title: National Orthopedic Residency Attrition: Who Is At Risk?
abstract: BACKGROUND
  National U.S. orthopedic resident attrition rates have been historically low, but no literature exists as to the characteristics of those who leave nor the circumstance of the departure. We aimed to determine factors that may place a resident at higher risk for attrition. Additionally, we planned to determine whether the 2003-work hour restriction affected attrition rate.
  
  
  METHODS
  All orthopedic surgery residency program directors in the United States were surveyed on demographic data for their current resident class, the number of residents who left the program, as well as demographic description for each of the residents who left their program from 1998 to 2013. Exclusion criteria included military programs and those younger than 3 years. All data were deidentified and compared to the Accreditation Council for Graduate Medical Education Data Resource book to protect against sample error in respondents.
  
  
  RESULTS
  Of 146 programs included, the overall response rate was 54% of residency directors, representing 51% of orthopedic residents. The respondent demographic make-up of 13.7% female, and average program size of 22.3 residents, compared similarly to the Accreditation Council for Graduate Medical Education national average of 13% female and 23-resident program size. Compared to all respondents, residents who left their program were more likely to be female (27%, p = 0.0018), single (51%, p = 0.0028), and without children (80%, p = 0.0018). There was no statistical difference based on minority status or 2003-instituted work hour restriction. Of those who left, 45% transferred to another specialty, 34% were dismissed, 14% voluntarily withdrew or cited personal reasons, and 6% transferred to another orthopedic program. The most common specialties to transfer into were radiology (30%), emergency medicine (25%), and anesthesia (18%).
  
  
  CONCLUSIONS
  Orthopedic residents who are female, single, or without children are statistically more likely to undergo attrition. Consideration could be given to targeted mentoring of these resident groups.
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: jennifer.m.bauer@gmail.com.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Bauer
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Ginger E
authors.initials: GE
authors.lastname: Holt
mesh_terms: D002321:Career Choice; D003710:Demography; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D009985:Orthopedics / Q000193:education*; D012307:Risk Factors; D014481:United States; D000078329:Workforce
keywords: Interpersonal and Communication Skills; Professionalism; orthopedic residency; resident attrition; resident education