The Effect of Intersectionality on Attrition among US General Surgery Trainees

Objective: To examine the association between intersectionality of race, ethnicity, and sex on retention of U.S. general surgery residents. Summary Background Data: There are limited data on the role that intersectionality plays on the US general surgery resident experience. Methods: Analysis was performed using Association of American Medical Colleges (AAMC) data for general surgery residents who started their training between 2005-2015 (followed through completion). Regression analyses were used to assess demographic associations with time to attrition or successful completion of residency training. Associations between faculty and resident demographics were assessed. Results: 25,029 residents were included. Over the decade-long study period, the number of underrepresented in medicine (UIM) residents as a percentage of all residents remained similar from 17% to 19% ( P =0.24). The percent of UIM males starting training in 2005 was 11% and 12% in 2015 ( P -value=0.38). UIM females comprised 5.5% of trainees in 2005 and increased to 6.9% ( P -value=0.003) in 2015; and female non-UIM residents increased from 23 to 28% ( P -value<0.001). The overall rate of resident attrition was 15%. UIM females had the highest yearly attrition rate at 21% compared to non-UIM males at 13% (HR 1.7, P <0.001). UIM females were more likely to leave residency compared to UIM males (HR: 1.5; P <0.001). The percent of UIM faculty was positively correlated with percent of UIM residents (r=0.64, P <0.001). Conclusions: Increasing intersectionality is positively associated with attrition during surgery residency. The diversity of faculty appears to be associated with resident diversity.