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.
