A National Study of Attrition During General Surgery Training:
Which Residents Leave, and Where Do They Go?
*Heather Yeo1, *Emily Bucholz1, *Julie Ann Sosa1, *Leslie Curry1, Frank R. Lewis, Jr.2, *Andrew T. Jones2, *Kate Viola1, *Zhenqui Lin1, Richard H Bell, Jr.2
1Yale University, New Haven, CT;2American Board of Surgery, Philadelphia, PA
Implementation of the 80-hour mandate was expected to reduce attrition from general surgery (GS) residency. This is the first quantitative report from a national prospective study of resident/program characteristics associated with attrition.
Analysis included all categorical GS residents entered on American Board of Surgery (ABS) residency rosters in 2007-8. Cases of attrition were identified by program report, individually confirmed, and linked to demographic data from the National Study of Expectations and Attitudes of Residents in Surgery (NEARS) administered January 2008.
RESULTS 6,303 categorical GS residents were analyzed for overall attrition. Complete NEARS demographic information was available for 3,962; the total and survey groups were similar with regard to important characteristics. 3.1% of U.S categorical residents resigned in 2007-8, and 0.4% had contracts terminated. Across all years (including research), there was a 19.5% cumulative risk of resignation. Attrition was highest in R1 (6.1%), R2 (4.4%) and research year(s) (4.3%). Women were no more likely to leave programs than men (2.4% vs. 2.0%). Of several program/resident variables examined, PGY-level was the only independent predictor of attrition in multivariate analysis. Residents who left GS whose plans were known most often pursued non-surgical residencies (85%), particularly anesthesiology (26%) and radiology (15%). Only 15% left for surgical specialties.
CONCLUSIONS:<br /Attrition rates are high despite mandated work hour reductions; one in five GS categorical residents resigns, and most pursue nonsurgical careers. Residents are at risk for attrition early in training and during research, and this could afford educators a target for intervention.