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

BACKGROUND: 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. STUDY DESIGN: We conducted a retrospective longitudinal cohort study linking Medicare Physician and Other Practitioners Public Use Files (2013-2023) 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 three consecutive years with <50 evaluation and management services. Kaplan-Meier methods estimated cumulative attrition; multivariable Cox regression evaluated associations with specialty, sex, years in practice, U.S. Census region, and rural versus urban location. RESULTS: Among 224,629 surgeons (1,722,692 surgeon-year observations), 15,753 exited active practice over a median 8 years (IQR 6-8), yielding cumulative attrition of 9.7%. Annual attrition was 1.5-1.7% from 2013-2018, peaked at 2.5% (n=2,977) in 2019, and was 1.3% (n=1,462) in 2020. Five-year cumulative attrition reached 25.1% in oral and maxillofacial surgery, 23.2% in obstetrics and gynecology, and 19.3% in plastic surgery. In adjusted analyses, surgeons 10-14 years in practice had more than double the hazard of attrition versus 5-9 years (hazard ratio [HR] 2.58, 95% CI 2.48-2.68), whereas <5 years (HR 0.91, 95% CI 0.87-0.96) and 15-19 years (HR 0.19, 95% CI 0.13-0.27) had lower hazards. Oral and maxillofacial surgery (HR 2.64, 95% CI 2.43-2.86) and obstetrics and gynecology (HR 2.23, 95% CI 2.16-2.30) demonstrated the highest specialty-specific hazards. Female sex was not associated with attrition (HR 0.99, 95% CI 0.97-1.01). CONCLUSIONS: Nearly one in ten surgeons exited active practice over 8 years, with disproportionate losses among mid-career and select subspecialty surgeons. Targeted retention strategies are needed to sustain the US surgical workforce.