title: Factors associated with general surgery residents' desire to leave residency programs: a multi-institutional study.
abstract: OBJECTIVE
  General surgical residency continues to experience attrition. To date, work hour amendments have not changed the annual rate of attrition.
  
  
  OBJECTIVE
  To determine how often categorical general surgery residents seriously consider leaving residency.
  
  
  METHODS
  At 13 residency programs, an anonymous survey of 371 categorical general surgery residents and 10-year attrition rates for each program. Responses from those who seriously considered leaving surgical residency were compared with those who did not.
  
  
  METHODS
  Factors associated with the desire to leave residency.
  
  
  RESULTS
  The survey response rate was 77.6%. Overall, 58.0% seriously considered leaving training. The most frequent reasons for wanting to leave were sleep deprivation on a specific rotation (50.0%), an undesirable future lifestyle (47.0%), and excessive work hours on a specific rotation (41.4%). Factors most often cited that kept residents from leaving were support from family or significant others (65.0%), support from other residents (63.5%), and perception of being better rested (58.9%). On univariate analysis, older age, female sex, postgraduate year, training in a university program, the presence of a faculty mentor, and lack of Alpha Omega Alpha status were associated with serious thoughts of leaving surgical residency. On multivariate analysis, only female sex was significantly associated with serious thoughts of leaving residency (odds ratio, 1.2; 95% CI, 1.1-1.3; P = .003). Eighty-six respondents were from historically high-attrition programs, and 202 respondents were from historically low-attrition programs (27.8% vs 8.4% 10-year attrition rate, P = .04). Residents from high-attrition programs were more likely to seriously consider leaving residency (odds ratio, 1.8; 95% CI, 1.0-3.0; P = .03).
  
  
  CONCLUSIONS
  A majority of categorical general surgery residents seriously consider leaving residency. Female residents are more likely to consider leaving. Thoughts of leaving seem to be associated with work conditions on specific rotations rather than with overall work hours and are more prevalent among programs with historically high attrition rates.
authors: Department of Surgery, Harbor-UCLA Medical Center, Los Angeles, California.
authors: Edward
authors: E
authors: Gifford
authors: Division of Trauma and Acute Care Surgery, UC Davis Medical Center, Sacramento, California.
authors: Joseph
authors: J
authors: Galante
authors: Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, California.
authors: Amy H
authors: AH
authors: Kaji
authors: Department of Surgery, Harbor-UCLA Medical Center, Los Angeles, California.
authors: Virginia
authors: V
authors: Nguyen
authors: Department of General Surgery, University of New Mexico Hospital, Albuquerque.
authors: M Timothy
authors: MT
authors: Nelson
authors: Department of General Surgery, Iowa Methodist Medical Center, Des Moines.
authors: Richard A
authors: RA
authors: Sidwell
authors: Department of Surgery, Mount Carmel Health System, Columbus, Ohio.
authors: Thomas
authors: T
authors: Hartranft
authors: Department of Surgery, Gunderson Health System, La Crosse, Wisconsin.
authors: Benjamin
authors: B
authors: Jarman
authors: Department of Surgery, Stanford University Medical Center, Palo Alto, California.
authors: Marc
authors: M
authors: Melcher
authors: Department of Surgery, Loma Linda University Health, Loma Linda, California.
authors: Mark
authors: M
authors: Reeves
authors: Department of Surgery, UC San Diego Health System, San Diego, California.
authors: Christopher
authors: C
authors: Reid
authors: Department of Surgery, UC San Diego Health System, San Diego, California.
authors: Garth R
authors: GR
authors: Jacobsen
authors: Department of Surgery, University of Nebraska Medical Center, Omaha.
authors: Jonathan
authors: J
authors: Thompson
authors: Department of Surgery, University of Nebraska Medical Center, Omaha.
authors: Chandrakanth
authors: C
authors: Are
authors: Department of Surgery, UC Irvine Medical Center, Orange, California.
authors: Brian
authors: B
authors: Smith
authors: Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York.
authors: Tracey
authors: T
authors: Arnell
authors: Department of Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, California.
authors: Oscar J
authors: OJ
authors: Hines
authors: Department of Surgery, Harbor-UCLA Medical Center, Los Angeles, California.
authors: Christian
authors: C
authors: de Virgilio
mesh_terms: D000328:Adult; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008019:Life Style; D008297:Male; D015999:Multivariate Analysis; D010563:Personnel Turnover / Q000706:statistics & numerical data*; D010820:Physicians / Q000523:psychology; D010822:Physicians, Women / Q000523:psychology / Q000706:statistics & numerical data