Abstract
Background
Since 1997, the Fellowship Council (FC) has evolved into a robust organization responsible for the advanced training of nearly half of the US residency graduates entering general surgery practice. While FC fellowships are competitive (55% match rate) and offer outstanding educational experiences, funding is arguably vulnerable. This study aimed to investigate the current funding models of FC fellowships.
Methods
Under an IRB-approved protocol, an electronic survey was administered to 167 FC programs with subsequent phone interviews to collect data on total cost and funding sources. De-identified data were also obtained via 2020–2021 Foundation for Surgical Fellowships (FSF) grant applications. Means and ranges are reported.
Results
Data were obtained from 59 programs (35% response rate) via the FC survey and 116 programs via FSF applications; the average cost to train one fellow per year was $107,957 and $110,816, respectively. Most programs utilized departmental and grants funds. Additionally, 36% (FC data) to 39% (FSF data) of programs indicated billing for their fellow, generating on average $74,824 ($15,000–200,000) and $33,281 ($11,500–66,259), respectively. FC data documented that 14% of programs generated net positive revenue, whereas FSF data documented that all programs were budget-neutral.
Conclusion
Both data sets yielded similar overall results, supporting the accuracy of our findings. Expenses varied widely, which may, in part, be due to regional cost differences. Most programs relied on multiple funding sources. A minority were able to generate a positive revenue stream. Although fewer than half of programs billed for their fellow, this source accounted for substantial revenue. Institutional support and external grant funding have continued to be important sources for the majority of programs as well. Given the value of these fellowships and inherent vulnerabilities associated with graduate medical education funding, alternative grant funding models and standardization of annual financial reporting are encouraged.
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References
Swanstrom LL, Park A, Arregui M, Franklin M, Smith CD, Blaney C (2006) Bringing order to the chaos: developing a matching process for minimally invasive and gastrointestinal postgraduate fellowships. Ann Surg 243(4):431–435
Weis JJ, Alseidi A, Jeyarajah DR, Schweitzer M, Hori Y, Scott DJ (2019) Providing complex GI surgical care with minimally invasive approaches: a survey of the practice patterns of fellowship council alumni. Surg Endosc. https://doi.org/10.1007/s00464-019-06929-1
Matching Process Statistics [Internet]. https://fellowshipcouncil.org/fellowship-programs/matching-process-statistics Accessed 25 Feb 2020
Fowler DL, Hogle NJ (2013) The fellowship council: a decade of impact on surgical training. Surg Endosc 27(10):3548–3554
Weis JJ, Goldblatt M, Pryor AD, Schultz L, Scott DJ (2019) SAGES advanced GI/MIS fellowship redesign: pilot results and adoption of new standards. Surg Endosc 33:3056–3061
Richardson JD (2013) ACS transition to practice program offers residents additional opportunities to hone skills. Bull Am Coll Surg 98(9):23–27
Membership Requirements and Application [Internet]. https://fellowshipcouncil.org/fellowship-programs/membership-requirements-and-applications/. Accessed 25 Feb 2020
Evensen A, Duffy S, Dawe R, Pike A, Nelson BD (2019) Status of global health fellowship training in the United States and Canada. Can Med Educ J. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6892312/. Accessed 25 Feb 2020
Buyske J, Easter D, Forde K, Holzman M, Melvin WS, Schirmer B, Schwaitzberg S, Scott D, Smith CD, Talamini M (2010) Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) statement on the relationship between professional medical associations and industry. Surg Endosc 24:742–744
Richardson E (2020) The physician payments sunshine act [Interne]. Health Affairs, Bethesda. https://www.healthaffairs.org/do/10.1377/hpb20141002.272302/full/ Accessed 25 Feb 2020
Schultz L (2020) An update from the foundation for surgical fellowships: growing need requires broader support [Internet]. Bariatric Times, Westchester. https://bariatrictimes.com/an-update-from-the-foundation-for-surgical-fellowships-growing-need-requires-broader-support/ Accessed 25 Feb 2020
Learn [Internet]. Foundation for Surgical Fellowships, Los Angeles. https://www.surgicalfellowships.org/about/learn Accessed 26 Feb 2020
Cost of Living Index by State 2020 [Internet]. Missouri Economic Research and Information Center, Jefferson City. https://worldpopulationreview.com/states/cost-of-living-index-by-state/ Accessed 27 Feb 2020
Fellowship Council Accreditation, Core Curriculum and Program Requirements [Internet]. The Fellowship Council. https://fellowshipcouncil.org/about/program-guidelines/. Accessed 13 Mar 2020
Acknowledgements
This manuscript was reviewed and approved by the Fellowship Council (FC) Board of Directors and the Foundation for Surgical Fellowships (FSF) Board.
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Ms. Hori reports being the employee-executive director for The Fellowship Council, outside the submitted work. Ms. Schultz reports being the employee-executive director for the Foundation for Surgical Fellowships (FSF). Drs. Lee, Weis, Talamani, Nagaraj, and Scott have no conflicts of interest or financial ties to disclose.
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Podium Presentation at SAGES 2020 Annual Meeting, Cleveland, Ohio.
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Lee, J.H., Weis, J.J., Talamini, M.A. et al. Thriving or surviving? A critical examination of funding models for fellowship council fellowships. Surg Endosc 36, 2607–2613 (2022). https://doi.org/10.1007/s00464-021-08553-4
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DOI: https://doi.org/10.1007/s00464-021-08553-4