Analysis of national trends in neurosurgical resident attrition

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Resident attrition creates a profound burden on trainees and residency programs. This study aims to analyze trends in resident attrition in neurological surgery.


This study followed a cohort of 1275 residents who started neurosurgical residency from 2005 to 2010. Data obtained from the American Association of Neurological Surgeons (AANS) included residents who matched in neurosurgery during this time. Residents who did not finish their residency training at the program in which they started were placed into the attrition group. Residents in the attrition group were characterized by one of five outcomes: transferred neurosurgery programs; transferred to a different specialty; left clinical medicine; deceased; or unknown. A thorough internet search was conducted for residents who did not complete their training at their first neurosurgical program. Variables leading to attrition were also analyzed, including age, sex, presence of advanced degree (Ph.D.), postgraduate year (PGY), and geographical region of program.


Residents starting neurosurgical residency from 2005 to 2010 had an overall attrition rate of 10.98%. There was no statistically significant difference in attrition rates among the years (p = 0.337). The outcomes for residents in the attrition group were found to be as follows: 33.61% transferred neurosurgical programs, 56.30% transferred to a different medical specialty, 8.40% left clinical medicine, and 1.68% were deceased. It was observed that women had a higher attrition rate (18.50%) than men (10.35%). Most attrition (65.07%) occurred during PGY 1 or 2. The attrition group was also observed to be significantly older at the beginning of residency training, with a mean of 31.69 years of age compared to 29.31 in the nonattrition group (p < 0.001). No significant difference was observed in the attrition rates for residents with a Ph.D. (9.86%) compared to those without a Ph.D. (p = 0.472).


A majority of residents in the attrition group pursued training in different medical specialties, most commonly neurology, radiology, and anesthesiology. Factors associated with an increased rate of attrition were older age at the beginning of residency, female sex, and junior resident (PGY-1 to PGY-2). Resident attrition remains a significant problem within neurosurgical training, and future studies should focus on targeted interventions to identify individuals at risk to help them succeed in their medical careers.

ABBREVIATIONS ACGME = Accreditation Council for Graduate Medical Education; PGY = postgraduate year; ROC = receiver operating characteristic.

Article Information

Correspondence Nitin Agarwal: University of Pittsburgh Medical Center, Pittsburgh, PA.

INCLUDE WHEN CITING Published online November 23, 2018; DOI: 10.3171/2018.5.JNS18519.

Disclosures The authors report no conflict of interest concerning the materials and methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.



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    Graph showing the resident attrition rate for each class of residents matching into neurosurgery between 2005 and 2010. There was no trend in the change of attrition rate between years (r2 = 0.229, p = 0.337).

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    Pie chart representing the different specialties transferring residents chose to pursue. The specialties for a total of 107 transferring residents were found. The percentage of transferring residents who went into each specialty were as follows: other neurosurgery residency (37.38%), anesthesiology (12.15%), radiology (13.08%), neurology (14.95%), internal medicine (0.93%), family medicine (2.80%), pathology (1.87%), radiation oncology (5.61%), pediatrics (0.93%), orthopedic surgery (1.87%), physical medicine and rehabilitation (PM&R; 0.93%), emergency medicine (3.74%), general surgery (1.87%), psychiatry (0.93%), and dermatology (0.93%). Figure is available in color online only.

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    One hundred nineteen residents in the attrition group with known outcomes were included in the figure. The 21 residents categorized as “unknown” were omitted. The percentage of residents within each outcome category was as follows: transferred neurosurgery programs (33.61%), transferred to different specialty (56.30%), left clinical medicine (8.40%), and deceased (1.68%). Figure is available in color online only.

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    Resident attrition categorized by PGY. This figure represents a total of 140 different residents leaving their original residency programs; however, there are 146 plotted points due to 5 residents leaving programs more than once. Breakdown of resident attrition by PGY includes: 48 PGY-1 residents, 47 PGY-2 residents, 21 PGY-3 residents, 18 PGY-4 residents, 8 PGY-5 residents, and 4 PGY-6 or above residents. Figure is available in color online only.





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