Surgical Residency and Attrition: Defining the Individual and Programmatic Factors Predictive of Trainee Losses
Abstract
Background Voluntary resident attrition remains problematic despite recent changes in postgraduate general surgery training, including reduction of work hours. Study design We conducted a prospective study of all postgraduate year (PGY)-1 and -2 trainees on the 2008 American Board of Surgery resident roster (ABS-RR) who completed the National Study of Expectations and Attitudes of Residents in Surgery (NEARS) survey after the American Board of Surgery In-Training Examination (ABSITE) in 2008 or 2009. Results Among 2,222 PGY-1 and -2 residents on the 2008 ABS-RR, 2,033 completed the NEARS survey in 2008 or 2009 (91.5%). The only demographic or programmatic variables associated with voluntary attrition on univariate analysis were PGY-1 status (9.4% risk vs 4.5% risk for PGY-2, p Conclusions Resident attitudes, PGY-1 status, and program location are most frequently associated with voluntary attrition. Our risk score calculation represents a novel potential tool for programs to quantify deficiencies in the training experience of residents, and develop targeted strategies to limit disaffection and improve resident retention.
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The loss of a trainee is logistically burdensome and costly to the hospital.
“the loss is not only logistically burdensome but costly to the hospital.”
A significant amount of time and resources are invested in recruiting and training every physician.
“A significant amount of time and resources are invested in recruiting and training every physician2-4”
Having a dedicated mentor does not automatically translate to a favorable support system, but mentor-mentee interactions have been linked to increased resident satisfaction and less desire to leave prematurely.
“However, having a dedicated mentor does not automatically translate to a favorable support system27 but interactions derived from the mentor-mentee relationship have been linked to increased resident satisfaction and less desire to leave prematurely4.”
A study by the American College of Surgeons suggests that private practice surgeons are more likely to experience burnout and lower career satisfaction than surgeons practicing in academic settings.
“A study by the American College of Surgeons suggests that private practice surgeons are more likely to experience burnout and lower career satisfaction than surgeons practicing in academic settings [36].”
From How Can We Reduce Attrition in General Surgery Residents? (2018) · cites this paper as [36]
Brooks and Bosk found that duty regulation hours had made the field of surgery more attractive to women and men seeking a more balanced life.
“Brooks and Bosk found that 'duty regulation hours had made the field of surgery more attractive to women and men seeking a more balanced life' [36].”
From How Can We Reduce Attrition in General Surgery Residents? (2018) · cites this paper as [36]
Cites
Our Trainees’ Confidence: Results From a National Survey of 4136 US General Surgery Residents
Bucholz, E. M. (2011) · Archives of Surgery · doi:10.1001/archsurg.2011.178 · Cited by 244 · see citing works
Why do residents leave general surgery? The hidden problem in today's programs
Dodson, T. F., & Webb, A. L. B. (2005) · Current Surgery · doi:10.1016/j.cursur.2004.07.009 · Cited by 137 · see citing works
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National Survey of Burnout among US General Surgery Residents
Elmore, L. C., Jeffe, D. B., Jin, L., Awad, M. M., & Turnbull, I. R. (2016) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2016.05.014 · Cited by 476 · see citing works
Schwed, A. C., Lee, S. L., Salcedo, E. S., Reeves, M. E., Inaba, K., Sidwell, R. A., Amersi, F., Are, C., Arnell, T. D., Damewood, R. B., et al. (2017) · JAMA Surgery · doi:10.1001/jamasurg.2017.2656 · Cited by 54 · see citing works
Thoughts of Quitting General Surgery Residency: Factors in Canada.
Ginther, D. N., Dattani, S., Miller, S., & Hayes, P. (2016) · Journal of Surgical Education · doi:10.1016/j.jsurg.2015.11.008 · Cited by 31 · see citing works
How Can We Reduce Attrition in General Surgery Residents?
DM, A. (2018) · Austin Journal of Surgery · doi:10.26420/austinjsurg.2018.1129 · Cited by 2 · see citing works
Tabuñar, S. M. S., & Parreño Sacdalan, M. D. (2025) · PubMed · doi:10.47895/amp.vi0.9376 · Cited by 2 · see citing works
- Authors
- Sullivan, M. C., Yeo, H., Roman, S. A., Ciarleglio, M. M., Cong, X., Bell, R. H., & Sosa, J. A.
- Affiliations
- Yale University (US)
- Memorial Sloan Kettering Cancer Center (US)
- Duke University (US)
- University of Pennsylvania (US)
- Corresponding author
- Sosa, Julie A.
- Venue
- Journal of the American College of Surgeons
- Published
- 2013-03
- Volume
- 216
- Issue
- 3
- Pages
- 461-471
- ISSN
- 1072-7515 (ISSN-L)
- OpenAlex
- W2017916703
- Cited by
- 103
- References
- 2
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 11 · 2023: 1 · 2022: 10 · 2021: 16 · 2020: 6 · 2019: 11 · 2018: 12 · 2017: 6 · 2016: 5 · 2015: 9 · 2014: 7 · 2013: 4
- FWCI
- 15.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American College of Surgeons (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Gender Studies › Diversity and Career in Medicine
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Keywords
- surgical residency, resident attrition, general surgery residency, postgraduate year 1 residents, program location, resident attitudes, risk score, ABSITE, operative experience, resident retention, working time reduction
- MeSH terms
- Workforce, Adult, Attitude of Health Personnel, Female, Humans, Internship and Residency, Life Style, Male, Personnel Staffing and Scheduling, Social Isolation, General Surgery, Multivariate Analysis, Young Adult
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