Nearly 1 in 10 Surgeons Leave the Profession Within 8 Years

Elemosho A, Chatzipanagiotou OP, Angez M, Janis JE, Pawlik TM. National Analysis of Trends and Factors Associated with Surgeon Attrition in the US. J Am Coll Surg. May 2026.

Surgeon attrition threatens access to complex and time-sensitive operative care, but specialty-specific and career-stage patterns remain poorly defined. Elemosho and colleagues explored national trends and predictors of attrition from active clinical surgical practice.

Authors 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.

Among 224,629 surgeons (1,722,692 surgeon-year observations), 15,753 exited active practice over a median of 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 surgeons with <5 years (HR 0.91, 95% CI 0.87–0.96) and those with 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).

For surgeons, hospitals, policymakers, and other stakeholders, the key takeaway is that nearly one in ten surgeons exited active practice over an 8-year period, and there was disproportionate attrition among mid-career and select subspecialty surgeons. Targeted retention strategies are needed to sustain the US surgical workforce. The ACS has been actively advancing these efforts, including through its recently released workplace standards framework, “Developing Specialty-Specific Workplace Standards for Surgeons: A Framework to Support Sustainable Surgical Careers.”