National prospective cohort study describing how financial stresses are associated with attrition from surgical residency.

BACKGROUND: Attrition from general surgery residency is high with a national rate of 20%. We evaluated potential associations between financial considerations and attrition.

METHODS: National prospective cohort study of categorical general surgery trainees.

RESULTS: Of the 1048 interns who started training in 2007, 681 (65%) had complete survey and follow-up data. In logistic regression, those with higher starting attending salary expectations (>$300K) were more likely to leave training (OR 2.9, 95% CI 1.2-6.9). Women with a partner who earned more (>$50K/year) were more likely to leave training (OR 4.1, 95% CI 1.6-10.5). In a subgroup of interns undecided about their future practice setting (academic, community, private practice, industry), those with less debt (≤$100K) were more likely to leave training (OR 2.4, 95% CI 1.1-5.2).

CONCLUSIONS: Several financial matters were associated with attrition. Addressing these financial concerns may help decrease attrition in surgical training and improve surgical training.