20. Resident Attrition in Graduate Medical Education: the Impact of Race and Gender

Background: Residency programs annually invest in recruiting qualified trainees to ensure completion of training. Unfortunately, attrition remains a significant issue, particularly for surgery programs, and impacts both residency programs and trainees financially. Few studies have reported rates and associated factors of attrition among surgical and non-surgical programs. Therefore, our study aimed to determine the rate of attrition among surgical and nonsurgical residents and identify the characteristics of residents who leave their training programs. Methods: The Association of American Medical Colleges (AAMC) provided residents’ data from 2001 to 2020. Data included social demographics, medical school type, program location, resident citizenship, and type of residency (surgical versus non-surgical). Medical specialties were categorized as surgical (n=10) based on the definition from the American College of Surgeons. Anesthesiology, dermatology, emergency medicine, family medicine, internal medicine, neurology, pathology–anatomic and clinical, pediatrics, psychiatry, and diagnostic radiology were categorized as non-surgical. Underrepresented in medicine (URM) was categorized according to AAMC’s definition–African Americans and/or Black, Hispanic/Latino, Native American (American Indians, Alaska Natives, and Native Hawaiians), Pacific Islander. Trainees in any fellowship programs and those with missing data were excluded. Results: 438,116 residents met the inclusion criteria. 53.6% were male, 54% were white, 63.8% had US MD, and 14.2% identified as Underrepresented (URM). Attrition in the entire cohort was 4.8%. The rate of attrition in the surgical residency program was 6.7% and non-surgical residency program was 4.4%. Attrition was associated with sex, race, older age at commencement of residency, residency type, and program location. On multivariable regression, female gender, surgical training, URM status, and attending US residency in the South were associated with higher attrition rates. Conclusion: Despite the push for increased diversity in residency, the proportion of URM residents who quit is greater than non-URM residents, especially in surgical programs. Similar trends have been reported in female residents. The data highlights a discrepancy in completion, suggesting a training environment that is inopportune to URM and female resident matriculation. Residency programs should devise better ways to improve the training environment for all recruited trainees.