Objective:

To analyze surgeon attrition rates across various specialties and career stages.

Approach:

• Study Design: National longitudinal analysis linking Medicare billing data with National Provider Identifiers.
• Population: 224,629 surgeons across 19 surgical specialties with 1.7 million surgeon-year observations.
• Attrition Definition: Surgeons were classified as having left practice if they recorded fewer than 50 evaluation and management services annually for 3 consecutive years.
• Statistical Methods: Kaplan-Meier methods for cumulative attrition and multivariable Cox proportional hazards regression for associations.

Key Findings:

• 15,753 surgeons exited active clinical practice, with a cumulative attrition rate of just under 10%.
• Annual attrition rates remained 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.
• Highest attrition rates were in oral and maxillofacial surgery (7%), obstetrics and gynecology (6%), and plastic and reconstructive surgery (5%).
• 5-year cumulative attrition reached 25% in oral and maxillofacial surgery, 23% in obstetrics and gynecology, and 19% in plastic and reconstructive surgery.
• Surgeons with 10 to 14 years in practice had 2.6 times the odds of attrition compared to those with 5 to 9 years.
• Attrition rates were similar among female and male surgeons, with the proportion of female active surgeons increasing from 21% in 2013 to 29% in 2023.

Interpretation:

Limitations:

• Reliance on administrative billing data may lead to misclassification of practice status.
• The attrition definition does not differentiate between permanent retirement and transitions to nonclinical roles.
• Lack of data on factors influencing attrition such as burnout, mental health, and family responsibilities.

Conclusion:

Sources:

• Journal of the American College of Surgeons