Change of heart: Why are so many residents dropping out?
Key Takeaways
Residency dropout rates range by specialty from 0.46% among dermatologists to 7.53% among psychiatrists.
This is a cause for concern as the US navigates an ongoing physician shortage, especially in primary care specialties.
Formal mentorship may reduce attrition, especially among female and racial minority residents.
They wanted to be doctors. In many cases, it was a lifelong dream that began in childhood. Then suddenly, their dream ended when they quit during residency.
But why the change of heart? How many residents are we talking about? And what is the impact of residency attrition on the already troubling physician shortage?
Research sheds light on the scope of this trend, as well as the common reasons residents drop out—and possible interventions.
The numbers
According to a Brain and Neurological Disorders study published in 2022, median residency attrition rates are estimated to range from 0.46% among dermatology residents to 7.53% among psychiatry residents. Their work demonstrated stark resignation-rate differences between specialties.[]
The researchers assessed data from the Accreditation Council for Graduate Medical Education covering the years 2010–2011 and 2019–2020. In addition to calculating the median attrition rate by specialty, the research team also assessed these rates over time.
Falling behind psychiatry for the highest median rates were:
Surgery: 3.37%
Pathology (anatomic and clinical): 2.91%
Neurological surgery: 2.43%
Family medicine: 2.21%
Following dermatology for the lowest median rates were:
Orthopedic surgery: 0.78%
Ophthalmology: 0.82%
Emergency medicine: 0.83%
Otolaryngology: 0.84%
During the study period, urology saw the most rapid improvement in attrition rate, with internal medicine falling slightly behind (-0.93691, compared with -0.92173).
Data indicated that primary care specialties, such as family medicine, pediatrics, and obstetrics and gynecology, had heightened retention difficulties. During the study period, 246 family medicine residents didn’t graduate, followed by 98 pediatric residents, and 73 OB/GYNs.
This is troubling when placed into the context of the PCP shortage. According to a 2021 AAMC report, the US faces a shortage in this category projected to range from 17,800–48,000 doctors by 2034.[]
The situation is worse among non-primary care specialties. The AAMC anticipated a shortfall somewhere between 21,000 and 77,100 physicians by the same year.
"Left simply to workforce supply and demand, physician shortage and maldistribution could further expose the more vulnerable of our society to disastrous consequences."
— Wang, et al., Brain and Neurological Disorders
The reasons
What factors are contributing to these changes of heart? Several studies offer some insights. The first is a study published in 2020 in the American Journal of Surgery.[]
Researchers queried 7,409 general surgery residents in 2018. Among this group, 12.6% had thought about leaving surgery behind within the last year. The data also indicated that residents were more likely to weigh other surgery programs if they were in their second or third year of residency, or if they were subject to “frequent duty hour violations.” About 46% of respondents fell into this category.
General dissatisfaction with surgery caused 47% of respondents to consider other specialties. Female residents were more likely to think about leaving medicine, as were people who were unhappy with the prospects of a career in surgery.
“Higher rates of duty hour violations and dissatisfaction with resident education in residents considering other programs may imply that local educational and workload factors drive residents that are otherwise enjoying general surgery towards different training environments,” the researchers wrote.
Why are women residents leaving?
Another study, published in 2019 by the Western Journal of Emergency Medicine, focused on emergency medicine residents and may offer some clues as to why women residents are jumping ship.[]
As with surgical residents, the data indicated that more women in EM considered quitting than men. Women comprised 44.2% of the doctors reconsidering their residency programs. That number was higher than the overall proportion of women EM residents (38.8%).
Female residents were also more likely to cite “health/family reasons” as considerations (21.5% compared with 9.6% of male residents). Other reasons for leaving included:
Change in career plans (139 residents)
Other/unknown (65 residents)
Military obligations (two residents)
"These findings suggest male and female EM residents may experience different demands in and outside of residency training."
— Lu, et al., Western Journal of Emergency Medicine
The researchers added that prior research has shown that women tend to experience more depressive symptoms during their intern year, and they tend to cite work-family conflicts as a source of the problem.
The race factor
A study published in 2021 by the Journal of the National Medical Association suggested that race is influential in residency exits.[] Researchers queried 504 residents about their experiences and 498 provided race and gender data.
The data indicated that racial minority trainees had lower ease of execution scores for orders, compared with non-minority trainees. They also had “numerical but nonsignificant” score differences in mentorship access and feelings of isolation.
Residents who contemplated leaving in this study also indicated they had less access to mentorship and were more likely to report feelings of isolation.
"Minority status and female gender impact some of the key elements of the residency experience, manifesting as decreased respect afforded to these trainees."
— Aryee, et al., Journal of the National Medical Association
A potential solution
Research indicates that mentorship helps.
Data in the Journal of the National Medical Association study indicated that residents who had more positive experiences also had more access to mentorship and experienced less isolation, compared with residents who indicated neutral or negative experiences.
“Attention should be paid to ensuring that high-risk trainees have adequate access to mentorship, making deliberate efforts to cultivate a sense of community and camaraderie among residents, and emphasizing the value of diversity and inclusion,” the researchers wrote.
A 2019 Journal of Surgical Research study included similar findings.[] Researchers assessed a 1-year mentorship program for general surgery residents at an academic institution. The program included assigned mentors, social events, and recommended meetings.
Among these residents, those who attended two or more mentor meetings were more likely to say that faculty were interested and concerned about their progress and were approachable about residency and concerns outside of practice.
"Implementation of a mentorship program can improve resident experience, and few interactions are needed to affect the change."
— Bingmer, et al., Journal of Surgical Research
Mentorship may offer residents who are struggling and contemplating an early exit a “life raft” to help them through this challenging stage of their medical education. Residents may want to take advantage of the opportunity to have a mentor whenever it’s offered.
What this means for you
Specialty, gender, and racial minority status may affect attrition rates among residents. Research suggests that mentorship may diminish resignations. Residents may want to avail themselves of mentorship opportunities, and attendings may want to become mentors to ensure that the physician workforce grows sufficiently to meet patient needs.