A new study found resident attrition was significantly elevated for female and underrepresented in medicine (URiM) residents, specifically Black/African Americans. Further, the study suggests that the percentage of female residents in surgical specialties, including plastic surgery, has improved over the last 18 years, and the percentage of URiM residents has remained relatively unchanged.

According to the study, published in JAMA Surgery, these results highlight current racial and sex disparities in resident attrition and demonstrate the importance of developing strategies to recruit, retain, and support residents. The large cross-sectional study looked at 407,461 program-reported resident years collected from 112, 205 individual surgical residents

As the authors point out, this retrospective study is not the first on resident attrition. A previous single-specialty study found plastic surgery residents had an attrition rate of 3.0%. This study focuses on all surgical subspecialties over an 18-year period. 

The study, led by Lee S. Haruno, MD, from Cedars Sinai Medical Center in Los Angeles, found that sex disparity was most prevalent in orthopedic surgery and neurosurgery. Orthopedic surgery was also the least demographically diverse field, while integrated vascular surgery was the most demographically diverse. The study’s authors reported that ophthalmology and otolaryngology has the lowest mean percentage of URiM residents over the study period, where as OB-GYN had the highest. 

Overall attrition rate among all the specialties was 6.9%, with an unintended attrition rate of 2.3%. According to the study’s authors, resident attrition includes all-cause withdrawals, dismissals, and transfers to another specialty; unintended attrition includes all withdrawals, dismissals, and transfers except for changing career plans. 

Female residents had a significantly higher relative risk of attrition and unintended attrition compared to their male counterparts. URiM residents also had a higher relative risk of attrition and unintended attrition compared to non-URiM residents, with Black/African American residents having the highest attrition and unintended attrition rates. The lowest rates of both types of attrition were found in White residents.  

The study’s authors found that across all specialties, Hispanic residents did not have a significantly elevated relative risk of attrition or unintended attrition. 

In assessing the findings, the study’s authors write: 

This study highlights the issue of limited diversity and attritional disparities in surgical residency training programs. The rates presented herein are fundamental and actionable. Developing an enhanced understanding of these findings will allow potential solutions, informed decision-making, and direct avenues for change. Increasing diversity in surgical specialties is vital in providing quality care, improving trust in physicians, and increasing satisfaction of patient care. Physicians of minoritized groups are also more likely to practice in underserved communities. To better serve our patients, the need to recruit and retain underrepresented minorities and women is paramount.