Qualitative Factors Underlying Attrition Rates in U.S. Neurosurgery Residency Programs

Introduction: Neurosurgery resident attrition rates have continued to rise in recent years with studies reporting 11%-43%, ranking neurosurgery among the highest of all residency programs. Previous studies investigating attrition in neurosurgery have lacked qualitative metrics and there is a paucity of published data around the reasons residents are leaving training.

Methods: All those enrolled in a U.S. neurosurgery residency program from 1990 to 2018 who are non-board certified by the American Board of Neurological Surgery were identified using a public database available from the American Association of Neurological Surgeons, with additional search of the National Provider Identifier Registry. After obtaining a filtered list of eligible participant names, individuals were contacted via email or LinkedIn and invited to complete a brief, anonymous online survey inquiring about personal, medical school and residency characteristics, as well as specific reasons for attrition.

Results: 12 individuals responded to the survey, 8 male 4 female, who left neurosurgery at various stages of training ranging from PGY 2 to 6. Top reasons for leaving neurosurgery residency included high stress, lack of work-life balance, and working too many hours. Better work hours, more supportive environment, and better mentorship were cited as factors that if implemented meaningfully may have led to these individuals’ staying in neurosurgery. The qualitative responses highlighted additional themes contributing to attrition, including a toxic/malignant culture at some programs, gender and racial discrimination, lack of support to cope with high demands and expectations, and poor patient outcomes.

Conclusion : These results provide a detailed snapshot of the reasons why some former U.S. neurosurgery residents left their programs. Though the small sample size limits generalizability, these data provide valuable insight into the qualitative factors underlying neurosurgery residency attrition and provide impetus to improve the culture of neurosurgery residency programs through more effective mentorship and support structures for residents.