Determinants of subspecialty training intention among general surgeons in Türkiye: A national survey.

Abstract

Objective: This study aimed to evaluate, at a national level, the individual, professional, and institutional factors associated with the intention to pursue subspecialty training among general surgery residents and surgeons across a range of career stages in Türkiye.

Material and methods: This descriptive cross-sectional survey was conducted online between December 10 and 25, 2025. The questionnaire, developed via Google forms, was distributed through professional email lists and national/regional WhatsApp groups. A total of 195 responses were received; after excluding five incomplete questionnaires, 190 participants were analyzed. Data were summarized using descriptive statistics. Group comparisons were performed using chi-square and Fisher's exact tests. Multivariable logistic regression analysis was used to identify independent predictors of subspecialty training intention. Statistical significance was set at p<0.05.

Results: Among participants, 20.5% intended to pursue subspecialty training, 24.2% were undecided, and 55.3% did not. In bivariable comparisons (yes vs. no, undecided excluded), intention was associated with shorter professional experience (≤5 years; p<0.001), workplace violence exposure (p<0.001), higher monthly on-call burden (p=0.003), absence of children (p=0.016), and single marital status (p=0.035). In multivariable analysis (Firth penalized logistic regression), professional experience ≤5 years (odds ratio 7.51) and workplace violence exposure (odds ratio 3.44) were the only independent predictors. Many participants reported negative perceptions regarding workload, on-call burden, and insufficient institutional support.

Conclusion: The intention to pursue subspecialty training among general surgeons in Türkiye is relatively low and is independently associated with shorter professional experience and exposure to workplace violence. Decision-making is shaped by both individual factors and working conditions, indicating a multidimensional process that should be considered in workforce planning and training policy.