Investigators identified substantial variation in surgeon attrition across specialties and career stages in a national longitudinal analysis, with the highest rates observed in oral and maxillofacial surgery, obstetrics and gynecology, and plastic and reconstructive surgery.
Over the study period, 15,753 surgeons exited active clinical practice, corresponding to a cumulative attrition rate of just under 10%. Annual attrition remained relatively stable from 2013 through 2018 at about 1.5% to 1.7% per year, peaked at 2.5% in 2019, and fell to 1.3% in 2020.
The investigators linked Medicare Physician and Other Practitioners Public Use Files from 2013 to 2023 with the National Plan and Provider Enumeration System using National Provider Identifiers. The analysis included 224,629 surgeons across 19 surgical specialties who billed Medicare fee-for-service Part B at least once during the study period, representing 1.7 million surgeon-year observations.
Surgeons were classified as having left practice when they recorded fewer than 50 evaluation and management services annually for 3 consecutive years after a period of active practice. The investigators used Kaplan-Meier methods to estimate cumulative attrition and multivariable Cox proportional hazards regression to evaluate associations with specialty, sex, years in practice, US Census region, and rural vs. urban practice location.
“Nearly one in every 10 surgeons left active clinical practice with attrition concentrated in specific subspecialties and among mid-career surgeons, occurring against a backdrop of an aging and increasingly rural-scarce workforce,” wrote lead study author Abdulaziz Elemosho, MD, of the Department of Surgery at The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center as well as the Department of Plastic and Reconstructive Surgery at The Ohio State University Wexner Medical Center College of Medicine, and colleagues.
Oral and maxillofacial surgery had the highest average annual attrition rate at 7%, followed by obstetrics and gynecology at 6% and plastic and reconstructive surgery at 5%. The 5-year cumulative attrition reached 25% in oral and maxillofacial surgery, 23% in obstetrics and gynecology, and 19% in plastic and reconstructive surgery.
By comparison, orthopedic surgery, otolaryngology, podiatry/foot and ankle surgery, and vascular surgery had 5-year cumulative attrition rates of 2.4%, 1.8%, 1.8%, and 3.1%, respectively.
In adjusted analyses, surgeons with 10 to 14 years in practice had 2.6 times the odds of attrition compared with surgeons with 5 to 9 years in practice. Those with fewer than 5 years in practice had a slightly lower hazard of attrition, while surgeons with 15 to 19 years in practice had approximately one-fifth the odds of attrition.
Compared with general surgeons, oral and maxillofacial surgeons had 2.6 times the odds of attrition, while physicians in obstetrics and gynecology had 2.2 times the odds. Plastic and reconstructive surgeons had 1.7 times the hazard of attrition, while cardiac surgeons had 1.5 times the hazard, compared with general surgeons. Compared with general surgery, lower attrition hazards were observed among orthopedic surgery, otolaryngology, urology, colorectal surgery, hand surgery, and podiatry/foot-and-ankle surgery.
Attrition rates were similar among female and male surgeons. The proportion of female active surgeons increased from 21% in 2013 to 29% in 2023. The median years in practice increased from 7 years to 16 years, and the proportion of surgeons practicing in rural or nonmetropolitan areas declined from 11% to 8%.
The investigators noted several limitations. Because the study relied on administrative billing data, misclassification of practice status was possible. The attrition definition could not distinguish permanent retirement from transitions to nonclinical roles, part-time practice, or changes in billing patterns. Years in practice were estimated using National Provider Identifier enumeration dates and may not have captured earlier clinical experience. The data also lacked information on factors that may influence attrition, including burnout, mental health, compensation models, academic rank, part-time status, musculoskeletal injuries, and family responsibilities. The findings may not generalize to surgeons who practice exclusively outside the data sources used in the analysis.
The study authors reported no conflicts of interest.
