Incidence of attrition among early-career abdominal transplant surgeons

Delman, Aaron M.; Kassam, Al‐Faraaz; Turner, Kevin M.; Ammann, Allison M; Lynch, Caroline; Morris, Mackenzie C.; Vaysburg, Dennis M.; Cortez, Alexander R.; Quillin, Ralph C.

doi:10.1016/j.surg.2022.08.017

Cited by 9 publications

(7 citation statements)

References 16 publications

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“…7,8 Furthermore, transplant surgeons sleep significantly less than the average American, averaging 6.33 h a night. 9 This optimal procurement time could possibly further contribute to lack of sleep among these individuals and lead to higher rates of burnout [10][11][12][13][14][15] as well as medical errors. 16 However, this scheduled procurement timing could possibly alleviate lack of transparent schedules among providers.…”

Section: Discussionmentioning

confidence: 99%

Is Time Scheduling Important? An Analysis of Donor Heart Cross-clamp Times During Heart Transplantation

Gouchoe,

Ganapathi,

Cui

et al. 2024

Transplantation Direct

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Background. Outcomes in heart transplantation are affected by a variety of variables and patient factors. However, the impact of circadian rhythms, gene expression, and transcription remain underexplored. We thus evaluated the potential role of donor heart cross-clamp times on short-term and long-term outcomes after heart transplantation. Methods. A total of 31 713 heart transplants were identified from the United Network for Organ Sharing Database. Patients were first stratified on the basis of time of donor procurement: 12 am to 12 pm or 12 pm to 12 am. To evaluate a possible effect of circadian rhythms, donor time was further divided into 5 groups based on preclinical data: 4 am to 8 am; 8 am to 11 am; 11 am to 5 pm; 5 pm to 10 pm; 10 pm to 4 am. Groups were assessed with comparative statistics. Long-term survival was evaluated using Kaplan-Meier methods and a multivariate Cox proportional hazard model. Results. Patients who received hearts recovered between 12 am and 12 pm had significantly higher survival than those who received hearts recovered between 12 pm and 12 am. This survival difference was observed in both unadjusted (P = 0.002) and adjusted analyses (hazard ratio [HR]: 0.93; 95% confidence interval [CI], 0.89-0.97; P < 0.001). On unadjusted analysis, the survival difference among the 5 groups was insignificant (P = 0.07). Following adjustment, the periods of 11 am to 5 pm (HR: 1.09, 95% CI, 1.02-1.17; P = 0.012), 5 pm to 10 pm (HR: 1.11; 95% CI, 1.04-1.19; P = 0.002), and 10 pm to 4 am (HR: 1.07; 95% CI, 1.01-1.15; P = 0.034), were all independently associated with increased long-term mortality. Notably, the time of 8 am to 11 am was not associated with a change in survival (HR: 1.04; 95% CI, 0.96-1.14; P = 0.3). Conclusions. Given the independent association of donor timing and survival after adjustment in a large national cohort, further investigation into the role of donor circadian rhythm and donor procurement time is warranted in preclinical and clinical studies. Understanding the underlying mechanisms of this observation could potentially lead to the development of effective treatments and donor procurement processes that prepare the organs for transplantation in a better condition.

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Section: Discussionmentioning

confidence: 99%

Is Time Scheduling Important? An Analysis of Donor Heart Cross-clamp Times During Heart Transplantation

Gouchoe,

Ganapathi,

Cui

et al. 2024

Transplantation Direct

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“…Burnout among transplant fellows is prevalent and three primary contributors are work/life balance, finances, and job security, with, 79% of surveyed fellows reporting worry about job opportunities 17 . Recent work also found that 25% of early‐career transplant surgeons experience attrition and leave the field, which was directly associated with individual transplant volume 18 . Rather than implementing non‐individualized, large scale wellness initiatives that have been shown to be time consuming, costly, and ineffective, 19,20 supporting fellows during transition to practice and mentorship during the early years of one's career to achieve job satisfaction may prove more beneficial.…”

Section: Discussionmentioning

confidence: 99%

“…17 Recent work also found that 25% of early-career transplant surgeons experience attrition and leave the field, which was directly associated with individual transplant volume. 18 Rather than implementing non-individualized, large scale wellness initiatives that have been shown to be time consuming, costly, and ineffective, 19,20 supporting fellows during transition to practice and mentorship during the early years of one's career to achieve job satisfaction may prove more beneficial. Despite the challenges associated with the nature of the job, a career in transplant surgery is very rewarding and transplants surgeons report some of the highest rates of satisfaction compared to other surgeons.…”

Section: Center-volume Analysismentioning

confidence: 99%

Examining the transplant case composition of early‐career transplant surgeons

Cortez

Delman

Quillin

2022

Clinical Transplantation

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Fellowship training established by the American Society of Transplant Surgeons and certified by the Transplant Accreditation and Certification Council provides trainees with broad exposure and practice readiness for the core aspects of abdominal transplantation. However, the operative case mix of a new transplant surgeon early in practice is unknown. This study examined the volume and composition of the transplant case mix of early-career transplant surgeons to better inform residents interested in transplantation about potential career opportunities following fellowship. cas 209 early-career transplant surgeons were identified from the UNOS database containing encrypted surgeon-specific identifiers and were included in this study. At 5 years into practice, there were 85 (40.7%) kidney-predominant, 38 (18.2%) liver-predominant, and 86 (41.1%) multiorgan transplant surgeons. Comparing surgeon subgroups, multiorgan surgeons performed more transplants in year 5 of practice than both liver-predominant and kidney-predominant surgeons (both p < .05). This is the first study to describe the transplant case composition of the early-career transplant surgeons. This data can be used to inform aspiring transplant surgeons about potential career opportunities and to assist fellowship programs in guiding and mentoring fellows.

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“…Early-career attrition, often defined as leaving practice within the first 5 to 10 years, is a major issue for several reasons [7,13]. Whereas attrition among older individuals might be attributed to retirement and is seen as a natural component of workforce fluctuations, attrition during the early-career phase poses a host of challenges from an individual, health system, and societal perspective [13,25,28]. Recent survey studies have estimated that most orthopaedic residents report personal debts in excess of USD 200,000 [20,23].…”

Section: Introductionmentioning

confidence: 99%

“…The second condition was consistent absence from the PC-NDF dataset for the following 6 years (Q1 2016, Q1 2017, Q1 2018, Q1 2019, Q1 2020, and Q1 2021), and the third condition was absence from the Centers for Medicare and Medicaid Services Opt-Out registry, which tracks clinicians who have formally discontinued enrollment in the Medicare program. Of the 18,107 orthopaedic surgeons identified in the dataset, 5% (938) were women, 33% (6045) were subspecialty-trained, 77% (13,949) practiced in groups of 10 or more, 24% (4405) practiced in the Midwest, 87% (15,816) practiced in urban areas, and 22% (3887) practiced Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members.…”

mentioning

confidence: 99%

What Factors Are Associated With Early Career Attrition Among Orthopaedic Surgeons in the United States?

Jella

Patel

Cwalina

et al. 2023

Clin Orthop Relat Res

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Background The attrition of medical personnel in the United States healthcare system has been an ongoing concern among physicians and policymakers alike. Prior studies have shown that reasons for leaving clinical practice vary widely and may range from professional dissatisfaction or disability to the pursuit of alternative career opportunities. Whereas attrition among older personnel has often been understood as a natural phenomenon, attrition among early-career surgeons may pose a host of additional challenges from an individual and societal perspective. Questions/purposes (1) What percentage of orthopaedic surgeons experience early-career attrition, defined as leaving active clinical practice within the first 10 years after completion of training? (2) What are the surgeon and practice characteristics associated with early-career attrition? Methods In this retrospective analysis drawn from a large database, we used the 2014 Physician Compare National Downloadable File (PC-NDF), a registry of all healthcare professionals in the United States participating in Medicare. A total of 18,107 orthopaedic surgeons were identified, 4853 of whom were within the first 10 years of training completion. The PC-NDF registry was chosen because it has a high degree of granularity, national representativeness, independent validation through the Medicare claims adjudication and enrollment process, and the ability to longitudinally monitor the entry and exit of surgeons from active clinical practice. The primary outcome of early-career attrition was defined by three conditions, all of which had to be simultaneously satisfied (“condition one” AND “condition two” AND “condition three”). The first condition was presence in the Q1 2014 PC-NDF dataset and absence from the same dataset the following year (Q1 2015 PC-NDF). The second condition was consistent absence from the PC-NDF dataset for the following 6 years (Q1 2016, Q1 2017, Q1 2018, Q1 2019, Q1 2020, and Q1 2021), and the third condition was absence from the Centers for Medicare and Medicaid Services Opt-Out registry, which tracks clinicians who have formally discontinued enrollment in the Medicare program. Of the 18,107 orthopaedic surgeons identified in the dataset, 5% (938) were women, 33% (6045) were subspecialty-trained, 77% (13,949) practiced in groups of 10 or more, 24% (4405) practiced in the Midwest, 87% (15,816) practiced in urban areas, and 22% (3887) practiced at academic centers. Surgeons not enrolled in the Medicare program are not represented in this study cohort. A multivariable logistic regression model with adjusted odds ratios and 95% confidence intervals was constructed to investigate characteristics associated with early-career attrition. Results Among the 4853 early-career orthopaedic surgeons identified in the dataset, 2% (78) were determined to experience attrition between the first quarter 2014 and the same point in 2015. After controlling for potential confounding variables such as years since training completion, practice size, and geographic region, we found that women were more likely than men to experience early-career attrition (adjusted OR 2.8 [95% CI 1.5 to 5.0]; p = 0.006]), as were academic orthopaedic surgeons compared with private practitioners (adjusted OR 1.7 [95% CI 1.02 to 3.0]; p = 0.04), while general orthopaedic surgeons were less likely to experience attrition than subspecialists (adjusted OR 0.5 [95% CI 0.3 to 0.8]; p = 0.01). Conclusion A small but important proportion of orthopaedic surgeons leave the specialty during the first 10 years of practice. Factors most-strongly associated with this attrition were academic affiliation, being a woman, and clinical subspecialization. Clinical Relevance Based on these findings, academic orthopaedic practices might consider expanding the role of routine exit interviews to identify instances in which early-career surgeons face illness, disability, burnout, or any other forms of severe personal hardships. If attrition occurs because of such factors, these individuals could benefit from connection to well-vetted coaching or counseling services. Professional societies might be well positioned to conduct detailed surveys to assess the precise reasons for early attrition and characterize any inequities in workforce retention across a diverse range of demographic subgroups. Future studies should also determine whether orthopaedics is an outlier, or whether 2% attrition is similar to the proportion in the overall medical profession.

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Incidence of attrition among early-career abdominal transplant surgeons

Cited by 9 publications

References 16 publications

Is Time Scheduling Important? An Analysis of Donor Heart Cross-clamp Times During Heart Transplantation

Is Time Scheduling Important? An Analysis of Donor Heart Cross-clamp Times During Heart Transplantation

Examining the transplant case composition of early‐career transplant surgeons

What Factors Are Associated With Early Career Attrition Among Orthopaedic Surgeons in the United States?

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