Attrition rates in Surgical Specialties

[libertyyne]

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I have read read varying statistics regarding the attrition rate in surgical specialties with numbers as high as 25% in some studies. What happens to the people who drop out of surgical subspecialties? Are they able to find other GME training in other specialties? Do they just quit medicine?

 

[lagbydesign]

For ortho, it's typically rads I think. For other surgical subs/gen surg, I've seen gas, psych, and EM.

 

[jhamaican]

met a few that went into PM&R. Few that went into geriatrics. Met an uber driver who quit CVTS residency. Just depends.

 

[mrbreakfast]

Met a few who went into rads, but the majority I've met went into IM.

Though, I've also met two gen surg residents who switched from OBGYN.

 

[AnatomyGrey12]

In my experience it's generally anesthesia. Met more than one anesthesiologist who started out GS and then got jealous of the guy on the other side of the drape. I can see rads being a natural fit for a resident who burns out of ortho

 

[jdh71]

I have read read varying statistics regarding the attrition rate in surgical specialties with numbers as high as 25% in some studies. What happens to the people who drop out of surgical subspecialties? Are they able to find other GME training in other specialties? Do they just quit medicine?

Also will depend on when you drop out. Medicare will pay for five years. If you used up one or two years and are fine with a three year residency good but if you've used up three years of that money basically you will be up a creek without a paddle. Unless you've got a desperate program that needs bodies and has alternative funding.

 

[libertyyne]

Also will depend on when you drop out. Medicare will pay for five years. If you used up one or two years and are fine with a three year residency good but if you've used up three years of that money basically you will be up a creek without a paddle. Unless you've got a desperate program that needs bodies and has alternative funding.

Ah, thanks i didnt even remember that you can take your funding with you. That makes a lot more sense, so even programs that dont have a spot open will open one up since you are basically free labor.

 

[jdh71]

Ah, thanks i didnt even remember that you can take your funding with you. That makes a lot more sense, so even programs that dont have a spot open will open one up since you are basically free labor.

Hm. No. It's kind of the opposite since no one works for free, you won't be offered a spot if you are out of enough funding to finish that residency.

 

[libertyyne]

Hm. No. It's kind of the opposite since no one works for free, you won't be offered a spot if you are out of enough funding to finish that residency.

i meant early enough with enough years of funding left.

 

[CherryRedDracul]

For ortho, it's typically rads I think. For other surgical subs/gen surg, I've seen gas, psych, and EM.

We've had several ex-orthopods and an ex-gen surgery at my program.

 

[DubbiDoctor]

Have a family who got forced out of his surgery residency and become an anesthesiologist. Anesthesia seems to be the most common choice for people who are flame out of surgery residency.

 

[mymembernames]

Met several gen surg people going into psych on the interview trail...

 

[Oso]

It still amazes me how high the attrition rates for these fields are, especially gen surg.

Out of curiosity, how do residency programs view/handle this? Is it something they simply expect, or do they see it as an issue they need to fix (perhaps in their recruiting?), or both?

 

[libertyyne]

It still amazes me how high the attrition rates for these fields are, especially gen surg.

Out of curiosity, how do residency programs view/handle this? Is it something they simply expect, or do they see it as an issue they need to fix (perhaps in their recruiting?), or both?

yeah, i am always curious as to this being a bad fit problem. performance issue or a genuine change of heart on behalf of the resident.

 

[MerYangBey]

yeah, i am always curious as to this being a bad fit problem. performance issue or a genuine change of heart on behalf of the resident.

I’m also curious about this. Do most people get told that they need to leave (as in they failed examinations/aren’t doing what they need to do) or do people leave because they don’t wanna do it anymore.
Anyone have any insight on this ?

 

[Frogger27]

I’m also curious about this. Do most people get told that they need to leave (as in they failed examinations/aren’t doing what they need to do) or do people leave because they don’t wanna do it anymore.
Anyone have any insight on this ?

My guess is that it rarely has to do with competency issues (either technical or knowledge based), but more so just the desire not to go through a surgical residency. I'll wait for a surgeon with more knowledge to comment though

 

[MerYangBey]

My guess is that it rarely has to do with competency issues (either technical or knowledge based), but more so just the desire not to go through a surgical residency. I'll wait for a surgeon with more knowledge to comment though

I feel like if you’re the person that ends up preforming less than your peers then you’ll end up having the faculty focus and scrutinize you more than the other resident. That in turn makes your experience a lot less enjoyable than the other residents. So you decide to gracefully switch to family Med before you get asked to leave or have to endure a couple more years of being the weak link. Then you tell people that you switched because you wanted to have work-life balance.
(This is all speculation of course)

 

[sinombre]

My guess is that it rarely has to do with competency issues (either technical or knowledge based), but more so just the desire not to go through a surgical residency. I'll wait for a surgeon with more knowledge to comment though

Yep, this is generally true. The majority of people who leave choose to do so. It’s rare that someone gets kicked out of a program for poor performance, but it does happen.

 

[sinombre]

I feel like if you’re the person that ends up preforming less than your peers then you’ll end up having the faculty focus and scrutinize you more than the other resident. That in turn makes your experience a lot less enjoyable than the other residents. So you decide to gracefully switch to family Med before you get asked to leave or have to endure a couple more years of being the weak link. Then you tell people that you switched because you wanted to have work-life balance.
(This is all speculation of course)

I’m sure this does happen, but it’s certainly not the norm. Residency programs invest a lot into their residents, so when they struggle it makes more sense to be supportive and try and correct problems rather than try and get them to leave.

From what I have seen (and from what I have heard from others), the residents who leave generally do so because they realize they would be happier doing something else. General surgery residency is hard, and you really have to enjoy it to make it through in one piece.

 

[AMEHigh]

I’m family med and we have a resident that switched from surgery. We had a few others from surgery on the interview trail as well. From what I can tell most people switch due to wanting to do so and not because of performance issues.

 

[MerYangBey]

I’m sure this does happen, but it’s certainly not the norm. Residency programs invest a lot into their residents, so when they struggle it makes more sense to be supportive and try and correct problems rather than try and get them to leave.

From what I have seen (and from what I have heard from others), the residents who leave generally do so because they realize they would be happier doing something else. General surgery residency is hard, and you really have to enjoy it to make it through in one piece.

That actually makes me happy. As of now general surgery is what I want to go for and it’s comforting to know that for most people performance issues aren’t the reason they leave.

 

[DubbiDoctor]

"Reviewing 22 studies on residents from general surgery programs, the authors concluded that overall attrition prevalence among residents was 18% (95% CI 14%-21%), reported Mohammed Al-Omran, MD, MSc, of St. Michael's Hospital in Toronto, and colleagues.

Of the residents who departed from their residency program, one-fifth relocated to another general surgery program (20%, 95% CI 15%-24%). Another 13% switched to anesthesia (95% CI 11%-16%). "Plastic surgery, radiology, and family medicine were other common specialties that attracted general surgery residents," the researchers indicated.

About half left the program after their first postgraduate year, and 30% left after the second.

Michael E. Shapiro, MD, surgical program director at Rutgers New Jersey Medical School in Newark, believes that the issue of attrition, specifically the distinction between voluntary and involuntary attrition, is more complicated than the paper presents.

"There are likely many residents who left voluntarily because they were told the alternative was having their contract non-renewed. Some might have gone into anesthesia or other specialties because they could see the handwriting on the wall," he told MedPage Today."
Residents Continue to Quit General Surgery

As others have said, it's complicated - not every surgery resident who voluntarily leaves genuinely wants to leave. I remember reading on the residency forum that gen surgery programs expect you to score 20th or 25th percentile or better on the yearly exams, at risk of termination. Seems like a really tough road and I'm surprised gen surg is as popular as it is. Too many Grey's Anatomy fans, perhaps.

 

[sinombre]

As others have said, it's complicated - not every surgery resident who voluntarily leaves genuinely wants to leave. I remember reading on the residency forum that gen surgery programs expect you to score 20th or 25th percentile or better on the yearly exams, at risk of termination. Seems like a really tough road and I'm surprised gen surg is as popular as it is. Too many Grey's Anatomy fans, perhaps.

It’s worth pointing out that this is explicitly prohibited. A program cannot terminate a resident for scoring poorly on the ABSITE.

 

[mrbreakfast]

Everyone I've met who switched was because they wanted to (that's what they said, anyway). Pretty much all of them switched after their intern or PGY2 year.

Several said they switched (from gen surgery) because they would have rather quit medicine than continue.

I'm not sure the attrition rates due to performance are much higher than other fields - I know of several residents who were terminated for performance from "easy" residencies - but would believe people leaving voluntarily is much more common.

 

[AsianPersuasion]

It's not call General Slavery without stories lol.

 

[mymembernames]

Two of the psych program heads I interviewed at used to be surgeons lol


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[W19]

As others have said, it's complicated - not every surgery resident who voluntarily leaves genuinely wants to leave. I remember reading on the residency forum that gen surgery programs expect you to score 20th or 25th percentile or better on the yearly exams, at risk of termination. Seems like a really tough road and I'm surprised gen surg is as popular as it is. Too many Grey's Anatomy fans, perhaps.

That does not seem to be a high bar IMO.

 

[DubbiDoctor]

That does not seem to be a high bar IMO.

I mean, isn't it? 4% of med students fail the Step exams, giving them problems with getting through med school. Seems like it should be similar for residency. Or lower, since residents have already demonstrated academic competence by getting through med school and passing the step exams (usually doing fairly well, if they're gen surg residents).

This is the thread I was thinking of, by the way. Obviously cannot vouch for the accuracy of any of the comments.

 

[Smurfette]

That does not seem to be a high bar IMO.

It's because 25th percentile on the ABSITE is about where it correlates to passing the boards.

 

[getdown]

It’s worth pointing out that this is explicitly prohibited. A program cannot terminate a resident for scoring poorly on the ABSITE.

While that may be the case, they can make life very hard for the resident so that they quit by themselves. Making them repeat a year is pretty common. Not letting them graduate (and keeping them in the program longer for "remediation") until they get a decent enough score that they wont be at risk of failing the boards is also another common tactic. All of these puts enough stress on a struggling resident that they may decide to quit or switch.

 

[WinslowPringle]

There are numerous studies on attrition and general surgery. A recent paper that can be a starting point is Khoussal et al. Here is another view on the matter.

I know of 4 people who left surgery residency; three were related to personal/family reasons, one was related to a change in professional interests.

 

[Skindoc83]

That does not seem to be a high bar IMO.

The problem is 25% of all surgical residents have to be in the bottom 25th percentile. That would mean every year, a quarter of the nations pgy-1’s are failed out of training. Then a quarter of pgy-2’s...pgy-5, 6, and 7. That would make an already miserable training environment absolutely unbearable.

 

[Newyawk]

I imagine it could also work like this:

I'm miserable doing surgery, I start coming late and showing no enthusiasm for my job, I am no longer a pleasure to be around --> others can sense this and I start to be ostracized by peers and attendings --> makes me feel even worse about my job --> leave.

The few people I know who have left their residencies (surgery and obgyn) both did so because they were just flat out miserable.

 

[libertyyne]

The problem is 25% of all surgical residents have to be in the bottom 25th percentile. That would mean every year, a quarter of the nations pgy-1’s are failed out of training. Then a quarter of pgy-2’s...pgy-5, 6, and 7. That would make an already miserable training environment absolutely unbearable.

i believe the data speaks to complete attrition over the duration of the program, and not just one year. The studies linked did indicate that a majority left after the first year with smaller losses afterward.