Why do trainees leave hospital-based specialty training? A nationwide survey study investigating factors involved in attrition and subsequent career choices in the Netherlands

OBJECTIVE: To gain insight into factors involved in attrition from hospital-based medical specialty training and future career plans of trainees who prematurely left their specialty training programme. DESIGN: Nationwide online survey study. SETTING: Postgraduate education of all hospital-based specialties in the Netherlands. PARTICIPANTS: 174 trainees who prematurely left hospital-based medical specialty training between January 2014 and September 2017. MAIN OUTCOME MEASURES: Factors involved in trainees' decisions to leave specialty training and their subsequent career plans. RESULTS: The response rate was 38%. Of the responders, 25% left their programme in the first training year, 50% in year 2-3 and 25% in year 4-6. The most frequently reported factors involved in attrition were: work-life balance, job content, workload and specialty culture. Of the leaving trainees, 66% switched to another specialty training programme, of whom two-thirds chose a non-hospital-based training programme. Twelve per cent continued their career in a non-clinical role and the remainder had no specific plans yet. CONCLUSIONS: This study provides insight in factors involved in attrition and in future career paths. Based on our findings, possible interventions to reduce attrition are: (1) enable candidates to develop a realistic view on job characteristics and demands, prior to application; (2) provide individual guidance during specialty training, with emphasis on work-life balance and fit with specialty.