How many of these guys were actually canned?

Selznick · Jan 11, 2006

A common question to ask PD's is "Do any people leave the program to go to another surgery program?" The assumption is that when people decide to transfer to another specialty like anesthesia or ER, that it's the result of some kind of epiphany where they see that surgery wasn't for them and that it's no reflection on the program. Well, I was at a program a couple of weeks ago, someone asked the PD anyone had left for another surgery program. The pd, who was pretty upfront about things answered no, but told us of a few people who had left in the last few years to go to other speciatlies. Then someone else asked if anyone had been asked to leave (ie, canned) in the last few years. The PD answered yes and mentioned the same people - those who had "left" for other specialties.

How many of those who "leave" for other specialties are actually canned? I guessing that there's no official statement about these cases, but you guys hear about these things on the grapevine, I'm sure. How many of these "transfers" are more or less obliged to leave?

robotsonic · Jan 11, 2006

I even wonder if they are being honest when they say that no one has left for another surgery residency. At every program I've seen, they emphasize that the people who left did so because they realized that surgery wasn't for them, but the topic is almost always glazed over and they don't ever specify exactly what happened to the people.

Also, does anyone know the average attrition rate for gen surgery residency programs? A program last week told me that the overall average was about 10-20%, but that seems high to me. One in five doesn't complete residency?!

surg · Jan 12, 2006

That sounds about right to me. I actually checked it up once, and it works out to about that much. You can estimate it by figuring out about how many take the boards in a given year for the 1st time (1280/yr take the test, 20% fail/yr overall and non-first time takers fail at about a 40% rate), and checking up how many categorical positions there are. This would be an underestimate because it misses those that dropped out and got their spots filled by a prelim. Don't forget that there are some that leave to pursue plastics after year 3, as well as the other usual suspects (anesthesia, etc.)

Selznick · Jan 16, 2006

Selznick · Jan 16, 2006

robotsonic said:
At every program I've seen, they emphasize that the people who left did so because they realized that surgery wasn't for them, but the topic is almost always glazed over and they don't ever specify exactly what happened to the people.

!

I've noticed that too. Funny though, that some programs have an awfull lot of people come to this decision. I think that assuming that this has nothing to do with the culture of the program is wishful thinking at best. I've also noticed that at programs with a noticibly healthy culture there are much fewer people "choosing" this kind of career change. For example, at Mt.Sinai they a have a PD who emphasizes resident quality of life. They've had a zero attrition rate for the last eight years. This can't be just chance, can it?

njbmd · Jan 16, 2006

Hi there,
Most people leave surgery because they come to the conclusion that surgery and the general surgery lifestyle is not for them. Some categorical people change residency programs too largely because they have a spouse in another city or some other pressing need. One person in my program had an fiance that became very ill with leukemia and relocated to California to be near her.

A fair number of folks will give up on surgery 80-hour work week or not because they find that they really do not enjoy the practice of surgery. This can be at any level, but the later, the more difficulty finding something else to do. I am certain that program directors do not enjoy talking about the people who leave their programs. On the other hand, if a program is good, that opening will fill pretty quickly.

njbmd

Selznick · Jan 16, 2006

njbmd said:
Some categorical people change residency programs too largely because they have a spouse in another city or some other pressing need. One person in my program had an fiance that became very ill with leukemia and relocated to California to be near her.

A fair number of folks will give up on surgery 80-hour work week or not because they find that they really do not enjoy the practice of surgery. This can be at any level, but the later, the more difficulty finding something else to do. I am certain that program directors do not enjoy talking about the people who leave their programs.

This is the standard spiel gived by PD's and for the most part, unquestioned by applicants.

njbmd said:
Most people leave surgery because they come to the conclusion that surgery and the general surgery lifestyle is not for them.

These are the folks I'm talking about. Often, if not usually, these are a greater proportion of the people who leave than the family/illness. It definately seems that where program cultures are less pleasant much more people come to this decision about surgery. And as mentioned in the OP I learned in one program the people listed under this gatagory were essentially canned - "asked to leave". I wonder how common that is.

njbmd said:
On the other hand, if a program is good, that opening will fill pretty quickly.

The efficiency of the pyramid not exactly a positive factor when choosing a program.

Smurfette · Jan 16, 2006

I remember seeing somewhere that the national surgery resident attrition rate is ~17%. I've heard it quoted by PDs as well. Honestly, in the handful of programs I know well enough to use as an example, ALL residents who left did so b/c they decided surgery wasn't for them, and NONE were fired. I assume given the surgery lifestyle, more people choose to leave than are asked to leave (especially at lower levels). However, any 4th or 5th yr residents who leave I would highly suspect were asked to leave...*most* people wouldn't stick out residency that long to leave as a chief.

Pir8DeacDoc · Jan 16, 2006

Don't you think that a terrible, malignant environment could help someone decided that "sugery isn't for them" ??

I think it's not as neat and tidy to quantify as we as applicants would hope.

robotsonic · Jan 16, 2006

Pir8DeacDoc said:
Don't you think that a terrible, malignant environment could help someone decided that "sugery isn't for them" ??

Exactly. I know people in my med school class have been turned off to a certain field (not surgery) because of how malignant the program is at my hospital. I can't believe that the atmosphere of the program doesn't have a role in someone's decision to leave surgery.

fourthyear · Jan 16, 2006

Let's say you're kind of on the lazy side (compared to other surgery residents)...you're inefficient in being able to juggle a bunch of tasks at once with constant interupptions from the pagers, make more mistakes than others without catching them and trying to fix them, you maybe tell some fibs to cover up your inaccuracies, show up late and routinely can't see all your patients in time for rounds, don't know your patients well enough to answer attendings questions on them...that sort of thing.

Well, people are going to be harder on you than on a resident who is able to live up to expectations better.

So you get beat on every day by your senior residents, your attendings...you might start longing for an easier job. This is generally how it happens. Programs probably rarely have to officially fire someone....rather in the process of trying to tell people daily that they are not living up to the job expectations, residents realize maybe this job is not for them and they'd prefer a job where it would be easier to meet expectations of their bosses.

njbmd · Jan 16, 2006

Selznick said:
The efficiency of the pyramid not exactly a positive factor when choosing a program.

Hi there,
Pyramid programs do not exist in general surgery today. If you start as a categorical, you are expected to finish the program unless you decide to do something else. In the old pyramid programs, the first years were in competition with each other for fewer slots the next year and so on until you got to fourth year where you could be considered safe. These are not around any more.

Still, there are quite a few folks who leave general surgery for anesthesia, emergency medicine etc. because of the lifestyle and there are a few people who are just not cut out for surgery and are asked to leave.

njbmd

Selznick · Jan 17, 2006

fourthyear said:
Let's say you're kind of on the lazy side (compared to other surgery residents)...you're inefficient in being able to juggle a bunch of tasks at once with constant interupptions from the pagers, make more mistakes than others without catching them and trying to fix them, you maybe tell some fibs to cover up your inaccuracies, show up late and routinely can't see all your patients in time for rounds, don't know your patients well enough to answer attendings questions on them...that sort of thing.

Well, people are going to be harder on you than on a resident who is able to live up to expectations better.

So you get beat on every day by your senior residents, your attendings...you might start longing for an easier job. This is generally how it happens. Programs probably rarely have to officially fire someone....rather in the process of trying to tell people daily that they are not living up to the job expectations, residents realize maybe this job is not for them and they'd prefer a job where it would be easier to meet expectations of their bosses.

Excellent portrait. This is definately something I see at my home program. Here, every new class seems to have someone who's "it". There's someone in each intern class who's the weak one. This person is constantly talked about and is soon more or less totally isolated. These interns tend to "decide that surgery isn't for them". My home program is generally considered to be a malignant one. I'm thinking that this kind of gang/scapegoat situation is almost the hallmark of a malignant program. Other programs I've seen have much more of a cooperative culture. Struggling residents are more likely to be leant a hand and supported by their colleages. This was stressed by the Mt.Sinai program, and oddly enough no one there has "decided that surgery isn't for them" for the last eight years. Attrition is probably one of the best indexes of an inhospitable culture that we have. It's a no brainer that residents exposed to a malignant work environment are more likely to decide not to further pursue a career in that environment.

Selznick · Jan 17, 2006

njbmd said:
Pyramid programs do not exist in general surgery today. If you start as a categorical, you are expected to finish the program unless you decide to do something else. In the old pyramid programs, the first years were in competition with each other for fewer slots the next year and so on until you got to fourth year where you could be considered safe. These are not around any more.

Programs with high attrition and a steady stream of prelim to cat transfers are de facto pyramid programs.

njbmd said:
Still, there are quite a few folks who leave general surgery for anesthesia, emergency medicine etc. because of the lifestyle

This occurs consistantly at a much higher rate at some programs than at others. Either these programs take less care in choosing their residents or they offer a lower quality of life for residents, neither of which are good.

njbmd said:
and there are a few people who are just not cut out for surgery and are asked to leave.

Again, people are more likely to flounder in environments that are unsupportive or hostile. They're more likely to be fired in programs that see residents as expendible.

Surviving a hostile atmosphere and succeeding in it is laudible. But refusing to accept obvious indexes of a program's employee satisfaction when forming a rank list would be downright foolish. A consistantly higher than average attrition rate is undeniably a red flag.

supercut · Jan 22, 2006

Pehaps a key question is when did those that leave decide that surgery isn't for them...

In my program, most of the folks that have left did so after going into the lab. Perhaps returning to the long forgotten 8-5 lifestyle makes them realize that they don't want the work hours of a surgeon. In the past 3 years, all the defectors from my program have made the decision during their lab years, except for one intern.

And all went into the lifestyle friendly specialties...most into Anesthsia, one to EM and one to Rads.

How many of these guys were actually canned?

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