Attrition and replacement of general surgery residents

Attrition from surgical residency training: perspectives from those who left

“…Our study offers a deeper understanding and contextual lens to findings from the existing quantitative literature which catalog factors leading to attrition in surgical residency. [2][3][4][5]7,[9][10][11]20,26,27 Many of our findings are consistent with previous studies and this qualitative perspective contributes a nuanced understanding of this phenomenon. For example, our participants felt similarly frustrated about educational time being overwhelmed by clinical duties.…”

“…1 Changes in graduate surgical education policy, such as transitioning to a nonpyramidal structure, instituting an 80-hour work week, implementing 16-hour shift rules for interns, and increasing supervision at junior levels, have had little effect on attrition among categorical general surgery residents. [2][3][4] Despite these myriad Accreditation Council for Graduate Medical Education (ACGME) regulations, 5,6 attrition rates in general surgery programs continue to range from 3 to 5.8% annually, 7,8 and remain as high as 26% over the course of a 5-to 7-year residency program. 2,4,8 Programs reporting the loss of multiple residents increased from 29% to 44% after the 80-hour work week was implemented 5 and rates have continued to rise.…”

“…5,9 Several studies have identified factors that contribute to general surgery resident attrition, including perceived deficits in day-to-day operative experience, difficult relationships with faculty and peers, PGY-1 status, and non-Southern program location. 3,4,7,8,10 Studies have differed on the effect of female gender on resident attrition. 3,10 Program directors have broadly cited work-hour and lifestyle considerations as the most common reasons for attrition.…”

“…3,10 Program directors have broadly cited work-hour and lifestyle considerations as the most common reasons for attrition. 7,8 Across studies, these factors were identified using quantitative methods with structured, forced-choice questionnaires, generating important yet limited understanding of a deeply complex and multifaceted phenomenon.…”

“…Prior investigation also has shown most residents switch out of surgery entirely, as opposed to entering another general surgery or surgical sub-specialty training program, 4,5,7,11 contributing to concerns about whether current training will keep pace with anticipated needs in the country's surgical workforce. With some organizations estimating an impending shortage of general surgeons by greater than 21,000 by 2020, 1 a deeper understanding of individual experiences of attrition can inform ongoing efforts to mitigate risk factors for attrition from surgical residency training.…”