Demand Shock Exposes Surgical Training Problem: What Bariatric Volume Collapse Reveals About the Future of Minimally Invasive Surgery Fellowship Training

Metabolic and bariatric surgery (MBS) volume has contracted sharply in the era of GLP-1 receptor agonists, exposing a mismatch among residency competence, MIS fellowship structure, and bariatric workforce demand. Therefore, we propose that core MIS and robotic competence should move into residency training under enforceable ACGME and American Board of Surgery (ABS) standards, while remaining fellowships train multifaceted MIS surgeons with additional bariatric depth rather than bariatric-only specialists. In this Viewpoint, we call for three reforms: MIS and robotic credentialing within residency, consolidation of MBSAQIP-accredited centers through enforced volume standards, and meaningful fellowship contraction with curricular recalibration. These changes satisfy existing governance roles: ACGME for residency requirements, ABS for board standards, partner societies for curricula, and the Fellowship Council for accreditation and match oversight. The aim is not to diminish bariatric specialization, but to preserve it by concentrating advanced training and case volume where expertise can be maintained, and workforce demand can support durable practice.