2004 APDS spring meeting: part 3Why do residents leave general surgery? The hidden problem in today’s programs
Introduction
General surgery residency programs are in increasing turmoil for a number of reasons. The recent initiation of the 80-hour workweek1, 2 and the emergence and increased utilization of new technology in several fields of endeavor, including laparoscopic surgery and endovascular surgery,3, 4have provided new challenges to surgical education. Faculty members are working harder, longer, and with reduced reimbursements, resulting in diminished time for teaching. Additionally, the consideration of entirely new paradigms in surgical training, with some advocating 3 years of general surgery training followed by 3 years of specialty training, whereas others push for 4 and 2, and yet others bemoan any change in the status quo, has placed a strain on residency programs. Although the results from 2003 and 2004 are encouraging, with 11 and 2 unfilled categorical positions, respectively;5, 6 lurking in the program director’s mind are the bleak statistics of the 2001 and 2002 National Resident Matching Program (NRMP), which noted 68 unfilled categorical positions in 2001 and 58 unfilled categorical positions in 2002.7, 8
Although the above issues are cause for concern and perhaps trepidation, a problem with even more immediacy and possibly with more opportunity for solution lies largely hidden within our residency programs: attrition of surgical residents. Although the literature regarding withdrawal rate of residents from general surgery training programs is limited, there have been a number of studies that document a fairly consistent attrition rate of 14% to 23%.9, 10, 11, 12 Other studies have looked more broadly at attrition rates in surgery programs by means of national surveys13, 14, 15, 16 or by looking at specific specialties.17, 18, 19 The stimulus for our own review of resident withdrawal was an upcoming Residency Review Committee for Surgery evaluation of our program and a degree of curiosity about the reasons for withdrawal as well as the demographics of those who had withdrawn.
Section snippets
Design, setting, and participants
Over a 13-year period of time, from 1990 to 2003, 120 residents were accepted into our general surgery residency program in 5-year categorical positions. Of these, 20 residents withdrew from the program over that period of time. The complete files of those 20 residents (11 male and 9 female) were reviewed in detail and form the basis for this report. Residents who matched into preliminary positions, including designated 3-and-3 plastic surgery positions, were not included in this study.
Results
Our overall attrition rate during this 13-year period of time was 17%. This figure (essentially losing 1 of every 6 surgical residents) is within the range reported by most programs (see Table 1). Most programs divide their withdrawals into 2 categories: voluntary and involuntary. In that respect, 16 of the 20 residents (80%) withdrew voluntarily, with 15 of the 16 continuing in another medical specialty and 1 leaving the practice of medicine entirely. Four residents left involuntarily
Discussion
It is no wonder that, given the enormous changes in surgical technology, sicker patients and therefore increasing workload, work constraints, declining reimbursement, government oversight, and other factors, surgical residents may conclude that they have made a wrong decision. Although many medical students take additional rotations in a variety of surgical fields, it is almost impossible for them to understand completely both the difficulties and the joys of “the surgical life.” Faculty
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National Residency Matching ProgramResults and Data, 2004 Match
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Investigating First Year Surgery Residents' Expectations of Demand, Control, and Support During Training
2024, Journal of Surgical EducationIdentifying Potential Attrition during the Residency Applicant Screening Process Using a Situational Judgment Test
2022, Journal of Surgical EducationGender differences in work-life balance of European neurosurgeons
2022, Brain and SpinePublic Perceptions of General Surgery Residency Training
2021, Journal of Surgical EducationCitation Excerpt :Fifty articles were excluded as they did not address perceptions of general surgery residency training. The majority of the published literature regarding perceptions of general surgery training pertained to those perceptions of medical students, residents, fellows, and faculty (e.g., Table 18-89). Only 7 manuscripts met the inclusion criteria, meaning that articles assessing the public's perception of general surgery training constitute 3% of the published literature90-96 (Table 2).
Race, Gender, and Residency: a Survey of Trainee Experience
2021, Journal of the National Medical AssociationCitation Excerpt :Former classmates are left with the addition of an unexpected often burdensome labor shortage, while program officials are left to manage the resulting disruptions of patient care, scheduling and coverage challenges, and demoralized house staff. Residents with certain demographics, specifically racial minority and female gender, have been reported as making up a disproportionate number of the cohort of trainees who undergo attrition.3,6-8 Demographic based-differential attrition poses unique short and long-term challenges in addition to the already stated issues with voluntary attrition.