Rate of Programs Affected by Resident Attrition and Program Factors Associated With Attrition in Emergency Medicine

Abstract

Background Resident attrition negatively affects residents and programs. The incidence of attrition in emergency medicine (EM) and program-specific factors associated with attrition remain unclear. Objective We quantified the percentage of EM residencies affected by attrition between 2007 and 2016 and identified program-specific factors associated with attrition. Methods We performed a retrospective analysis of data derived from the American Medical Association National Graduate Medical Education Census. We defined attrition as any postgraduate who left their residency training program prior to completion. We calculated the percentage of residency programs that experienced attrition and the overall incidence of attrition. We used Fisher's exact tests, Wilcoxon rank sum tests, and t tests, as well as multivariable logistic regression, to identify program-specific factors associated with attrition. Results Between 2007 and 2016, 139 EM residency programs (82%) experienced attrition of at least 1 resident. An average of 23% of EM training programs experienced attrition annually. The incidence of EM resident attrition averaged 0.85% per year. Program-specific factors associated with attrition include 4-year residencies ( P = .031), programs with medium class size ( P = .0003), more female residents ( P = .002), and more female faculty ( P = .003). After analysis, only medium class size (compared to small) was associated with attrition (odds ratio = 4.96, 95% confidence interval 1.65–14.91). Conclusions Between 2007 and 2016, while the incidence of resident attrition in EM was low (< 1%), the majority of programs experienced resident attrition. Medium class size (7 to 12 residents) was the only program-specific factor associated with increased attrition.

A Nationwide Survey of Program Directors on Resident Attrition in Emergency Medicine

“…Comparably, Brockberg et al reported that 23% of EM programs experienced attrition each year and more than 80% experienced attrition over the 10-year period of 2007–2016. 1 Our data is consistent with existing studies demonstrating that while the overall incidence of resident attrition in EM on an individual level is low, a substantial portion of training programs are impacted.…”

“…Resident attrition is often defined as the premature loss of a resident prior to completion of training. 1 , 2 Attrition has the potential to negatively impact fellow trainees and program leadership. 3 – 6 It can harm future recruitment efforts.…”

“…Brockberg et al showed that a quarter of EM residencies are impacted by resident attrition each year. 1 Our primary objectives were to quantify resident attrition in EM training programs and elucidate the reasons behind it. Our secondary objectives were to describe demographic characteristics of residents undergoing attrition, personal factors associated with attrition, and avenues of resident replacement.…”

Factors driving burnout and professional fulfillment among emergency medicine residents: A national wellness survey by the Society for Academic Emergency Medicine

“…The actual annual rate of attrition for EM residents is approximately 0.8%. [45][46][47] Potential barriers to attrition include student debt, lack of other employment options, and the opportunity cost of leaving the field of medicine. Furthermore, even though most residents train within academic institutions, over a third of EM residents in our study reported that they did not wish to pursue academic medicine, with burnout and professional fulfillment being strong drivers of these plans.…”

A Systemic Approach to Trainee Physician Wellness: Using the Theory of Change to Restructure a Pediatric Residency Program

“…One might say that these two de nitions could be linked together, as can be seen in the case of residency programs. Attrition is a major concern for any residency program, as it not only hinders the process of training but also negatively affects all those involved (9,10,11). Some of the side effects of attrition include disruption of schedules, add-on workload on the remaining trainees, compromised service provision, and the greater problem of hiring a replacement (12).…”