The job market for HPB surgeons: leadership perspectives on surgeon skillsets, training pathways, and hiring

Published:October 02, 2022DOI:



      Three tracks prepare Hepato-Pancreato-Biliary (HPB) surgeons: HPB, surgical oncology, and transplant fellowships. This study explored how surgical leaders thought about HPB surgery and evaluated potential candidates for HPB positions.


      This descriptive qualitative study utilized interviews of healthcare leaders whose responsibilities included hiring HPB surgeons. We coded inductively then used thematic network analysis to organize the data. Individual codes formed basic themes, then larger secondary themes, then finally “primary” themes.


      Primary themes were: (1) What defines an HPB surgical practice?, (2) How do they assess candidates for HPB positions?, and (3) How will HPB practices continue to evolve? Leaders assessed applicants’ training, behaviors and cultural fit, technical excellence, and more. Personal recommendations and professional networks significantly influenced the hiring process. HPB surgery needs were growing due to population changes, treatments advances, and changing market conditions.


      Surgical societies should focus on facilitating networking, promoting transparency, sharing quality data, providing evidence of technical skills and teamwork, mentorship, and providing guidance to general surgery residency program directors. There is great interest in unification and cooperation across the profession, protocol standardization enhancing quality, continued workforce diversification, and evaluation of the alignment between training and practice.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to HPB
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jeyarajah D.R.
        • Abouljoud M.
        • Alseidi A.
        • Berman R.
        • D'Angelica M.
        • Hagopian E.
        • et al.
        Training paradigms in hepato-pancreatico-biliary surgery: an overview of the different fellowship pathways.
        J Gastrointest Surg. 2021 Aug; 25: 2119-2128
        • Warner S.G.
        • Alseidi A.A.
        • Hong J.
        • Pawlik T.M.
        • Minter R.M.
        What to expect when you're expecting a hepatopancreatobiliary surgeon: self-reported experiences of HPB surgeons from different training pathways.
        HPB. Sep 2015; 17: 785-790
        • Corbin J.
        • Strauss A.
        Basics of qualitative research: techniques and procedures for developing grounded theory.
        4th ed. SAGE Publications Ltd., Thousand Oaks, CA2015
        • Glaser B.
        • Strauss A.
        The discovery of grounded theory: strategies for qualitative research.
        Aldine Transaction, New Brunswick1999
        • Hennick M.M.
        • Kaiser B.N.
        • Marconi V.C.
        Code saturation versus meaning saturation: how many interviews are enough?.
        Qual Health Res. 2017; 27: 591-608
        • Morse J.M.
        Critical analysis of strategies for determining rigor in qualitative inquiry.
        Qual Health Res. 2015; 25: 1212-1222
        • Attride-Stirling J.
        Thematic networks: an analytic tool for qualitative research.
        Qual Res. 2001; 1: 385-405
        • Pories S.E.
        • Turner P.
        • Greenberg C.C.
        • Babu M.A.
        • Parangi S.
        Leadership in American surgery: women are rising to the top.
        Ann Surg. 2019; 269: 199-205
        • Merrill A.
        • Beal E.W.
        • Ackah R.
        • Patterson K.
        • Horning P.
        • Ejaz A.
        • et al.
        Women in hepatopancreaticobiliary surgery: is there a pipeline problem?.
        HPB. 2021; 23: 817-820
        • Pickens R.C.
        • Bloomer A.K.
        • Sulzer J.K.
        • Murphy K.
        • Lyman W.B.
        • Iannitti D.A.
        • et al.
        Modifying interhospital hepatopancreatobiliary transfers based on predictive analytics: moving from a center of excellence to a health-care system of excellence.
        Am Surg. Sep 1 2019; 85: 1033-1039
        • Yadav D.
        • Lowenfels A.B.
        The epidemiology of pancreatitis and pancreatic cancer.
        Gastroenterology. Jun 2013; 144: 1252-1261
        • Papis D.
        • Vagliasindi A.
        • Maida P.
        Hepatobiliary and pancreatic surgery in the elderly: current status.
        Ann Hepatobiliary Pancreat Surg. Feb 2020; 24: 1-5
        • Subhas G.
        • Mittal V.K.
        Training minimal invasive approaches in hepatopancreatobilliary fellowship: the current status.
        HPB. Mar 2011; 13: 149-152
        • Patti J.C.
        • Ore A.S.
        • Barrows C.
        • Velanovich V.
        • Moser A.J.
        Value-based assessment of robotic pancreas and liver surgery.
        Hepatobiliary Surg Nutr. 2017; 6: 246-257
        • Hartford L.
        • Doucet V.
        • Ramkumar J.
        • Leslie K.
        • Shum J.
        • Asai K.
        The impact of a new hepatopancreatobiliary surgery program on the management of pancreatic cancer at Health Sciences North.
        Can J Surg. Aug 1 2019; 62: 275-280
        • Lau K.
        • Salami A.
        • Barden G.
        • Khawja S.
        • Castillo D.L.
        • Poppelaars V.
        • et al.
        The effect of a regional hepatopancreaticobiliary surgical program on clinical volume, quality of cancer care, and outcomes in the Veterans Affairs system.
        JAMA Surg. 2014; 149: 1153-1161
        • Rosemurgy A.S.
        • Ryan C.E.
        • Klein R.L.
        • Wood T.W.
        • Co F.
        • Ross S.B.
        Financial benefits of a hepatopancreaticobiliary program.
        Am Surg. 2016; 82: 380-385
        • Thompson J.S.
        • Murayama K.M.
        • Edney J.A.
        • Rikkers L.F.
        Pancreaticoduodenectomy for suspected but unproven malignancy.
        Am J Surg. 1994; 168 (; discussion 573-575): 571-573
        • Cameron J.L.
        • Riall T.S.
        • Coleman J.
        • Belcher K.A.
        One thousand consecutive pancreaticoduodenectomies.
        Ann Surg. 2006; 244: 10-15
        • Imamura H.
        • Seyama Y.
        • Kokudo N.
        • Maema A.
        • Sugawara Y.
        • Sano K.
        • et al.
        One thousand fifty-six hepatectomies without mortality in 8 years.
        Arch Surg. 2003; 138 (; discussion 1206): 1198-1206
        • Mise Y.
        • Sakamoto Y.
        • Ishizawa T.
        • Kaneko J.
        • Aoki T.
        • Hasegawa K.
        • et al.
        A worldwide survey of the current daily practice in liver surgery.
        Liver Cancer. 2013; 2: 55-66
        • Schwarz J.L.
        • Hogg M.E.
        Current state of minimally invasive pancreatic surgery.
        J Surg Oncol. May 2021; 123: 1370-1386
        • Ali N.
        • O'Rourke C.
        • El-Hayek K.
        • Chalikonda S.
        • Jeyarajah D.R.
        • Walsh R.M.
        Estimating the need for hepato-pancreatico-biliary surgeons in the USA.
        HPB. Apr 2015; 17: 352-356
        • Robson A.J.
        • Parks R.W.
        HPB fellowship training: consensus and convergence.
        HPB. May 2016; 18: 397-399
        • Jeyarajah D.R.
        • Berman R.S.
        • Doyle M.
        • Geevarghese S.K.
        • Posner M.C.
        • Farmer D.
        • et al.
        Consensus conference on North American training in hepatopancreaticobiliary surgery: a review of the conference and presentation of consensus statements.
        Ann Surg Oncol. Jul 2016; 23: 2153-2160
        • Minter R.M.
        Hepatopancreatobiliary surgery fellowships: how many do we need?.
        JAMA Surg. Mar. 2016; 151: 213-214
        • Seshadri R.M.
        • Ali N.
        • Warner S.
        • Cochran A.
        • Vrochides D.
        • Iannitti D.
        • et al.
        Training and practice of the next generation HPB surgeon: analysis of the 2014 AHPBA residents’ and fellows’ symposium survey.
        HPB. Dec 2015; 17: 1096-1104
        • Pagkratis S.
        • Cho E.E.
        • Lewis F.
        • Miller K.
        • Osman H.
        • Doyle M.B.N.
        • et al.
        Expectations of hepato-pancreato-biliary fellows; do we meet them?.
        J Surg Educ. Nov–Dec 2019; 76: 1546-1555
        • Merrill A.
        • Beal E.W.
        • Ackah R.
        • Patterson K.
        • Horning P.
        • Ejaz A.
        • et al.
        Women in hepatopancreaticobiliary surgery: is there a pipeline problem?.
        HPB. Jun 2021; 23: 817-820
        • Sorouri K.
        • Khan S.
        • Bowden S.
        • Searle S.
        • Carr L.
        • Simpson J.S.
        The glaring gender bias in the operating room: a qualitative study of factors influencing career selection for first-year medical students.
        J Surg Educ. Sep–Oct 2021; 78: 1516-1523
        • Valbuena V.S.M.
        • Obayemi J.E.
        • Purnell T.S.
        • Scantlebury V.P.
        • Olthoff K.M.
        • Martins P.N.
        • et al.
        Gender and racial disparities in the transplant surgery workforce.
        Curr Opin Organ Transplant. Oct 1 2021; 26: 560-566
        • Pawlik T.M.
        Dream big, think little: the impact of the AHPBA.
        HPB. 2021; 23: S443-S447
        • Pitt H.A.
        IHPBA: the first 25 years.
        HPB. 2020; 22: 1655-1666
        • Sheetz K.H.
        • Nuliyalu U.
        • Nathan H.
        • Sonnenday C.J.
        Association of surgeon case numbers of pancreaticoduodenectomies vs related procedures with patient outcomes to inform volume-based credentialing.
        JAMA Netw Open. Apr 1 2020; 3e203850