The generation gap: perspectives of a program director.

T he results of the 2001 National Internship and Residency Matching Program for general surgery raised alarms for every surgeon and surgical organization involved in resident education, but it was especially concerning to surgical program directors. In the 2001 match, there were 68 unfilled postgraduate year 1 (PGY-1) categorical surgical positions and 425 unfilled PGY-1 preliminary positions. Many of these eventually filled after the match, but the implications of having this many initially unfilled slots, combined with the trends of decreasing applicants for categorical surgical positions (down 14%) and increasing attrition rates for surgical residents (now 25%), point to upcoming shortand long-term crises. This realization led to concerns being raised at the October 2001 meeting of the Association of Program Directors in Surgery and at other presentations and discussions at the American College of Surgeons.