Factors Associated With General Surgery Residents’ Desire to Leave Residency Programs: A Multi-institutional Study | Medical Education and Training | JAMA Surgery | JAMA Network
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Original Investigation
Pacific Coast Surgical Association
September 2014

Factors Associated With General Surgery Residents’ Desire to Leave Residency Programs: A Multi-institutional Study

Author Affiliations
  • 1Department of Surgery, Harbor-UCLA Medical Center, Los Angeles, California
  • 2Division of Trauma and Acute Care Surgery, UC Davis Medical Center, Sacramento, California
  • 3Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, California
  • 4Department of General Surgery, University of New Mexico Hospital, Albuquerque
  • 5Department of General Surgery, Iowa Methodist Medical Center, Des Moines
  • 6Department of Surgery, Mount Carmel Health System, Columbus, Ohio
  • 7Department of Surgery, Gunderson Health System, La Crosse, Wisconsin
  • 8Department of Surgery, Stanford University Medical Center, Palo Alto, California
  • 9Department of Surgery, Loma Linda University Health, Loma Linda, California
  • 10Department of Surgery, UC San Diego Health System, San Diego, California
  • 11Department of Surgery, University of Nebraska Medical Center, Omaha
  • 12Department of Surgery, UC Irvine Medical Center, Orange, California
  • 13Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
  • 14Department of Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, California
JAMA Surg. 2014;149(9):948-953. doi:10.1001/jamasurg.2014.935

Importance  General surgical residency continues to experience attrition. To date, work hour amendments have not changed the annual rate of attrition.

Objective  To determine how often categorical general surgery residents seriously consider leaving residency.

Design, Setting, and Participants  At 13 residency programs, an anonymous survey of 371 categorical general surgery residents and 10-year attrition rates for each program. Responses from those who seriously considered leaving surgical residency were compared with those who did not.

Main Outcomes and Measures  Factors associated with the desire to leave residency.

Results  The survey response rate was 77.6%. Overall, 58.0% seriously considered leaving training. The most frequent reasons for wanting to leave were sleep deprivation on a specific rotation (50.0%), an undesirable future lifestyle (47.0%), and excessive work hours on a specific rotation (41.4%). Factors most often cited that kept residents from leaving were support from family or significant others (65.0%), support from other residents (63.5%), and perception of being better rested (58.9%). On univariate analysis, older age, female sex, postgraduate year, training in a university program, the presence of a faculty mentor, and lack of Alpha Omega Alpha status were associated with serious thoughts of leaving surgical residency. On multivariate analysis, only female sex was significantly associated with serious thoughts of leaving residency (odds ratio, 1.2; 95% CI, 1.1-1.3; P = .003). Eighty-six respondents were from historically high-attrition programs, and 202 respondents were from historically low-attrition programs (27.8% vs 8.4% 10-year attrition rate, P = .04). Residents from high-attrition programs were more likely to seriously consider leaving residency (odds ratio, 1.8; 95% CI, 1.0-3.0; P = .03).

Conclusions and Relevance  A majority of categorical general surgery residents seriously consider leaving residency. Female residents are more likely to consider leaving. Thoughts of leaving seem to be associated with work conditions on specific rotations rather than with overall work hours and are more prevalent among programs with historically high attrition rates.