New England Section of the American Urological Association

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Comparing Physician Retention in State of Training by Subspecialty Surgical Field and Sex
Jennifer Fantasia, MD; Boris Gershman, MD; Simone Thavaseelan, MD
Brown University/Rhode Island Hospital, Providence, RI

Newly trained physicians will be an increasingly valuable resource in the setting of forecasted physician workforce shortages. This is particularly relevant for the field of urology, where the workforce shortage is anticipated to be compounded by both the aging demographic of current practicing urologists as well as that of the general population and its associated urologic disease burden. Policy designed to improve retention of newly trained physicians should be prioritized as graduate medical education represents a significant financial commitment at the federal, state and community level. However, there is a paucity of data specifically evaluating urology trainees and retention in state of training.
This study examines the current trends in retention of newly trained physicians, focusing on urology trainees compared to other surgical subspecialties and all medical fields overall, sub-analyzed by sex. We hypothesized that the in-state retention of urologic trainees would be less compared to all fields overall but similar to other competitive surgical subspecialties and similar across gender.
Data on specialty, sex, state of residency training and current state of practice were obtained from the Association of American Medical Colleges' Report on Residents from 2006 to 2016. The in-state retention of urology trainees was compared to other surgical subspecialties as well as the overall rate of retention for trainees in all fields. Statistical analysis consisted of chi-square testing; significance was set at p<0.05.
Between 2006-2016, a total of 237,176 GME graduates were identified by the AAMC's Report on Residents and retention in state of training was compared by specialty and sex. Comparative analysis demonstrated that surgical subspecialties tended to have lower rates of trainee retention in state of residency compared to all fields, p-values < 0.0001 (Table 1). Overall, plastic surgery, ophthalmology and urology demonstrated the lowest rates of in-state retention. When analyzed by sex, men in neurosurgery (35.7%), plastic surgery (36.2%), ophthalmology (36.9%), and urology (41.6%) were least likely to practice in the same state of training (Table 1). Women in plastic surgery (39.6%) and urology (40.9%) were also less likely to practice in the same state of training when compared to all fields overall (Table 1).
This study demonstrates that newly trained urologists are among the most likely to transition from their state of training, even when compared with other similar subspecialty surgical fields. Additional research should evaluate post-training migration trends of surgical subspecialists to understand motivating factors and the transition behavior of trainees. Given the significant financial investment required for resident training, this information may aid sponsoring institutions to train and retain the needed workforce.
Table 1: Chi-Square Analysis of Trainee Retention in Urology v Other Surgical Subspecialties v All Fields

SpecialtyIn State (%)Out of State (%)P-value*
- Men5 (35.7)9 (64.3)<0.0001
- Women00n/a
- Men1019 (46.4)1179 (53.6)<0.0001
- Women4593 (54.5)3837 (45.4)<0.0001
- Men836 (36.9)1427 (63.1)<0.0001
- Women727 (44.0)927 (56.0)<0.0001
- Men1158 (42.2)1587 (57.8)<0.0001
- Women132 (42.6)178 (57.4)<0.0001
- Men623 (40.4)920 (59.6)<0.0001
- Women308 (48.1)332 (51.9)<0.0001
Plastic Surgery
- Men317 (36.2)558 (63.8)<0.0001
- Women108 (39.6)165 (60.4)<0.0001
General Surgery
- Men2078 (49.6)2110 (50.4)<0.0001
- Women1075 (53.0)955 (47.0)<0.0001
- Men744 (41.6)1043 (58.4)<0.0001
- Women168 (40.9)243 (59.1)<0.0001
All Fields
- Men64554 (51)62094 (49)n/a
- Women64792 (59)45736 (41)n/a

* p-value significance set at < 0.05

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