Do Surgical Residents Often Fail Out Of Programs Or Quit?

[medhope15]

.

[Fresh fry]

Some surgical programs hemorrhage people, some are even proud of it. Some decide to quit and go to different programs, others are "encouraged" to quit and go to other programs. Part of the "pyramid" is also because people do a masters or PhD during residency, others take time off for personal reasons like having kids or illness. 

 

For many surgical programs doing a fellowship after graduation is becoming more of a necessity so some people do that but there are also many hospitals not affiliated with a university. There is definitely a glut of most surgical specialists right now but outside of ortho and ENT where there is no work anywhere, other specialties can generally find work at smaller centers and community hospitals. Academic centers tend to hire in spits and spurts and part of it is luck and the other part is having a grad degree and fellowship to bring to the table. 

 

You can't forecast it. people have been trying for years to figure out how it will go. There are too many variables. right now there is a lot of grey hair hanging on because of the down turn in 2009. At some point they are going to have to retire and then there will be a shortage. OR time dictates hiring which is dictated by budgets which are determined by politicians which change every few years. All you can do is follow your heart and hope you don't end up driving a cab.

 

A mature soon to be surgical resident (hopefully)

[ralk]

It's fairly common to see year-to-year changes in the make-up of a resident cohort. People often take time off to have kids or pursue graduate work. The overall number in each cohort usually isn't radically different though, since one person taking time off is reasonably likely to be replaced by someone the year ahead of them who also took time off. If there's a true drop-off in the numbers of people, then as French fry says, they're going somewhere, usually to other programs.

 

The bottom line is that surgical specialties - along with a few non-surgical specialties - are currently facing a pretty rough job market. Even community spots are getting harder to come by, especially those near or in larger cities. That may change in the future (people have to retire/die sometime). It might not (there might be more excess job-seekers in the system than we realize).

 

If you're thinking about surgery, you may need to accept a job market that isn't very favourable in many respects. Whether that's a worthwhile trade-off is entirely a personal decision. Many potential surgeons choose not to pursue that path because of lifestyle factors, including the job market. Yet, surgical residencies are still some of the most competitive in the country, so plenty of students are willing to accept that job market in order to become a surgeon. You're well over a decade away from hitting the job market and even if you started medical school soon, you're years from picking your specialty. There's no need to make a call yet, one way or the other. There's nothing wrong with dipping your toes in the water in med school, so to speak, and deciding then whether the upsides of surgery outweigh the downsides.

[NLengr]

I'm a premed but a mature applicant. It's been a long road. A friend who is studying medicine right now advised me to sort of keep an eye out on the specialties in which I might be interested by following their social media and checking in on university newsletters. So I've been doing that for quite some time now. I've followed some recent newsletters from a couple of schools and I noticed something interesting.

The numbers of "current residents" don't match from year to year. I've noticed for instance in the PGY1 list 12 residents, but the following year's newsletter has only 8 of those people listed as PGY2. I noticed this trend in a few programs.

Are people failing out? Do they change their mind about surgery?

 

My other question is in regards to employment after training. I've volunteered and done research in a hospital for a long period of time (>3 years), in the department where I work I have met many trainees each year, I have not seen one new staff hire in 3 years. Upon talking to a couple of nurses I know at different hospitals, they ALL tell me there has not been one new staff MD hire in their unit in the past 5-6 years. Sure they have lots of new residents and fellows, but not one new surgical staff.

 

So where do all the trainees go? The newsletters tell me that schools have 5-10 new surgical grads (in one subspecialty) per year, I see 0 hires where I work. This makes me really worried about even considering surgery as an option. (Yes I realize I'm still in the pre-med stage, but as a mature applicant i want to have all my ducks in a row; I have a couple of fields that really interest me, but I want to be fully informed that I'm making a good decision / and plan for my approach).

 

It's not unusual to see people leave surgical programs during the first couple years (gen surg at my center loses a couple of people a year it seems). I think it's mostly because people have a change of heart after first year. Those people who leave will go on to other fields that they may now have a greater interest in (I know people who switched into family and into anesthesia from gen surgery). Switching out of the smaller, more competative, programs is much less common in my experience. I can't think of a single ENT, optho, uro or plastics resident who has switched.

 

That's not unique to surgery though. Most programs will have people switching in an out in the first couple of years.

 

The problem with looking at hiring at your center is that i's only a small portion of the jobs in the country. The majority of people who finish residency will go on to work in the community. That's why you don't see your academic center hiring back lots and lots of its grads. On top of that, a bunch of them may be going down to the states to work. Many academically oriented people end up in the states doing a fellowship. Then they get scooped up by US academic centers looking to hire. (traditionally US grads will go into community practice at a much higher rate that Canadians).

[jnuts]

Failing out or quitting is very very rare.

 

Transferring to another program (with our without encouragement from the surgical program) is common.  One resident a year in most programs is about average.  Agreed it's less common in more competitive and smaller training programs.

[rmorelan]

Makes sense though - I mean no matter how much you do in medical school it is hard to be completely sure you really, really love a field enough to actually put up with all the downsides (which you often don't see in clerkship) until you actually do off and do it continuously for some time.

[JohnGrisham]

Makes sense though - I mean no matter how much you do in medical school it is hard to be completely sure you really, really love a field enough to actually put up with all the downsides (which you often don't see in clerkship) until you actually do off and do it continuously for some time.

Any strategies to try to find out about these downsides during clerkship? Obviously until your in a role 24/7 it is hard to know, but any tips to try to best attempt to illuminate them?

[ralk]

Any strategies to try to find out about these downsides during clerkship? Obviously until your in a role 24/7 it is hard to know, but any tips to try to best attempt to illuminate them?

 

Obviously not a resident, but I think simply keeping an eye on what the residents are doing (rather than just what you're doing) helps a lot. Are they doing a lot of scutwork while you're doing the fun stuff? Are you enjoying the hours on the rotation, but the residents are routinely sending you home before they leave? Are they taking significantly more call than you?

 

I've tried to get a sense of the typical emotional state of my residents too, though I know that can change from program to program. Are they happy? Serious? Exhausted? Irritable? Are their parts of their work that seem to get them excited more than others (and do you share that feeling to an extent that it could keep you happy through residency)? Some residents definitely seem happier and more fulfilled than others.

 

Best of all, just ask them about their residency. Keep in mind that no one's going to flat-out bad-mouth their program if they're still in it, but there's a big difference between an enthusiastic response and a measured one. What they like about their field of study and what they don't like helps a lot, because someone may love their specialty, but for reasons that don't apply to you. Better yet, try to figure out why they didn't go into other specialties they were considering. Most residents were choosing between 2-3 specialties in med school, but they chose one over the others for a reason - asking about those reasons reveals a lot about those specialties that they didn't try for as well as the one they're in.

[Lactic Folly]

Any strategies to try to find out about these downsides during clerkship? Obviously until your in a role 24/7 it is hard to know, but any tips to try to best attempt to illuminate them?

Just ask the people currently practising in these fields. Same questions as what ralk poses to residents above. And ask a cross-section of people (personalities, stage of career, and practice setting all make a difference).