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A National Study of Attrition in General Surgery Training: Which Residents Leave and Where Do They Go?

Yeo, Heather MD*; Bucholz, Emily BA*; Ann Sosa, Julie MD*; Curry, Leslie PhD, MPH*; Lewis, Frank R. Jr. MD†; Jones, Andrew T. PhD†; Viola, Kate MD*; Lin, Zhenqui PhD*; Bell, Richard H. Jr. MD†

doi: 10.1097/SLA.0b013e3181f2789c
Original Articles

Objective(s): 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.

Methods: Analysis included all categorical GS residents entered on American Board of Surgery residency rosters in 2007 to 2008. 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 administered January 2008.

Results: All surgical categorical GS residents active on the 2007–2008 resident rosters (N = 6,303) were analyzed for attrition. Complete National Study of Expectations and Attitudes of Residents in Surgery demographic information was available for 3959; the total and survey groups were similar with regard to important characteristics. About 3% of US categorical residents resigned in 2007 to 2008, and 0.4% had contracts terminated. Across all years (including research), there was a 19.5% cumulative risk of resignation. Attrition was highest in PGY-1 (5.9%), PGY-2 (4.3%), and research year(s) (3.9%). Women were no more likely to leave programs than men (2.1% vs. 1.9%). Of several program/resident variables examined, postgraduate year-level was the only independent predictor of attrition in multivariate analysis. Residents who left GS whose plans were known most often pursued nonsurgical residencies (62%), particularly anesthesiology (21%) and radiology (11%). Only 13% left for surgical specialties.

Conclusions: Attrition rates are high despite mandated work hour reductions; 1 in 5 GS categorical residents resigns, and most pursue nonsurgical careers. Demographic factors, aside from postgraduate year do not appear predictive. Residents are at risk for attrition early in training and during research, and this could afford educators a target for intervention.

This is the first quantitative report from a national prospective study of resident/program characteristics associated with attrition. Postgraduate year appeared to be most strongly associated with resignation. Residents most at risk for attrition were early in training or in research, and this could afford educators a target for intervention.

From the *Department of Surgery, Yale University School of Medicine, New Haven, CT; and †American Board of Surgery, Philadelphia, PA.

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the Work, except as disclosed on a separate attachment. All funding sources supporting the Work and all institutional or corporate affiliations of the authors are acknowledged in a footnote in the Work.

Heather Yeo, MD, contributed to study design, analysis, paper writing, and editing. Emily Bucholz, BA, contributed to data analysis, data collection, and manuscript editing. Julie Ann Sosa, MD contributed to development of the paper, and study design and paper editing. Leslie Curry, PhD, MPH contributed top paper editing and study design. Frank R. Lewis, MD, Jr. contributed by helping with study design, paper writing, and proof reading. Andrew T. Jones, PhD helped with paper editing/writing and analysis. Kate Viola, MD, helped with study design and implementation. Zhenqui Lin PhD, helped with data analysis, paper writing, and database management. Richard H. Bell Jr, MD helped with project development, paper writing, paper editing.

Reprints: Heather Yeo, MD, Department of Surgery, Yale University School of Medicine, P. O. Box 208062, New Haven, CT 06520–8062. E-mail: heather.yeo@yale.edu.

© 2010 Lippincott Williams & Wilkins, Inc.