General Surgery Residents Face High Attrition Rates

A new study reveals that about one in five general surgery residents leaves before finishing the program, with the most common reasons being the uncontrollable lifestyle and switching specialties.

Researchers at St. Michael’s Hospital (Toronto, Canada), King Saud University (KSU; Riyadh, Saudi Arabia), and other institutions conducted a literature review, searching for studies from 1946 to the present day reporting on the prevalence and causes of attrition in surgical residents, as well as the characteristics and destinations of residents who left general surgery training programs. Of 41 full-text articles identified, 22 studies (53.7%) met the selection criteria. Data on 19,821 residents was then extracted and summarized by two independent reviewers.

The researchers found that overall attrition prevalence among general surgery residents was 18%, with attrition significantly higher among female (25%) than male (15%) residents. Most residents left after their first postgraduate year, often relocating to another general surgery program (20%), or switching to anesthesia (13%) and other specialties. The most common reported causes of attrition were uncontrollable lifestyle, transferring to another specialty, poor performance, dismissal, family or spousal factors, health issues, and financial burden. The study was published on December 14, 2016, in JAMA Surgery.

“The attrition rate among general surgery residents seemed to be comparable to that of obstetrics and gynecology and neurosurgery,” said lead author vascular surgeon Mohammed Al-Omran, MD, MSc, of St. Michael's Hospital. “But the rate is higher among general surgery residents than for some other specialties, including ophthalmology, otolaryngology, and orthopedics. General surgery programs generally have greater clinical demands than some other programs, and this can have significant consequences on resident lifestyle.”

General surgery focuses on abdominal contents, and often the thyroid gland (depending on local reference patterns). It also deals with diseases of the skin, breast, soft tissue, trauma, peripheral vascular surgery and hernias. In Canada, Australia, New Zealand, and the United States general surgery is a five to seven year residency. In the United Kingdom, surgical trainees enter training after five years of medical school and two years of the Foundation Programme. Trainees then go onto Higher Surgical Training (HST), lasting a further five to six years. Upon completion of training, the surgeon will become a consultant surgeon.

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St. Michael’s Hospital
King Saud University