A fire in our hearts: passion and the art of surgery

Surgery is a profoundly exciting and rewarding profession, so it is alarming to see a diminishing of passion for the field in the trainees that are now coming through our doors. The attrition rate of surgical residents is unacceptably high, especially when compared with other fields.

To investigate potential causes behind the current high attrition rates seen in general surgery residency programs. Medline was searched (January 1990 to November 2009). The Internet was searched (Google) for informational sites, newsletters, and informally published articles.

Attrition rates in general surgery residency programs are > or =20%, and many residents withdrawing from the programs go to other fields. The implementation of the 80-hour work week, while reported to improve quality of life, has not reduced attrition rates, presumably because the same amount of material needs to be learned in what is now a shorter period of time. The use of physician extenders to relieve residents of routine floor work that does not contribute to residency training is one solution. Another is the reformulation of clinical duties to make time use more efficient. Most importantly, recruitment should be restricted to those students with the intellectual, physical, behavioral, and emotional traits that make them suitable for the field of surgery.

Attrition rates from general surgery residencies may be reduced by increasing the efficiency of the training programs to optimize time use. Recruitment should target those students who have, or who are most likely to develop, a passion for the art of surgery.