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Original Investigation | Pacific Coast Surgical Association

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

Edward Gifford, MD1; Joseph Galante, MD2; Amy H. Kaji, MD, PhD3; Virginia Nguyen, BS1; M. Timothy Nelson, MD4; Richard A. Sidwell, MD5; Thomas Hartranft, MD6; Benjamin Jarman, MD7; Marc Melcher, MD, PhD8; Mark Reeves, MD, PhD9; Christopher Reid, MD10; Garth R. Jacobsen, MD10; Jonathan Thompson, MD11; Chandrakanth Are, MD11; Brian Smith, MD12; Tracey Arnell, MD13; Oscar J. Hines, MD14; Christian de Virgilio, MD1
[+] 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.
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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.

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Figure.
Male vs Female Desire to Leave Residency by Postgraduate (PG) Year

Data are expressed as a percentage of same-sex classmates within each year, and groups reaching significance are indicated by P value.

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