Annual Meeting 2019 Presentations

Ryan J Ellis, MD, MS, D. Brock Hewitt, MD, MPH, MS, Yue-Yung Hu, MD, MPH, Kathryn E Engelhardt, MD, MS, Anthony D Yang, MD, MS, Ryan P Merkow, MD, MS, Karl Y Bilimoria; Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL


Background: High attrition rates persist in general surgery residency. However, the thought process of residents considering attrition is poorly understood. The objectives of this study were to (1) characterize the frequency of thoughts of attrition in general surgery residents, (2) identify alternative career paths being considered by those with thoughts of attrition, and (3) examine reasons that those with thoughts of attrition had not left residency.

Methods: Cross-sectional national survey of clinically active general surgery residents administered in conjunction with the 2018 American Board of Surgery In-Training Examination. Outcomes of interest were thoughts of attrition, alternative career paths being considered, and reasons for staying in residency. Associations between outcomes and resident demographics, satisfaction with training, and duty hour violations were assessed by chi-square tests.

Results: Among 7,409 residents (99.3% response rate) from 262 general surgery programs, 930 (12.6%) reported thoughts of attrition over the last year. Residents were more likely to report thoughts of attrition if female (16.1% vs 10.1%, p<0.001) or if they were dissatisfied with time for rest (28.1% vs 5.2%, p<0.001), resident education (36.1% vs 6.6%, p<0.001), time for family (25.2% vs 4.0%, p<0.001), or reported 80 hour rule violations in more than two of the last six months (29.0% vs 9.9%, p<0.001). Among residents reporting thoughts of attrition, 49.7% considered leaving for non-medical careers, 46.2% for another general surgery residency, and 35.2% for a non-surgical residency. Female residents more frequently reported considering a non-medical career (54.6% vs 44.9%, p=0.015). The most common reasons for remaining in residency included a sense of too much invested to leave (65.3%), satisfaction with surgery as a career (55.5%), and satisfaction with caring for patients (51.7%).

Conclusion: More than one in ten clinically active general surgery residents have recently considered attrition, with nearly half of those considering leaving medicine altogether. Many residents cited continued enjoyment of surgery and patient care as reasons for continuing training. Efforts to improve both work-life balance and the amount of time in training spent on patient care activities may assist in further reducing the attrition rate in general surgery training.