Supply and Demand: Pediatric Surgical Specialties Fellowship Match Trends

INTRODUCTION: Surgical specialization is critical in medical training, with fellowships as key pathways for career advancement and shaping the pediatric surgical workforce. Given the surgical condition and procedural overlap between subspecialties, skills often complement each other to enhance comprehensive pediatric care. This study examines the balance of supply and demand across pediatric surgical fellowship positions, evaluating trends in individual fields and their collective impact on pediatric surgical care. METHODS: We analyzed available fellowship match data from 2004 to 2024 across nine pediatric subspecialties: anesthesiology, cardiac surgery, general surgery, gynecology, neurosurgery, orthopedics, otolaryngology, plastic surgery, and urology. Data were obtained from the National Resident Matching Program, San Francisco Match, and the Pediatric Orthopedic Society of North America. Applicant-to-position ratios were calculated, with 1 indicating balance, >1 reflecting higher demand, and <1 indicating lower demand. Statistical analysis was performed using least squares regression and ANOVA in SPSS (IBM SPSS Statistics, Version 29.0.2.0 (IBM Corp, Armonk, NY)). Data are expressed as mean ± standard deviation, where applicable. RESULTS: Nine subspecialties were assessed. Higher demand was found for available positions in pediatric general surgery (1.80 ± 0.23), gynecology (1.35 ± 0.21), and cardiac surgery (1.21 ± 0.46). Specialties with lower demand included urology (0.81 ± 0.08), plastic surgery (0.88 ± 0.13), anesthesiology (0.92 ± 0.20), otolaryngology (0.95 ± 0.14), and neurosurgery (0.96 ± 0.20). An analysis of trends revealed that all specialties experienced a decline in the ratio of applicants to available positions, except for orthopedics, which saw significant decreases in the ratios for anesthesiology, general surgery, and plastic surgery. The average number of unfilled fellowship positions was most notable for anesthesiology (35.2 ± 19.5), orthopedics (16.4 ± 5.5), and otolaryngology (11.2 ± 4.7). The percentage of unfilled positions was notably high for urology (31.9% ± 8.8%), plastic surgery (27.6% ± 11.6%), and otolaryngology (24.0% ± 9.4%). CONCLUSIONS: The findings suggest that pediatric general surgery, gynecology, and cardiac surgery continue to attract strong interest, while anesthesiology, orthopedics, otolaryngology, plastic surgery, and urology are seeing fewer applicants than available positions. What is most concerning, however, is that almost all fields have witnessed a decline in interest over time. If it continues, this trend portends poorly for the future of pediatric surgical care, as an imbalance between the decreasing supply of specialists and the growing demand for specialized care could lead to gaps in patient services. Addressing these imbalances is crucial to sustaining a well-rounded, highly qualified pediatric surgical workforce.