Why Residents Quit: National Rates of and Reasons for Attrition Among Emergency Medicine Physicians in Training

Abstract

Introduction Recruiting and retaining residents who will complete their emergency medicine (EM) training is vital, not only because residency positions are a limited and costly resource, but also to prevent the significant disruptions, increased workload, and low morale that may arise when a resident prematurely leaves a program. We investigated national rates of EM resident attrition and examined the reasons and factors associated with their attrition. Methods In this retrospective, observational study we used national data from the American Medical Association National Graduate Medical Education Census for all residents who entered Accreditation Council for Graduate Medical Education-accredited EM programs between academic years 2006–2007 and 2015–2016. Our main outcome was the annual national rate of EM resident attrition. Secondary outcomes included the main reason for attrition as well as resident factors associated with attrition. Results Compared to the other 10 largest specialties, EM had the lowest rate of attrition (0.8%, 95% confidence interval [CI] [0.7–0.9]), or approximately 51.6 (95% CI [44.7–58.5]) residents per year. In the attrition population, 44.2% of the residents were women, a significantly higher proportion when compared to the proportion of female EM residents overall (38.8%, p=0.011). A greater proportion of Hispanic/Latino (1.8%) residents also left their programs when compared to their White (0.9%) counterparts (p<0.001). In examining reasons for attrition as reported by the program director, female residents were significantly more likely than male residents to leave due to “health/family reasons” (21.5% vs 9.6%, p=0.019). Conclusion While the overall rate of attrition among EM residents is low, women and some under-represented minorities in medicine had a higher than expected rate of attrition. Future studies that qualitatively investigate the factors contributing to greater attrition among female and some ethnic minority residents are necessary to inform efforts promoting inclusion and diversity within the specialty.

Rate of Programs Affected by Resident Attrition and Program Factors Associated With Attrition in Emergency Medicine

“…Recent work demonstrated that female EM residents had significantly higher attrition rates than their male colleagues. 10 In our study, while having more female residents or full-time female faculty were associated with attrition in bivariate analyses, the statistical significance disappeared in multivariate analysis.…”

“…Our results reveal an average incidence of resident attrition in EM of 0.85% per year, consistent with other reports. 3,10 For comparison, studies have demonstrated an attrition rate among general surgery residents to be up to 26%. 8 A resident attrition rate of almost 7% was reported in the neurological surgery literature, 11 4.2% in OB-GYN, 3 and 1.1% in ophthalmology.…”

Who Gets the Benefit of the Doubt? Performance Evaluations, Medical Errors, and the Production of Gender Inequality in Emergency Medical Education

“…All residents remained in the study sample for the full amount of time expected based on their cohort. Attrition rates from residency are low, and EM residency has the lowest rate of attrition (less than 1 percent) of all major medical specialties (Lu et al 2019). Our dataset does not include information about race or other demographic characteristics beyond gender for either attendings or residents, a limitation we discuss in more detail in the Discussion section.…”

Medical students need experience not just competence

“…These factors, though, are an insufficient explanation for the UK’s retention problem. Only 10% of trainees (interns and residents) in the US, the Netherlands, and New Zealand take career breaks456 despite negative psychosocial experiences 78. The relative immaturity of UK trainees cannot explain their career breaks because students enter medicine straight from high school in the Netherlands and New Zealand too.…”