A. Swearingen1, J. Jin1, J. J. Shin1, E. Berber1, A. Siperstein1, V. D. Krishnamurthy1 1Cleveland Clinic,Department Of Endocrine Surgery,Cleveland, OH, USA
Introduction:
Recent ACGME defined category operative requirements will require that graduates participate in a minimum of fifteen endocrine cases during general surgery residency, which is nearly double from the previous requirement of eight. Parathyroid exploration is a common endocrine procedure and trainee exposure is variable. We analyzed current practice patterns of parathyroid operations in the United States with respect to specialty and training.
Methods:
Centers Medicare and Medicaid Services datasets were used to identify surgeons who performed >10 parathyroid operations in 2014 on Medicare Part B beneficiaries (MCB). Previous residency training was characterized as general surgery (GS) and otolaryngology (ENT). Fellowship-trained (FT) surgeons were categorized as endocrine surgeons (ES), surgical oncologists (SO), and head and neck oncologists (H&N). Surgeons who had entered practice in preceding decade were considered early-career. Statistical analysis was performed with JPM Pro V12.
Results:
We identified 317 surgeons in 44 states who performed 6,560 parathyroid explorations on MCB 2014. Median number of operations performed per surgeon was 17. Residency training was GS for 76% (n=240) and ENT for 24% (n=75). Overall, 41% were FT (n=128) and 59% were not-FT (N=187). Of FT surgeons, 66% were ES (n=85), 20% were SO (n=25), and 15% were H&N (18). Fifty percent practiced in non-academic settings (n=158). The mean number of operations performed per surgeon was greater for GS-trained surgeons compared to ENT (21±1 vs. 18±1, p=0.037), FT surgeons compared to not (23±1 vs. 20±1, p=0.014), and academic compared to community surgeons (23±1 vs. 18±1, p=0.0001). Early career surgeons who had completed fellowships performed more operations per surgeon when compared to their not-FT contemporaries (21±2 vs. 17±2, p=0.3).
Conclusion:
Most parathyroid surgery in the United States elderly population is performed by general surgeons, many of whom did not pursue an associated fellowship. This supports the ACGME’s effort to strengthen education and experience with parathyroid surgery during residency. For programs who are challenged by the increased minimum of endocrine procedure requirements, residents can gain further experience through faculty recruitment of fellowship-trained surgeons or by proctorship with endocrine surgeons practicing in the community.