Why Do Senior Residents Quit Kyla Terhune MD

Why Do Senior Residents “Quit”? Kyla Terhune, MD

Disclosures �None financial. �I did not quit… but I fantasized about it. �I have rehearsed quitting as a junior attending more than as a resident. . .

Who are the Senior Residents? �Age 29 -32 �Generation X: Born 1961 -1981 Generations, Strauss and Howe, 1991 Reagan, Chernobyl, Space Shuttle, fall Berlin Wall Surgery Senior Residents: 1990 -2010 �Generation Y (Millennial): Born 1982 -2001 1993 Ad Age editorial Generations (Strauss and Howe), 1991 Surgery Senior Residents: 2011 -2031

What Characterizes? Generation X Generation Y � Individualistic � Technologically adept � Flexible � Value work/life balance � Tech Savvy � Family Centric � Team-Oriented � Attention-Craving � Supervising: Freedom and autonomy Hands-off Work Alone � Supervising: Structure Stability Immediate feedback/praise Frequent communication

Asking the Real Question… �Why quit when coming so far?

A National Study of Attrition in General Surgery Training: Which Residents Leave and Where Do They Go? �Yeo et al, 2010 (Yale), Annals of Surgery �ABS Resident Roster; 2007 -08 (n=6, 303) �Residency Coordinators asked: Why left Plans following �Linked to National Study of Expectations and Attitudes of Residents in Surgery, 2008 (n=3959) Demographic info (gender, marital, race, children)

Yeo, et al (Annals of Surgery, 2010)

Yeo, et al. 2010 � 188 (3%) resigned in 2007 -08 � 27 residents (0. 4%) had contract terminated � 63 (1%) transferred– not considered attrition �Attrition highest in internship and junior residency PGY-3: 1. 5% PGY-4: 0. 6% �Other demographic characteristics not sig.

Yeo, et al. 2010 � 75% stayed in medical training but switched to other fields 62% of those who left went on to nonsurgical fields 13% other surgical specialties � 10% left medical profession altogether

EVENT PERSONAL REFLECTION NON-RENEWAL

Demographical Data � 248 total programs � 166 programs contacted Those contacted had posted at least one position in the PGY 3 - PGY 4 position advertised � 50 (30%) programs responded �De-identified by program and year

Questions Asked �Did the position fill? �With whom did the position fill? �Was the position from expansion or attrition? �If attrition: Why the attrition? ▪ Personal choice or nonrenewal? Gender? Finish the academic year? Eventual placement?

Overall Number �Total approved for Match (236) �Total attrition (83 positions) � 3 positions per year (PGY 3 -5) � 10 years of data � 1. 2% chance of attrition per year in PGY 3 -5 Changeover in program directors

PERSONAL EVENT CHOICE REFLECTION NON-RENEWAL

Total = 116 positions PGY-3 (n = 60) PGY-4 (n = 51) Attrition 43 (71. 7%) 40 (78. 4%) Expansion 17 11

Total Attrition = 83 Attrition (n=82) Women Rate/ Position per Year 39 (47. 5%) 1. 7% Men 43 (52. 4%) 0. 6% 33% women: USMGs entering GS in years 2000 -2006 (Davis et al. JACS, 2011)

Demographical Data �PGY 3 – PGY 5 7080 total years of positions 1. 2% loss of positions to attrition per year 0. 4% expansion rate per year

Attrition by Size Attrition % per (n=83) Small 8 Medium 30 Large 45 P=0. 024 Year 2. 2% 1. 5% 0. 9% Expansion (n=29) 4 10 15 Bell et al. , 2009 Nrmp. org

Is it easier for Programs to Fill Based on Size? Filled Small Total (n=114) 9 Medium 43 38 (88. 4%) Large 59 48 (81. 4%) 8 (88. 9%) Not significant

Breakdown: Reasons of Attrition N=82 Personal Choice 58 (70. 7%) 48. 3% men Non-Renewal 23 (28. 0%) 60. 9% men Other 1

Where did they go? Total (N=67) General Surgery 21 (31. 3%) Surgical Specialty 12 (17. 9%) NOT Surgery 30 (44. 8%) Left Medicine 4 (5. 9%)

Why Do Senior Residents “Quit”? �Individual �Personal Choice: hypothesize events �Nonrenewal of Contract: earlier prediction?