National Analysis of Trends and Factors Associated with Surgeon Attrition in the US.

Abstract

Surgeon attrition threatens access to complex and time-sensitive operative care, but specialty-specific and career-stage patterns remain poorly defined. We evaluated national trends and predictors of attrition from active clinical surgical practice. We conducted a retrospective longitudinal cohort study linking Medicare Physician and Other Practitioners Public Use Files (2013 to 2023) to the National Plan and Provider Enumeration System using National Provider Identifiers. Surgeons billing Medicare Part B across 19 specialties were included. Attrition was defined as the first year followed by 3 consecutive years with less than 50 evaluation and management services. Kaplan-Meier methods estimated cumulative attrition; multivariable Cox regression evaluated associations with specialty, sex, years in practice, US Census region, and rural vs urban location. Among 224,629 surgeons (1,722,692 surgeon-year observations), 15,753 exited active practice over a median 8 years (interquartile range 6 to 8), yielding cumulative attrition of 9.7%. Annual attrition was 1.5% to 1.7% from 2013 to 2018, peaking at 2.5% (2,977) in 2019, and decreasing to 1.3% (1,462) in 2020. Five-year cumulative attrition reached 25.1% in oral and maxillofacial surgery, 23.2% in OB/GYN, and 19.3% in plastic surgery. In adjusted analyses, surgeons 10 to 14 years in practice had more than double the hazard of attrition vs 5 to 9 years (hazard ratio [HR] 2.58, 95% CI 2.48 to 2.68), whereas <5 years (HR 0.91, 95% CI 0.87 to 0.96) and 15 to 19 years (HR 0.19, 95% CI 0.13 to 0.27) had lower hazards. Oral and maxillofacial surgery (HR 2.64, 95% CI 2.43 to 2.86) and OB/GYN (HR 2.23, 95% CI 2.16 to 2.30) demonstrated the highest specialty-specific hazards. Female sex was not associated with attrition (HR 0.99, 95% CI 0.97 to 1.01). Nearly 1 in 10 surgeons exited active practice over a median 8 years, with disproportionate losses among mid-career and select subspecialty surgeons. Targeted retention strategies are needed to sustain the US surgical workforce.