Prestigious educational pedigree matters much in the hiring and retention of academic surgeons. Should it?

Surgeons who not only operate on patients but also conduct impactful research and educate new surgeons tend to have something in common: They began their careers by graduating from a top-ranked medical school—and then stayed inside that rarified healthcare stratum for good. 

This pathway to faculty appointments at high-ranking med schools only seems reasonable. However, according to a study slated for publication in the October edition of the Journal of Surgical Education, there is a potential downside. 

“While this concentration may reflect successful training environments and strong scholarly productivity,” the authors remark, “it may also narrow the diversity of educational experiences and perspectives represented within academic departments.” 

Harvey Romell Lewis II, MD, and colleagues at the University of Chicago offer the concern for consideration based on one of their key findings: 

Almost 70% of current surgery-department chairs at the top 100 medical schools have an academic pedigree that includes one of the five highest-ranked medical-education programs. 

What’s more, Lewis et al. report, top-ranked programs “preferentially retain their own trainees for faculty positions.”

Air of exclusivity 

For the research, Lewis and team performed a cross-sectional analysis of 2,364 surgical faculty members at the top 20 medical schools as listed in the 2023 edition of U.S. News & World Report’s “Best Medical Schools” rankings. 

The researchers excluded surgeons in non-professorial positions and those trained entirely outside of the United States. They ranked educational pedigrees using composite medical school, hospital and specialty rankings.

Their key findings: 

• Among the 2,364 surgeons identified, 460 (19%) trained at the No. 1 ranked medical school or an affiliated residency or fellowship. 
   
• An academic pedigree including a top-5 program was seen in 1,416 surgeons (60%), a top-50 pedigree in 2,259 (96%). 
   
• More than half (1,268; 54%) were employed at institutions where they had trained.

Lonesome at the top? 

In their discussion section, Lewis and co-authors underscore and comment on findings that they deem important or consequential. Among them are the following five.
 

1. The vast majority of surgeons at top-20 institutions have academic pedigrees that include training at the highest-ranked institutions. 

As the level of training increased, the median rank and variance decreased, the researchers note. They suggest this finding indicates “an increasing importance of completing training at higher-ranked institutions in the pursuit of an academic career at a top-20 faculty institution.”

2. Close to one-third of the surgeons in the study group, 31%, were women. 

“This is fairly consistent with national estimates on the composition of the overall surgical workforce,” Lewis and co-authors point out, adding that the American Board of Surgery reported that women made up 29.1% of currently certified general surgeons in July 2025.

3. Previous studies across multiple educational disciplines have demonstrated a strong association between institutional prestige and faculty hiring. 

Similarly, the present findings “highlight the limited upward mobility within academia and the strong influence of institutional hierarchy,” Lewis et al. state. “Even outside of surgery, faculty hiring tends to favor a small subset of highly ranked programs, underscoring the persistent role of academic prestige in shaping career advancement.”

4. The potential importance of positions at the top-ranked institutions is particularly relevant because top-ranked institutions have a disproportionate influence on the surgical profession. 

The top 20 medical schools represent less than 10% of all U.S. medical schools, the researchers emphasize—yet the faculty at these institutions “account for a substantial proportion of leadership within organizations such as the American College of Surgeons, including more than 55% of its officers and 25% of the members of the board of Regents.”

5. Hiring patterns at these institutions may influence not only the composition of individual departments but also the future leadership, priorities and direction of academic surgery. 

With this, Lewis et al. conclude: 

“Future studies should examine whether broadening the range of training backgrounds represented among faculty influences mentorship, innovation, leadership and collaboration within academic surgery while maintaining the academic excellence of these institutions.” 

The full study is posted here.