Why are internal medicine residents at university medical centers not pursuing fellowship training in gastroenterology? A survey analysis

OBJECTIVE: The decrease in available GI fellowship positions appears to be associated with a disproportionate decrease in the quality of applicants. Thus, the aims of this study were: 1) to determine the current interest in advanced training of nonprimary care internal medicine residents at university medical centers, and 2) to identify the reasons why fellowship-bound residents an not pursuing GI. METHODS: Postage prepaid survey cards were distributed directly to the campus mailboxes of 1862 internal medicine residents at 61 university medical centers at the beginning of their second postgraduate year of training. E-mail questionnaires were then sent to 144 residents planning fellowship training and careers in academia other than in GI/hepatology. RESULTS: A total of 592 residents (32% response) returned completed survey cards. Overall, 392 (66%) indicated that they will pursue fellowship training and similar to 60% wanted to remain in academia. However, <10% indicated an interest in GI/hepatology. E-mail replies were then obtained from 122 residents (87% response) planning academic careers but not in GI. The major reasons for disinterest in GI/hepatology include the perception that jobs are not widely available, that the held is intellectually unchallenging, as well as that is too procedure-oriented. CONCLUSIONS: The majority of residents at university training programs plan advanced training and want to pursue careers in academia, but not in GI/hepatology. Efforts to attract highly qualified residents to GI must emphasize the improved job market, especially as it exists in academia; must advertise research opportunities; and must de-emphasize the procedural nature of this subspecialty. (Am J Gastroenterol 2000,95:777-783. (C) 2000 by Am. Coll. of Gastroenterology).