Increasing Cardiothoracic Training Programs in Sub-Saharan Africa to Improve Access to Care: Correlation of U.S. General Surgery Residencies and In-State Surgeons
Zachary Brennan1, John Treffalls2, Nathaniel Reed3, Sarin Paluri4, Grace Young5, Tyler Wallen6.
1Michigan State University, East Lansing, MI, USA, 2University of Texas Health Sciences Center San Antonio, San Antonio, TX, USA, 3DMC Sinai Grace, Detroit, MI, USA, 4Midwestern University, Chicago, IL, USA, 5ATSU - KCOM, Kirksville, MO, USA, 6Geisinger Health System, Wilkes-Barre, PA, USA.
OBJECTIVE: Limited access to cardiothoracic surgery in sub-Saharan Africa is well documented, with only one cardiothoracic training program: Tenwek Hospital in Kenya. Given that 43.1% of U.S. general surgeons stay to practice in the state where they train, we aimed to assess the relationship between the number of surgical training programs and practicing surgeons in the U.S.
METHODS: The number of general surgeons and PGY-1 general surgery positions per capita in each state were assessed using American Association of Medical Colleges, American College of Surgeons, American Board of Surgery, and U.S. census population data. States without a training program were excluded. Differences were analyzed using descriptive statistics.
RESULTS: There was a median of 7.42 surgeons per 100,000 people (IQR 7.06-8.96). There was a median of 0.74 PGY-1 general surgery positions per 100,000 (IQR 0.55-1.02). States with PGY-1 positions greater than the national median had more general surgeons per capita than states with fewer PGY-1 positions (8.1 vs. 7.2 per 100,000; p=0.039). The number of PGY-1 positions and general surgeons per capita positively correlated (Pearsonís r=0.32, p=0.03).
CONCLUSIONS: The number of practicing in-state surgeons increased with the number of general surgery residency positions. Similarly, both graduates of Tenwek Hospitalís cardiothoracic program now practice in Kenya. Development of training programs in sub-Saharan Africa may increase access to local cardiothoracic care, decreasing reliance on surgical mission trips that lack patient follow-up.
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