From aspiration to attrition: A qualitative study of general surgery residents' career decisions away from pediatric...

Pediatric surgery (PS) has a long-standing reputation as a highly desirable and competitive specialty. However, recent years have demonstrated a decline in the number of fellowship applicants, raising concerns about trainee interest in the specialty. We sought to understand why general surgery (GS) residents who once meaningfully considered PS ultimately did not pursue the specialty.

Current and recently graduated (2022-2025) GS residents across the United States who previously aspired to pursue PS but ultimately did not apply were recruited via purposive sampling. Participant recruitment and semi-structured qualitative interviews took place from June to September 2025. Interview transcripts were inductively coded and thematically analyzed.

Twelve participants were interviewed, including 9 current postgraduate year 4-7 GS residents and 3 recent graduates from 9 institutions. Five themes characterized participants' decisions: (1) disillusionment with the specialty, (2) perceived barriers and uncertainty in the fellowship match process, (3) rigor of fellowship training, (4) absence of effective mentorship, and (5) limited future career opportunities. Participants proposed strategies for PS to attract and retain interested residents, including re-consideration of research expectations for fellowship applicants, consideration of new training pathways to expand care delivery opportunities, interventions to improve fellowship culture, efforts to foster mentorship, and increased transparency regarding the job market.

Personal, interpersonal, and specialty-specific factors influence residents' decisions to pursue other specialties. While some of these factors are intrinsic to the field of PS, there are opportunities for interventions to promote and sustain future trainee interest.