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Invited Commentary
August 2018

Reducing Surgical Resident Attrition

Author Affiliations
  • 1Department of Surgery, University of Florida College of Medicine, Gainesville
JAMA Surg. 2018;153(8):717-718. doi:10.1001/jamasurg.2018.0619

Resident attrition remains high in general surgical training programs, in which approximately 1 in 5 residents will not complete training. This rate is higher than those of other surgical specialties and has remained constant since the 1990s.1,2 Attrition has not appreciably changed with Accreditation Council for Graduate Medical Education recommendations about duty hours, suggesting that attrition is not just about hours of training. Multiple studies during the past 25 years have examined factors potentially leading to attrition, such as age, sex, American Board of Surgery In-Service Training Examination scores, marital status, and program characteristics with inconsistent findings.

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2 Comments for this article
Surgical Residency Attrition
Philip Alford |
Prior to the 80-hour work week residency restrictions, I used to ask medical students in their 4th year who did well during their surgery rotations what specialties they were applying for. Many surprised me by answering "not surgery". They proceeded to explain that they had self-selected out of general surgery because of the hours the residents put in. After the 80-hour restrictions are in place, many students now opt for a general surgery residency because all residents work less than 80 hours a week (one size fits all, right?). Then other difficult parts of a surgical life manifest themselves, and the attrition kicks in. There is no soft-pedaling the difficult life of a general surgeon, compared to many other medical specialties. Especially since there is a huge emphasis on shift work. Let future residents know up front that in general surgery (like being a SEAL) "the only easy day was yesterday".
80 hour effects
Heather Yeo, MD, MHS | NYP-Weill Cornell Medical Center
Thanks to Dr. Alford for your comments. I actually initially thought that this would happen-that there would be a huge influx of residents with the 80 hours, and also possibly more attrition; however, this has not been the case, there have been a few articles looking at the 80 hours limits and attrition has been constant, despite the work hours. In fact, when surveyed initially, most of our cohort expected to work more than 80 hours. I don't know that there is an easy answer. I don't think we can "make" surgery easy, but I do think we can help smart and talented physicians who want to be surgeons understand it is hard and help train them to deal with the complexity of being a surgeon.

My biggest concern is for those trainees who leave late, and understanding why disproportionately they are more often women and minorities. This is a problem specific to general surgery, or neurosurgery, orthopedics and ent surgical colleagues do not have the same attrition, so we should think about how we can improve.

Thanks again.

CONFLICT OF INTEREST: I'm one of the paper authors