Factors Contributing to Attrition in Vascular Surgery Residency

Recent data suggest that there is a low, but constant, rate of attrition in vascular surgery residency programs. We sought to evaluate factors affecting this trend. We performed a survey-based study of current vascular resident trainees for the academic year of 2018-2019. Trainees from Accreditation Council for Graduate Medical Education-accredited integrated vascular training programs were emailed and voluntarily consented to participate. Responses were collected anonymously and the data was compiled and analyzed. Overall, 141 out of 302 residents responded to our study. Demographic information is provided in the Table. Regarding working conditions, 66% reported at least monthly occurrences of working more than 80 h/wk; 84% reported at least a moderate level of daily exhaustion; 62% reported at least monthly being affected by a nonwork stressor; and 95% reported the weekly ability to pursue at least one personal interest. Regarding expectations trainees had regarding residency, 26% felt stress levels are harder/exceeded expectations; 15% reported work hours being harder/exceeding expectations; 38% reported maintaining personal relationships is harder than expected; and 57% reported maintaining personal wellness is harder than expected. Regarding choosing vascular surgery as a specialty, 89% reported an unchanged or increased level of interest in vascular surgery; 87% would pick vascular surgery again if given the option; and 26% reported at least monthly considering leaving/quitting residency. Logistic regression showed that factors leading to significant increase burnout included postgraduate year 2 status (odds ratio [OR], 2.9; P = .035), stress levels exceeding expectations (OR, 10.9; P < .0001), and working greater than 80 h/wk (OR, 15.3; P = .021). Pursuing a personal interest at least weekly was found to be protective (OR, 0.23; P = .021). Logistic regression showed that factors leading to an increased desire to quit/leave residency included stress levels exceeding expectations (OR, 4.4; P = .004) and nonscience college major (OR, 2.5; P = .044). Pursuing a personal interest at least weekly was found to be protective (OR, 0.36; P = .024). Our results suggest that the majority of residents find it difficult to maintain personal wellness and are moderately stressed on a daily basis. With a majority of respondents working over Accreditation Council for Graduate Medical Education-mandated hours, and one-quarter of respondents considering quitting on a monthly basis, it is essential that we address resident physician overworking and burnout to prevent further vascular residency attrition.TableDemographic data and responsesDemographicNo. (%) or mean ± standard deviationRespondents141 (47)Male sex89 (63)Age, years31 ± 3.1PGY level Clinical 123 (16) Clinical 228 (20) Clinical 332 (23) Clinical 423 (16) Clinical 518 (13) Research17 (12)Marital status Single25 (18) Married70 (50) Relationship - never married43 (31) Relationship - previously married1 (0.7) Divorced2 (14)Significant other has a job100 (89)Significant other lives with trainee84 (74)Has dependents34 (24)Family dependent on trainee's earning potential43 (31)Current or planned nonvascular income source34 (25)Varsity athlete91 (65)Nonscience major49 (35)Armed forces5 (4)Practice martial arts30 (21)Played musical instrument106 (75)Vascular research before residency98 (70)Vascular subinternships 023 (16) 1-272 (51) ≥346 (33)Social support in city of training80 (57) Open table in a new tab