Study quantifies distressing rate of surgeon attrition from active practice

Surgeon recruitment and retention is already difficult for many facilities. According to a new study published as an article in press in the Journal of the American College of Surgeons, that difficulty will likely continue without effective interventions to stem the tide of surgeon attrition.

The retrospective longitudinal cohort study by researchers at The Ohio State University and The Ohio State University Wexner Medical Center examines national trends and predictors of attrition from active clinical surgical practice. Attrition was defined as “the first year followed by three consecutive years with less than 50 evaluation and management services.”

Among 224,629 surgeons and 1,722,692 surgeon-year observations, the study found that 15,753 exited active practice over a median eight years, yielding a cumulative attrition rate of 9.7%. Other findings:

• Five-year cumulative attrition was 25.1% in oral and maxillofacial surgery, 23.2% in obstetrics and gynecology, and 19.3% in plastic surgery.
• The lowest annual attrition rates were observed in podiatry/foot and ankle (0.4%), otolaryngology (0.5%), orthopedics (0.7%), and vascular (0.8%).
• Surgeons 10 to 14 years in practice had “more than double the hazard of attrition” versus those in practice for five to nine years. Surgeons with less than five years in practice and surgeons 15 to 19 years in practice “had lower hazards,” according to the study.
• The percentage of surgeons practicing in rural and non-metropolitan areas decreased from 10.5% to 8.5% from 2013 to 2023.
• Although the percentage of female surgeons rose from 21.2% in 2013 to 28.6% in 2023, the gender of the surgeon was not associated with attrition.
• Across the study period, the number of active surgeons ranged from 154,000 to 157,000 annually.

The study’s conclusion: “Nearly one in 10 surgeons exited active practice [within] eight years, with disproportionate losses among mid-career and select subspecialty surgeons. Targeted retention strategies are needed to sustain the U.S. surgical workforce.”

The American College of Surgeons (ACS) promoted the study thusly: “Surgeons are already in short supply, with the gap between the number needed and the number working expected to get worse.”

“These findings show that surgical attrition is a real problem, and that 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,” study co-author Timothy M. Pawlik, MD, MPH, PhD, FACS, a surgical oncologist at The Ohio State University Wexner Medical Center told ACS.

The study doesn’t examine the reasons for surgeon attrition. According to the researchers, however, it illuminates “where policy changes and support are most needed,” notes ACS. Said Dr. Pawlik, “By identifying who is most likely to leave, we can create targeted retention strategies to support surgeons most likely to leave, and close these gaps.”

ACS is doing its part. As we reported in March, it has released what it calls “the first-ever national workplace standards framework for surgeons aimed at, among other things, workforce sustainability and improving surgeon well-being.”