Research suggests mid-career surgeons are more likely to leave clinical practice than those with more than 15 years or less than nine years of experience, according to a study published May 20 in the Journal of the American College of Surgeons.
Researchers at the Ohio State University in Columbus and its medical center analyzed national attrition rates of U.S.-based surgeons between 2013 and 2023, finding higher attrition rates among mid-career surgeons and some subspecialties.
Although this study did not analyze why surgeons are leaving clinical practice, recent research from the American Medical Association found administrative burdens, or “hassle factor,” as a prime motivator for nearly 50% of physicians who have left clinical practice. Among 971 clinically inactive physicians, 11% reported never entering clinical practice after completing residency.
Four takeaways from the surgeon attrition study:
1. Attrition over the years
Among 224,629 surgeons, 15,753 left clinical practice over a median of eight years, equaling a cumulative attrition rate of 9.7%. Annual attrition ranged between 1.5% and 1.7% from 2013-18, peaked at 2.5% in 2019 and stabilized to the former trend in 2019, with a rate of 1.3%.
2. Tenure
Compared to surgeons with five to nine years of experience — the reference metric — surgeons with 10 to 14 years of practice had a hazard ratio of 2.58, meaning they are more than twice as likely to exit the profession than their peers who have practiced for five to nine years.
Early-career surgeons, or those with less than five years of experience, had an attrition hazard ratio of 0.91, while surgeons with 15 to 19 years had an even lower hazard ratio of 0.19.
“This ‘mid-career spike’ (10–14 years in practice) parallels literature noting that mid-career physicians often experience the highest rates of burnout, lowest professional fulfillment and greatest administrative burden, while simultaneously balancing leadership roles and family responsibilities,” the study said.
3. At-risk subspecialties
Across all variables, including tenure, regional geographics and gender, oral and maxillofacial surgery had the highest hazard ratio of attrition
The study analyzed 19 subspecialties and found the highest attrition rates for these three: oral and maxillofacial surgery (annual attrition rate of 6.9%), OB-GYN (5.9%), and plastic and reconstructive surgery (5%).
4. Gender’s role
Over the 10-year study period, the proportion of women surgeons increased from 21.2% to 28.6%, while male surgeons declined in proportion from 73.6% to 66.3%. Despite other literature recording higher attrition rates among female physicians, “sex was not associated with [a] hazard of leaving active practice in adjusted models” of this study.
“These findings show that surgical attrition is a real problem,” Timothy Pawlik, MD, PhD, a surgical oncologist and study co-author, said in a May 20 news release. “[We] need to address it in a nuanced and tailored way, focusing on certain subspecialties that are highest risk, and focusing on mid-level providers who are most likely to leave surgery.”
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