Many, many people start out in categorical surgery positions and then after a few months realize how hard surgery sucks. These people switch in to other specialties. In other words, the attrition for residents at many surgery programs is tremenedous. Before I get flamed, let me say that surgery is pretty cool but you have to love it, I mean absolutely love it to the exclusion of wife, family, God, and country or you will be miserable.
Case in point: I have a friend that did a surgery prelim year at a program that is coming under investigation. He worked 120+ hours/week and realized surgery was not for him. He liked it, but did not eat, breathe, and $#!t it. So now he is doing OB/GYN (go figure ) and loving only having to work 80 hours/week.
There is a whole netherworld of people bouncing from prelim to prelim. At some point they either: - land a gig in a rural ED (essentially as a GP) - work at a 'doc in the box' - earn a living on subsistence farming (aka insurance physicals) - enter a family practice residency - do another prelim in the hopes to become a surgeon While there are some RRC limits on the number of non-designated prelims, there seem to be a good number of surgery residencies (ab)using them to maintain their pyramid scheme. Abolishing them alltogether would probably not be a big loss to medical education (it would however be a financial loss to the institutions participating in this game).
