residency program, and help both current and future trainees have realistic expectations and successfully gain employment. In addition, we sought to explore the applicability of numerical metrics for evaluating the employment climate, namely number of jobs sought, number of job offers, and time spent seeking employment.
Methods This study consists of a descriptive, cross-sectional survey of residents currently training in Canadian vascular surgery programs, as well as recent (2011–2012) graduates (Online Appendix 1 and 2). The Tailored Design Method with multiple contacts was employed, following the methodology described by Dillman.2 We generated a list of all current trainees by contacting program administrators and directors of the 10 training programs in Canada. Program directors were also contacted for a list of graduates from their program for the years 2011 and 2012. The residents and graduates were contacted via email and asked to complete a survey with an online survey tool (Online Appendix 1 and 2). Survey responses were kept confidential, and no markers were used to identify respondents. All respondents were removed from the survey link to avoid duplicate responses. This study was approved by the Ethics Board for Research Involving Human Subjects at Western University. In order to assess the potential effect, the job market may have had in both the trainees’ and the graduates’ decisions to pursue vascular surgery; we asked how important employment opportunities were in deciding on vascular surgery training. The answers were recorded using a five-point Likert scale: 1, not important; 2, somewhat important; 3, important; 4, very important; and 5, most important. To compare the responses between graduates and trainees, we dichotomized the responses by considering answers to be not important (not important, somewhat important) or important (important, very important, most important). In a similar fashion, we recorded how important certain factors (publications/grants/research, extra-training, efforts by program director, individual efforts, serendipity, obtaining a graduate degree) were or would be to finding employment in vascular surgery, and again compared the results between graduates and trainees. We also explored graduates’ and trainees’ perceptions regarding barriers to finding employment
(lack of a strong research profile, competition from other specialists, oversaturation of the job market, overproduction of trainees, lack of surgeons retiring, fee-for-service remuneration). These were recorded using a four-point Likert scale: 1, extremely detrimental; 2, detrimental; 3, somewhat detrimental; and 4, inconsequential. In order to compare the results between trainees and graduates, we dichotomized the results by considering answers to be detrimental (extremely detrimental, detrimental) or not detrimental (somewhat detrimental, inconsequential). In addition to demographic data, we also collected data on the nature of recent graduate’s practices (academic, allocation of time, type of operative cases, advanced degrees). The answers to the questionnaires were coded using Microsoft Excel (version 2010; Microsoft, Mountain View, CA) and analyzed using SPSS (IBM version 20, Chicago, IL). Categorical variables were analyzed using Pearson Chi-squared test or Fischer’s exact test where appropriate with significance set at p ¼ 0.05.
Results Thirty-seven current trainees and 14 recent graduates were invited to participate in the study (Table 1). Completed surveys were submitted by 21 current trainees and 10 graduates, with a response rate of 57% and 71%, respectively. The majority of respondents were male, 57% of trainees and 67% of graduates. Average age of respondents was 27 years for trainees and 35 years for graduates. Ten percent of trainees and 40% of graduates had obtained a Masters or PhD. All of the recent graduates had completed a general surgery residency prior to completing a two-year vascular surgery residency. Only 43% of current trainees felt that the job market played an important role in their decision to pursue vascular surgery as a career, whereas 70% of recent graduates felt it played an important or very important role in their decision (Figure 1, p ¼ 0.25). A greater
Table 1. Demographics of Canadian vascular surgery trainees and recent graduates participating in survey.
Invites Participants Male Average age (years) Advanced education (Masters/PhD)
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Trainees, n (%/SD)
Recent graduates, n (%/SD)
37 21 (57%) 12 (57%) 27.6 (2.9) 2 (9%)
14 10 (71%) 6 (43%) 35 (1.3) 4 (40%)
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proportion of current trainees anticipated having difficulty finding a job compared with recent graduates, although this was not statistically significant (50% vs. 33%, p ¼ 0.45; Figure 2). The most detrimental factors, ranked by both trainees and graduates, included lack of surgeons retiring, overproduction of trainees, saturation of the job market, lack of strong research profile, competition from interventional radiologists, and fee-for-service remuneration (Figure 3). Trainees perceived competition from other specialties as more detrimental to obtaining employment than did graduates (37% vs. 10%, p ¼ 0.2). Otherwise, both groups had similar concerns regarding factors detrimental to finding employment. Graduates and trainees indicated that efforts by their home program, individual efforts, and serendipity were all important in finding employment (Figure 4). Trainees placed greater importance on publications/research experience (90% vs. 40%, p ¼ 0.01), extra-training following residency (86% vs.
40%, p ¼ 0.02), and efforts by the home program/program director (100% vs. 30%, p ¼ 0.001) than recent graduates. The majority of trainees felt that they would begin to pursue employment opportunities in their senior years with 5% as PGY1, 5% as PGY2, 24% as PGY3, 38% as PGY4, and 29% as PGY5 (Figure 5). The majority (62%) of current trainees foresee themselves extending their residency due to a lack of job opportunities (Figure 6). One-third (30%) of recent graduates were offered a staff position after completing a two-year vascular surgery residency, 50% during the second year, 10% during the first year, and 10% during their general surgery residency (Figure 7). Recent graduates spent an average of 12 10.6 months seeking employment in vascular surgery. The average number of staff positions applied for was 3.3 1.5, and the average number of job interviews received was 1.9 1.3. All graduates had obtained
Figure 1. Graduates’ and Trainees’ decision to pursue vascular surgery training based on employment opportunities assessed using a 5-point Likert scale (p ¼ 0.25).
Figure 2. Graduates and Trainees anticipating difficulty finding employment once completing their training, assessed using a 4-point Likert scale (p ¼ 0.45).
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Figure 3. Graduates and Trainees rank most detrimental factors affecting employability.
employment with an average of 2 1.2 job offers. Graduates had been practicing for an average of 14.9 8.3 months at the time survey completion (Table 2). The majority (60%) of graduates are employed in academic and 40% in community positions. The vast majority (89%) are remunerated feefor-service and 11% salary-based. Seventy percent are employed as an attending surgeon – full partner, 10% as an attending surgeon – junior partner, and 20% as attending surgeon – on contract. Most (90%) graduates live and practice in Canada and 10% in the United States (Table 3). When asked whether graduates received the job they wanted, 50% replied definitely yes, 40% mostly yes, and 10% mostly no (Figure 8).
Discussion The results of this survey highlight a disparity between the favorable employment situation of all recent vascular surgery graduates and the concern expressed by current residents. This likely reflects what is happening with other surgical specialties and highlights the need for due diligence in preventing an oversupply of vascular surgeons and unemployed graduates of our training programs. The United States 0 þ 5 (direct entry) vascular surgery training program graduated its first cohort in 2012. Recently, Colvard et al.3 performed a similar study of
this initial cohort of graduates of the 0 þ 5 training program as well as vascular surgery fellows (5 þ 2, which is analogous to Canada’s two-year vascular surgery residency following a general surgery residency). Similar to our findings, they demonstrated a positive job market with 100% of the graduates from both the 0 þ 5 training program and the fellowship program finding employment. Most (61%) graduates from American fellowship programs were offered one to two jobs and 39% offered three or more. Although these results are similar to our findings regarding Canada, it appears there are currently more job opportunities for graduates in the United States. This may suggest that if the Canadian market were to become saturated, graduates of Canadian vascular surgery programs may find a more favorable market in the United States. Despite the current favorable job market, current Canadian vascular surgery residents share a pessimistic outlook on their future employment possibilities, and over 60% foresee themselves extending their training specifically due to a lack of job availability. In our survey, current residents and recent graduates felt that the lack of surgeons retiring and an overproduction of trainees were the biggest issues threatening the workforce. In order to address these issues, objective metrics should be in place to balance the optimal number of
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Figure 4. Graduates and Trainees rank most helpful factors affecting employability.
Figure 5. Trainees estimate what post-graduate year (PGY) they will begin to pursue employment.
Figure 6. Trainees asked if they foresee themselves extending residency due to a lack of jobs.
residents. Although not tested in our survey, the average number of job interviews and job offers could serve as a metric for current employability of graduates, and a fluctuation of these numbers over subsequent years could be used to predict the number of graduates needed to populate the workforce. Currently, job opportunities for newly trained Canadian vascular surgery positions are favorable, with an average of two job offers per graduate; however, with the small number of graduates in Canada, this average could be rapidly decreased with only a small increase in the number of
graduates, leading to a surplus of graduates, and potential unemployment. Vanderby et al.4 published a model to predict the number of cardiac surgeons required to meet the increasing surgical demand from an aging population. Extrapolating their data, the aging population will subsequently increase the number of cardiovascular interventions required, and vascular surgeons should continue to be in high demand. However, currently no model exists to predict the exact number of vascular surgeons that will be required in Canada. In 1998,
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Figure 7. Time graduates were offered staff position as vascular surgeon.
Table 2. Employment opportunities for recent Canadian vascular surgery graduates. Job market
Recent graduates, mean (SD)
Staff positions applied for Job interviews Job offers Time seeking a position (months) Length of time in practice (months)
3.3 1.9 2 12 14.9
(1.5) (1.3) (1.2) (10.6) (8.3)
Table 3. Employment characteristics of recent Canadian vascular surgery graduates. Type of employment
Recent graduates, n (%)
Academic position Community position Fee-for-service Salary Attending surgeon – full partner Attending surgeon – junior partner Attending surgeon – on contract Practicing in Canada Practicing in United States
6 4 9 1 7 1 2 9 1
(60%) (40%) (89%) (11%) (70%) (10%) (20%) (90%) (10%)
Harris et al.5 predicted an increasing demand of for vascular surgeons, based on an aging population and the number of graduating vascular surgeons, which at that time was eight per year. However, models only looking at disease and population projections can be impractical when it comes to hospital-based positions in Canada. As in most western countries, Canada’s population continues to age with an increasing incidence of cardiovascular disease. With these metrics, one would easily surmise a growing need for vascular
Figure 8. Graduates asked if they got the job they wanted.
specialists. The reality, however, is that projection of vascular surgeon needs is more in keeping with hospital budgets rather than population projections. Therefore, we propose an ongoing evaluation of graduating residents’ job prospects as a metric for the optimum supply of vascular surgeons, until that point when hospital budgets, population and disease projections are better aligned. Models used to predict surgical workforce needs would also need to take into account a shift in trainees’ expectations regarding work hour restrictions. Although not assessed in this study, Maruscuk et al.6 did show that current surgical trainees plan to adopt more work hour restrictions in their future practice, and may require larger surgical groups to replace those retiring. Modeling future surgical workforce needs is a complex problem; however, if vascular surgery, as a specialty, is not progressive in balancing supply and demand, Canadian graduates may be forced to find employment in other countries, and attracting candidates to the specialty could become difficult. Having a more competitive job market, however, may have some positive effects. The direct entry vascular surgery residency program has quickly become one of the most competitive post-graduate training streams for Canadian medical graduates. In 2012, there were 28 applicants for eight available training positions, and in 2013, there were 28 applicants for 10 available training positions.7 This competitiveness may lead to better trained and more academically productive vascular surgeons. In our study, trainees placed more importance on research and publications as well as extratraining than did recent graduates. Lee et al. published an interesting study surveying applicants to the 0 þ 5 direct entry and the 5 þ 2 fellowship program in the United States. They found that applicants to the 0 þ 5 direct entry program were more likely to have an additional degree (PhD/Masters), have a higher number of publications, have higher United States Medical Licensure Examination test scores, and are more likely to be in the top quartile of their medical school
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class, compared to those applying to the 5 þ 2 fellowship program.8,9 With a more competitive job market in mind, current trainees are already developing their academic portfolios in order to secure a residency position, and also foresee this being an important step in attaining future employment. This parallels the changing nature of vascular surgery practice in Canada, with a move away from community-based, mixed vascular and general surgery, to solely vascular surgery in academic health care centers. Although adequate, our response rate of current trainees was 57%, and the views of the non-respondents were not captured in this data. With busy schedules and exposure to a number of surveys and evaluations, surgical residents can be a difficult group to survey. However, a systematic review of surveys published in medical journals revealed a mean response rate of 54% among surveys of physicians, and our response rates were comparable to this.10 Regardless, a limitation of our study is this response rate which could limit the generalizability of the study’s findings. Other limitations of this study include the inherent biased selfreporting that survey data relies on. Non-respondents among the recent graduates are more likely to have been unhappier with their employment status and potentially unemployed which may have led to an overestimation of the favorable employment climate among these graduates. With other surgical specialties in Canada faced with a surplus of well-trained graduates who are unable to obtain positions, vascular surgery currently has a favorable job market, but there is uncertainty about the future, particularly amongst current trainees. If this climate is to continue, regulatory bodies must be proactive in continually re-evaluating the need and output of trainees in vascular surgery. Ultimately, if proper oversight can be developed, then allocation of training position can potentially match need. Use of the metrics described here (number of job interviews, number of job offers, time spent seeking employment) may emerge as ways to track the employment climate in Canada.
Acknowledgment This article was presented as a poster at the Annual Meeting of the Canadian Society for Vascular Surgery, 13–14 September 2013, Edmonton, Alberta.
Conflict of interest None declared.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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