“…This may be due to factors such as having a larger or more influential network within the institution or the benefit that familiarity with an institution may provide in successfully fulfilling the role of PD ( Van Horne et al ). Some studies have commented on the impact of institutional loyalty on the appointment of PDs across other medical specialties such as cardiothoracic imaging and orthopedic surgery ( Cummings et al, 2023 , Zippi et al, 2022 ) In both of these fields, almost 60% of PDs held positions at institutions where they p.ursued medical education or training ( Cummings et al, 2023 , Zippi et al, 2022 ). This is a higher proportion than our finding for GYO PDs, which may indicate that institutional loyalty plays a more significant role in the appointment of PDs in other fields compared to GYO.…”