Neurosurgery Resident Attrition Rates Defy Trends and Decrease During COVID-19 Pandemic

Abstract

What effects did the COVID-19 pandemic have on United States neurosurgery resident attrition? This study reports on changes in resident attrition due to transfers, withdrawal, or dismissal from program training during the COVID-19 pandemic. Neurosurgery resident attrition data published by the American Council of Graduate Medical Education (ACGME) for the academic year starting in July of 2007 up to the academic year ending in June of 2022 was collected and the rate of attrition was calculated. Individual post-graduate year program transfer rates were also calculated for the past 7 consecutive academic years. The attrition rates for the academic years prior to the pandemic were then compared to those during the pandemic. A total of 465 residents did not graduate from neurosurgical training over the last 15 academic years, 3 of which took place at least partially during the COVID-19 pandemic resulting in a mean attrition rate of 2.5%. The attrition rates during the pandemic were lower than those prior to the pandemic 1.7% vs 2.7% (<0.001), driven largely by a nearly 2-fold decrease in withdraw rate of 0.67% vs 1.2% (p =0.003). Bivariate regression between withdraw and attrition rate showed a statistically significant correlation, r = .809, p < 0.001 r2 = .654. The first full year of the pandemic saw the most dramatic changes with a z score for attrition of -1.9. Linear regression of the impact of training under COVID-19 on attrition was statistically significant, r = 0.563, p = 0.029 r2 = 0.317. Rate of withdrawal was most affected by training during the pandemic, r = 0.594, p = .010 r2 = 0.353. There was a statistically significant decline in the rate of neurosurgery resident attrition during the COVID-19 pandemic, most notable during the first full academic year (2020-2021). These findings were largely driven by a drop in residents withdrawing from training programs. This contrasts with the overall trend towards resignation seen amongst healthcare workers during the pandemic. It is unclear what enduring ramifications this will have on neurosurgery residencies moving forward and whether we will see higher attrition rates as we transition towards a new normal. Future studies should look to examine trends in attrition rates post-pandemic and determine the long-term effects of decreased attrition rates of residents during the pandemic.