Transplantation is not the most popular subspecialty in surgery. Of course, we (the authors) are 100% sold on the magic of giving someone a new lease on life with an organ transplant, but we traditionally have been the mighty few. With the growing use of organ transplantation as a treatment for end-stage liver and kidney disease, there is a great need to continue training transplant surgeons and health professionals.
The state of the transplant surgery workforce was recently described by Kaldas et al. and describes a positive job recruitment outlook as well as a significant increase in the female transplant surgeon workforce1. However, transplant surgery fellowship remains a less desirable field, with many fellowship spots going unfilled2. The discrepancy between the growth and breadth of the field with the lack of trainee interest is certainly multifactorial. Transplantation certainly has work to do in reducing disparities of gender, race, and socioeconomic background of both the transplant workforce and transplant patients. This is compounded by the perceived demands the field places on nonsurgical aspects of lifestyle, which trainees, often legitimately, consider barriers to engagement with the field. It is difficult to recruit trainees into a field when they feel they “can’t be what they can’t see”. In order to correct these disparities for trainees and for patients we must engage in active change with a focus on diversifying our workforce to meeting the coming demands for our field!
These changes are already beginning to take place. At the national level, The American Society of Transplant Surgeons has promoted this recruitment of future transplant surgeons through the Pipeline Taskforce commissioned in 2018 (https://asts.org/training/resident-resources). In 2020, the Trainee Advisory Group composed of students and residents interested in transplantation were added to the faculty Taskforce. The Taskforce is partnering with the ASTS Diversity Issues Committee and the Boldly Against Racism Taskforce to “cultivate and maintain an environment that welcomes and fosters diverse persons.” In addition to the national effort led by the ASTS, there are many robust transplant research groups across the country working in basic science, translational, clinical, and health services research giving students and residents an opportunity to learn about transplantation through research3. Work in ethics, advocacy, policy, and diversity are all critical in the field of transplantation with many appealing opportunities for involvement of trainees!
These opportunities are excellent, but they reach people already interested in transplantation. Perhaps the greatest loss to the pipeline is those who are never even exposed to the field during their medication education. At our institution, we created a program for medical students to speak directly with transplant patients in a one-on-one virtual interaction as a novel way to increase their exposure to the field of transplantation. We used the positive response from the students to advocate for didactic time in order to provide a primer on the principles of abdominal transplantation. Due to the positive response from both students and patients, this has become a standing program within the MGH student surgical rotation4.
Despite all our efforts from within the field, there continues to be a negative connotation regarding a career in transplantation even among some of our surgical peers! Trainees interested in transplantation have been asked by other surgeons if they care at all about the rest of their life outside work, if they are interested in having relationships/families, and if they want to work all the time. All surgeons probably heard these questions when we chose our surgical residency, but to have them follow trainees interested in transplantation from within the field of surgery is not necessary. Transplant surgeons do not work all the time. We have lovely friends and families, and fantastic hobbies (check out @ASTSchimera on Twitter and Instagram)! Each surgical subspecialty has its appeal and deterrents, and we should encourage students to pursue the field that will bring them the most joy, regardless of whether it is our field or one we would want to pursue.
Transplant is a team sport! We want to encourage ALL interested people to consider transplantation as a career. Our team will be better and stronger as we grow and diversify! If you are a trainee interested in transplantation (even just a little bit at all) contact us and we will get you plugged in. @DanielCloonan @TCoeMD @LA_Dageforde
- Kaldas, F. M. et al. The Abdominal Transplant Surgery Workforce: Current state and future trends. Clin. Transplant. 33, 1–22 (2019).
- Quillin, R. C. et al. Transplant Surgery Pipeline: A Report from the American Society of Transplant Surgeons Pipeline Taskforce. J. Am. Coll. Surg. 233, 262–271 (2021).
- Highet, A. et al. Fostering Passion and Skills in Surgical Research Across the Medical Education Continuum: The Transplant Research, Education, and Engagement Group. J. Surg. Educ. 78, 356–360 (2021).
- Coe, T. M. et al. Medical Students and Patients Benefit from Virtual Non-Medical Interactions Due to COVID-19. J. Med. Educ. Curric. Dev. 8, 238212052110283 (2021).