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Cited by 46Diversity and Career in MedicineHealthcare professionals’ stress and burnoutInnovations in Medical Education

Why do trainees leave hospital-based specialty training? A nationwide survey study investigating factors involved in attrition and subsequent career choices in the Netherlands

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Bustraan, Jacqueline, Dijkhuizen, Kirsten, Velthuis, Sophie, van der Post, Rachel, Driessen, Erik, van Lith, Jan M M, de Beaufort, Arnout Jan·2019·BMJ Open
DOI 10.1136/bmjopen-2018-028631PMC PMC6589009
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Abstract

Objective: To gain insight into factors involved in attrition from hospital-based medical specialty training and future career plans of trainees who prematurely left their specialty training programme. Design: Nationwide online survey study. Setting: Postgraduate education of all hospital-based specialties in the Netherlands. Participants: 174 trainees who prematurely left hospital-based medical specialty training between January 2014 and September 2017. Main outcome measures: Factors involved in trainees’ decisions to leave specialty training and their subsequent career plans. Results: The response rate was 38%. Of the responders, 25% left their programme in the first training year, 50% in year 2–3 and 25% in year 4–6. The most frequently reported factors involved in attrition were: work-life balance, job content, workload and specialty culture. Of the leaving trainees, 66% switched to another specialty training programme, of whom two-thirds chose a non-hospital-based training programme. Twelve per cent continued their career in a non-clinical role and the remainder had no specific plans yet. Conclusions: This study provides insight in factors involved in attrition and in future career paths. Based on our findings, possible interventions to reduce attrition are: (1) enable candidates to develop a realistic view on job characteristics and demands, prior to application; (2) provide individual guidance during specialty training, with emphasis on work-life balance and fit with specialty.

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  • Even before the pandemic, burnout and lack of adequate social support were major contributors to trainees' mental health challenges.

    “It should be noted, however, that even before the pandemic, burnout and lack of adequate social support remained major contributors in trainees' mental health challenges.”

    From Attrition in the Training Programs of the University of the Philippines-Philippine General Hospital (UP-PGH): A 5-year Review of Trends and Reasons from 2018-2022 (2025) · cites this paper as [25]

    The Discussion links poor work-life balance with burnout and notes high burnout rates in residency. The Results (‘Other factors’ involved in attrition) identify lack of support from training leadership, but the study examines why trainees leave training; it does not establish burnout and inadequate social support as major contributors to trainees’ mental health challenges. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Burnout is associated with poor work-life balance, unhealthy working hours, heavy workload, and unrealized academic expectations, often coupled with external demands of family and private life.

    “Burnout is known to be associated with poor work-life balance, unhealthy working hours, heavy workload, and unrealized academic expectation which are oftentimes coupled with the external demands of family and private life.2,25,26”

    From Attrition in the Training Programs of the University of the Philippines-Philippine General Hospital (UP-PGH): A 5-year Review of Trends and Reasons from 2018-2022 (2025) · cites this paper as [25]

    The Discussion (page not specified) explicitly associates poor work-life balance with burnout and describes trainees’ clinical and administrative workload. The Results list heavy workload and family reasons as factors in training attrition, not as demonstrated burnout associations. The paper does not establish the claimed burnout associations with unhealthy working hours or unrealized academic expectations. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • A 2014-2017 nationwide survey in the Netherlands registered an overall attrition rate from hospital-based specialties of 11%, ranging from 2.2% to 24.3%.

    “A nationwide survey investigating factors involved in attrition at the Netherlands from 2014 to 2017 registered an overall attrition rate from hospital-based specialties at 11%, ranging from 2.2% to as high as 24.3%.25”

    From Attrition in the Training Programs of the University of the Philippines-Philippine General Hospital (UP-PGH): A 5-year Review of Trends and Reasons from 2018-2022 (2025) · cites this paper as [25]

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Authors
Bustraan, J., Dijkhuizen, K., Velthuis, S., van der Post, R., Driessen, E., van Lith, J. M. M., & de Beaufort, A. J.
Affiliations
  • Leiden University Medical Center (NL)
  • Department of Pathology, RadboudUMC, Nijmegen, The Netherlands
  • Maastricht University (NL)
  • Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
  • Centre for Innovation in Medical Education, Leiden University Medical Centre, Leiden, The Netherlands
Corresponding author
Dijkhuizen, Kirsten
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2019-06
Volume
9
Issue
6
Pages
e028631
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2018-028631
PMC
PMC6589009
OpenAlex
W2949016735
Cited by
46
References
5
Citations by year
2026: 2 · 2025: 8 · 2024: 6 · 2023: 2 · 2022: 7 · 2021: 12 · 2020: 8 · 2018: 1
FWCI
11.79
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, cc-by-nc)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Leiden Repository (Leiden University) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • HighWire Press Open Archive (submittedVersion)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
Funders
Ministerie van Volksgezondheid, Welzijn en Sport
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
medical specialty training, trainee attrition, career choice, work-life balance, job content, workload, career guidance, graduate medical education, Netherlands
MeSH terms
Work-Life Balance, Adult, Attitude of Health Personnel, Career Choice, Choice Behavior, Education, Education, Medical, Continuing, Female, Hospitals, Teaching, Humans, Male, Medicine, Netherlands, Physicians

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