A multi-institutional survey of newer surgery faculty on the impacts of education debt and debt repayment strategies

Association of Time to Attrition in Surgical Residency With Individual Resident and Programmatic Factors

Importance

Attrition in general surgery residency remains high, and attrition that occurs in the later years is the most worrisome. Although several studies have retrospectively investigated the timing of attrition, no study to date has prospectively evaluated a national cohort of residents to understand which residents are at risk for attrition and at what point during residency.

Objective

To prospectively evaluate individual resident and programmatic factors associated with the timing of attrition during general surgery residency.

Design, Setting, and Participants

This longitudinal, national cohort study administered a survey to all categorical general surgery interns from the class of 2007-2008 during their first 30 days of residency and linked the data with 9-year follow-up data assessing program completion. Data were collected from June 1, 2007, through June 30, 2016.

Main Outcomes and Measures

Kaplan-Meier curves evaluating time to attrition during the 9 years after the start of residency.

Results

Among our sample of 836 residents (306 women [36.6%] and 528 men [63.2%]; gender unknown in 2), cumulative survival analysis demonstrated overall attrition for the cohort of 20.8% (n = 164). Attrition was highest in the first postgraduate year (67.6% [n = 111]; absolute rate, 13.3%) but continued during the next 6 years, albeit at a lower rate. Beginning in the first year, survival analysis demonstrated higher attrition among Hispanic compared with non-Hispanic residents (21.1% vs 12.4%; P = .04) and at military programs compared with academic or community programs after year 1 (32.3% vs 11.0% or 13.5%; P = .01). Beginning in year 4 of residency, higher attrition was encountered among women compared with men (23.3% vs 17.4%; P = .05); at year 5, at large compared with small programs (26.0% vs 18.4%; P = .04). Race and program location were not associated with attrition.

Conclusions and Relevance

Although attrition was highest during the internship year, late attrition persists, particularly among women and among residents in large programs. These results provide a framework for timing of interventions in graduate surgical training that target residents most at risk for late attrition.

Trends associated with debt loads among oral and maxillofacial surgery chief residents

OBJECTIVE

This survey-based study was undertaken to investigate how total debt loads are impacting the personal and professional decisions made by graduating oral and maxillofacial surgery (OMS) residents. The aim of this study was to evaluate differences in total debt load on graduating residents and analyze the effects of this debt on career, family, and lifestyle choices after graduation.

STUDY DESIGN

This study was a cross-sectional, web-based survey of all graduating OMS residents in accredited OMS residency programs in the United States. Participation in the survey was optional, and all responses were anonymously collected and the data analyzed by using Qualtrics software. The respondents were analyzed as a collective, with the predictor of the study being program training length and the outcome being total debt load, with independent analysis of select other financial variables.

RESULTS

For the 246 deliverable emails, there were 120 respondents (48.7% response rate). The average graduating OMS resident was a Caucasian male (median age 32 years), living with a significant other or spouse who independently earned money, and had no dependents. The average range of accumulated debt of graduating residents was between $300,000 and $350,000, with 50.83% of the respondents having $350,000 or less in overall debt and 49.17% of the respondents having $350,000 or greater in accumulated debt. For those respondents completing 4-year programs, the average range of accumulated debt was between $250,000 and $300,000, and for those respondents completing 6-year programs, the average range of accumulated debt was between $400,000 and $450,000 (P < .08).

CONCLUSIONS

Graduating OMS residents carry with them a significant amount of debt whether graduating from a 4-year program or a 6-year program. However, when subjectively queried, most of these residents stated they would again choose OMS as a career choice.