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Original Investigation | Pacific Coast Surgical Association

Pregnancy-Related Attrition in General Surgery

Erin G. Brown, MD1; Joseph M. Galante, MD1; Benjamin A. Keller, MD1; Juanita Braxton, PhD1; Diana L. Farmer, MD1
[+] Author Affiliations
1Department of Surgery, University of California, Davis, Sacramento
JAMA Surg. 2014;149(9):893-897. doi:10.1001/jamasurg.2014.1227.
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Importance  Residency attrition rates remain a great challenge for general surgery training programs. Despite the increasing acceptance of pregnancy during training, 1 common perception is that women who become pregnant are at increased risk of leaving surgery programs.

Objective  To determine whether child rearing increases the risk of attrition from general surgery residency.

Design, Setting, and Participants  Retrospective review of all categorical general surgery residents in a single academic general surgery residency program over a 10-year period. All categorical general surgery residents matriculated from July 1, 1999, until July 1, 2009.

Main Outcomes and Measures  Voluntary attrition rate, involuntary attrition rate, and incidence of child rearing among residents.

Results  Eighty-five residents matched into categorical general surgery postgraduate year 1 spots from July 1, 1999, to July 1, 2009. Of the total residents, 49 (58%) were men while 36 (42%) were women. Attrition in the program was 18.8% (16 of 85). Seven (44%) of the residents who left the program were women; this was 19% of all female residents in the program. This was not significantly different from the proportion of men who left the program (P = .90). A higher percentage of women (57%) left after their intern year compared with men (22%). Furthermore, men had the highest rate of attrition during research (33%) while no women left during research years. Among the 85 residents, 9 women reported a total of 10 pregnancies and 16 men reported raising 21 children (1 woman and 1 man left the program). The proportion of child rearing was higher in those who did not leave the program but this did not reach significance (P = .10). Neither age (odds ratio, 1.0; 95% CI, 0.8-1.4), sex (odds ratio, 1.0; 95% CI, 0.2-3.6), nor incidence of child rearing during training (odds ratio, 1.0; 95% CI, 0.1-9.6) were associated with an increased risk of attrition. Residents with children born during training did not demonstrate fewer total case numbers (men, P = .40; women, P = .93) or board pass rates (men, P = .76; women, P = .50) compared with residents who did not have children during training. Women who had children during training were more likely to pursue fellowship (87.5%) than those who did not (66.7%)(P < .001).

Conclusions and Relevance  The current study demonstrated there was no association between female sex and attrition at our institution. Child rearing did not appear to be a risk factor for attrition in either men or women. Furthermore, child rearing did not negatively impact the quality of training based on case numbers and board pass rates. Despite prevalent stereotypes, child rearing did not cause women or men to leave the program.

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Figure 1.
Attrition Rates

A, Rate of attrition per postgraduate year (PGY). Incidence of attrition was highest after PGY-1 but residents continued to leave throughout research years. The numbers in parentheses indicate the total number of residents leaving. B, Rate of attrition by PGY and sex. Most women left after their intern years while men left at approximately equal rates from PGY-1 throughout the research years. The numbers in parentheses are the numbers of men or women leaving per PGY.

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Figure 2.
Rates of Child Rearing by PGY and Sex

Twenty-nine percent of residents had children during training. Child rearing occurred throughout all years for both sexes but was most common during research years and chief years. The numbers in parentheses indicate the numbers of children born to men and women during each postgraduate year (PGY).

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