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Academic Medicine:
doi: 10.1097/ACM.0b013e31828b7bff
Letters to the Editor

Two Thousand Is Too Many: What Must Be Done to Prevent Resident Attrition

Ramachandran, Sujantha MD

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Assistant professor of anesthesiology and associate program director, Anesthesiology Residency, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; sramacha@montefiore.org.

To the Editor: As the associate program director of a moderately large anesthesiology residency program, I receive several applications every year from residents who wish to transfer from other training programs. Why do residents who have undergone the arduous process of applying to, interviewing for, and securing a residency position discontinue the training that they worked so hard to obtain?

Resident attrition is a serious problem that poses significant challenges to the residents remaining in the abandoned program as well to those in the newcomer’s adopted program and to both programs’ directors. Hospital-specific limits on the number of GME positions that Medicare will fund reduce the flexibility to vary resident numbers to accommodate changes in residents’ plans.1 Resident attrition is a problem among most specialties. In 2011, the Accreditation Council for Graduate Medical Education reported that 2,200 (2.4%) residents within accredited residency programs failed to complete training.2

The most common reason that I hear from change applicants for abandoning their original specialties is the realization that their initial specialty choices are not right for them. Program directors on the receiving end of these applicants are faced with the important questions of how passionate these applicants are about the “new” specialty and what their perceptions are about that specialty. Program directors also have to deal with the dynamic of integrating a new member into the residency team. These are substantial challenges.

Since the numbers are relatively small for each specialty, I propose that all specialties work together to gather data on attrition so that we have a deeper understanding of it and can work to prevent it. It is also important that medical schools and residency programs work together to connect residencies with medical students who might be future applicants to those residencies, not merely in “clubs” as a recruitment venture but also to help students gain a deeper appreciation for the values held by those in the specialty, the types of work involved, and lifestyle options. We who manage residency programs don’t want to just recruit—We want to recruit those who will embrace the values of our specialty and be passionate about the work throughout their careers.

Sujantha Ramachandran, MD

Assistant professor of anesthesiology and associate program director, Anesthesiology Residency, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; sramacha@montefiore.org.

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References

1. Andriole DA, Jeffe DB, Hageman HL, Klingensmith ME, McAlister RP, Wheelan AJ. Attrition during graduate medical education— Medical school perspective. Arch Surg. 2008;143:1172–1177

2. Accreditation Council for Graduate Medical Education. . Data Resource Book Academic Year 2010–. 2011. http://www.acgme.org/acgmeweb/Portals/0/PFAssets/PublicationsBooks/2010-2011_ACGME_DATA_RESOURCE_BOOK.pdf. Accessed January 11, 2013.

© 2013 Association of American Medical Colleges

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