Why Residents Quit

National Rates of and Reasons for Attrition Among Emergency Medicine Physicians in Training

Dave W. Lu, MD, MSCI, MBE; Nicholas D. Hartman, MD, MPH; Jeffrey Druck, MD; Jennifer Mitzman, MD; Tania D. Strout, PhD, RN, MS


Western J Emerg Med. 2019;20(2):351-356. 

In This Article

Abstract and Introduction


Introduction: Recruiting and retaining residents who will complete their emergency medicine (EM) training is vital, not only because residency positions are a limited and costly resource, but also to prevent the significant disruptions, increased workload, and low morale that may arise when a resident prematurely leaves a program. We investigated national rates of EM resident attrition and examined the reasons and factors associated with their attrition.

Methods: In this retrospective, observational study we used national data from the American Medical Association National Graduate Medical Education Census for all residents who entered Accreditation Council for Graduate Medical Education-accredited EM programs between academic years 2006–2007 and 2015–2016. Our main outcome was the annual national rate of EM resident attrition. Secondary outcomes included the main reason for attrition as well as resident factors associated with attrition.

Results: Compared to the other 10 largest specialties, EM had the lowest rate of attrition (0.8%, 95% confidence interval [CI] [0.7–0.9]), or approximately 51.6 (95% CI [44.7–58.5]) residents per year. In the attrition population, 44.2% of the residents were women, a significantly higher proportion when compared to the proportion of female EM residents overall (38.8%, p=0.011). A greater proportion of Hispanic/Latino (1.8%) residents also left their programs when compared to their White (0.9%) counterparts (p<0.001). In examining reasons for attrition as reported by the program director, female residents were significantly more likely than male residents to leave due to "health/family reasons" (21.5% vs 9.6%, p=0.019).

Conclusion: While the overall rate of attrition among EM residents is low, women and some under-represented minorities in medicine had a higher than expected rate of attrition. Future studies that qualitatively investigate the factors contributing to greater attrition among female and some ethnic minority residents are necessary to inform efforts promoting inclusion and diversity within the specialty.


Methods of resident selection for graduate medical training have been widely studied, with prior work examining factors used by programs to select residents as well as exploring predictors of resident success during training.[1,2] One driver for the numerous analyses of the residency selection process is that training programs invest a significant amount of effort and resources to recruit and develop successful residents.[3,4] The premature loss of a resident during training for any reason is disruptive and can create significant difficulties for programs in terms of patient care responsibilities, increased burdens on other providers, and program morale.[5] For emergency medicine (EM), the competition for coveted residency positions has become increasingly intense.[6]

To ensure that this limited resource is allocated justly and effectively, it is incumbent upon programs to enroll those applicants who are likely to successfully complete residency training. Although other specialties have studied the factors surrounding attrition, EM has not investigated how often attrition occurs among its trainees and for what reasons.[7–9] This study's primary objective was to examine national rates of resident attrition in Accreditation Council for Graduate Medical Education (ACGME)-accredited EM programs between 2006 and 2016. Secondary objectives included investigating the reasons for attrition as well as the resident characteristics associated with attrition.