Henry VIII and the Barber Surgeons image from Wikimedia Commons
From the annual meeting of the American Surgical Association
Lifestyle and generational priorities are often cited as fostering the high attrition rate for both male and female surgical trainees.
According to the first prospective, national survey, one in five general surgery residents resigns before completing their training, Yale University surgical resident Dr. Heather Yeo reported at the ASA’s annual meeting. That number is based on 2007-2008 data in 6,303 general surgery residents, but is fairly constant despite earlier implementation of the ACGME work rules limiting residents to an 80-hour work week, which many at the meeting said they hoped would help reduce attrition.
Slightly more women than men resigned (2.1% vs. 1.9%). Singles were also more likely than married residents to resign (2.1% vs. 2%).
In multivariate analysis however, only postgraduate year level was a significant predictor of resignation, with most resignations occurring in PGY-1.
These data are both disturbing and strangely reassuring given the brain drain in general surgery and the well-known paucity of women in the field. Indeed, only a dozen or so women were in the audience, except for when the wives were allowed in for special sessions. And of the 39 new ASA fellows inducted at the meeting, only three were women.
Dr. Rachel Kelz stood out, both as one of the few women in that room and for her efforts to stop the bleeding.
Dr. Kelz and her surgical colleagues at the University of Pennsylvania modified the resident selection process to make it more extended, personalized and structured.
Their intervention, which required among other things that candidates write a 500-word essay related to stress management, organizational skills and future aspirations, dramatically decreased the overall 5-year attrition rate from 27% to 3% and attrition among women from 50% to 9%.
A smashing start considering that 63% of residents who left the program were women, 75% of exiting residents cited lifestyle issues as a reason for departing, and 38% of residents were flagged as having organizational/time management problems.
Other suggestions from the audience were for surgical programs to intentionally match additional residents to factor in attrition, and for medical schools to offer a more “robust” exposure to surgery so wannabe surgeons would have a better understanding of their residency and a surgeon’s lifestyle.
A quick peek at the old boy’s club could also motivate surgical residents to set their sights on the ASA, “the nation’s oldest and most prestigious surgical organization.”
— Patrice Wendling (on Twitter @pwendl)
