Gynecologic oncology fellowship trends: Supply outpacing demand, geographical maldistribution

Objective

To examine the trends and geographic distribution of US GO fellowship programs over time and analyze GO specific procedures by regions.

Methods

Using the publicly available data from the NRMP, the number of GO fellowship programs and positions between 2004 and 2023 was obtained. The number of programs and positions in each geographic region was calculated. Total number of GO cases was calculated based on SEER data by region, with GO-specific cases categorized as early cervical cancer and advanced ovarian cases as surrogates. Growth rates were calculated for the study period and a simple linear regression analysis was performed to study the significant trends by years.

Results

The Northeast exhibited the highest position growth (B = 0.49, p < 0.001), whereas program expansion was most rapid in the West (B = 0.42, p < 0.001). From 2004 to 2021, early-stage cervical cancer cases per fellow declined significantly across all regions (p < 0.001), with the Midwest decreasing the most by 68.2 % (from 85 to 27 cases). Similarly, advanced ovarian cancer cases per fellow decreased, with the Midwest experiencing a 70 % decline (from 202 to 60 cases) and the West demonstrating the greatest rate of decline at 8.86 fewer cases per fellow per year (p < 0.001).

Conclusions

There is a geographic imbalance in new programs and positions relative to the number of GO cases per fellow with surgical cases by fellow varying significantly by geographic region. These data raise the issue of an unmet need in considering the future of our profession.