Elsevier

Current Surgery

Volume 62, Issue 1, January–February 2005, Pages 128-131
Current Surgery

2004 APDS spring meeting: part 3
Why do residents leave general surgery? The hidden problem in today’s programs

https://doi.org/10.1016/j.cursur.2004.07.009Get rights and content

Objective

Much has been written and discussed about the reasons for reduced interest in surgery, but few institutions have chosen to examine the loss or attrition of general surgery residents from their own programs. In preparation for an upcoming Residency Review Committee analysis of our program, we took the opportunity to examine the reasons for attrition in our own institution.

Design, setting, and participants

During the years 1990 to 2003, 120 categorical residents were admitted into our general surgery residency program. Residents who matched into preliminary positions or non-5-year categorical positions were not included in this study. During this period of time, 20 residents (9 female and 11 male) left the program for a variety of reasons. The folders of those 20 residents along with all of the correspondence pertaining to each resident were reviewed in detail.

Results

Our overall attrition rate during this 13-year period of time was 20 of 120 residents or 17%. This is comparable with the often-quoted figure of approximately 20% attrition in other general surgery programs. The reasons for leaving could be divided into 4 categories: (1) lifestyle, (2) opportunity for early specialization, (3) asked to leave the program because of emotional or performance difficulties, or (4) decided to leave medicine entirely. The largest group was related to lifestyle issues and comprised 13 of the total of 20 residents who left the program. Of this group of 13, 3 went into plastic surgery, 4 went into anesthesiology, 2 went into radiology, and the remaining 4 went into public health, internal medicine, pathology, and emergency medicine. Seven of these 13 individuals were women. Two individuals entered residency with the goal of specializing in plastic surgery. They both left their 5-year categorical general surgery positions after the third year when they were offered the opportunity to enter three-year plastic surgery fellowship positions. The third category was composed of 4 individuals who were asked to leave the program during this 13-year period because of performance or emotional problems, with 3 of these 4 being men. Only 1 person left medicine entirely, and he is now the vice-president of a successful software company. Of the total of 20 residents who left our program, 9 (45%) were female. Given that there were 33 females in our program during the subject period of time, these 9 females represent an attrition rate of 27%. The 11 males who left during this period represent, however, an attrition rate of only 13%.

Conclusions

Although much concern has been expressed over the declining numbers of medical students interested in surgery, loss of residents after matching in general surgery is an equally significant problem. In our program over a 13-year period, 20 out 120 residents, or 17% dropped out or were released. The attrition rate for females (27%) was approximately twice that of males (13%), with 7 out of 9 females (78%) leaving for lifestyle reasons.

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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