Training should work for future parents and future surgeons.
Parental leave, childcare costs, and who leaves surgical training — with honest scope and both sides shown.
Leave on paper and in practice
The ACGME floor since July 1, 2022 is 6 weeks of paid medical, parental, or caregiver leave at 100% of salary[39].
Use lags the floor. In a 2018 survey of 2,188 surgery residents (before the current floor), 42.5% of leave-takers took under two weeks. About a third felt unsupported by peers (30.4%) or faculty (32.7%)[40]. Only 3.8% correctly identified the board leave policy[41].
| Finding | Share |
|---|---|
| Leave-takers taking under two weeks | 42.5% |
| Felt unsupported by peers | 30.4% |
| Felt unsupported by faculty | 32.7% |
| Correctly identified the board leave policy | 3.8% |
Performance fears look overstated in one specialty. Among 283 ophthalmology residents, the 44 who took leave (median 4.5 weeks; men 2, women 6) showed no performance gap versus peers[42]. The study lead calls under 6 weeks “probably not enough” and supports up to 12 weeks or a hybrid return, stated as expert opinion[43].
The other side: coverage is real. Programs cite coverage plus lost training time as obstacles, and some residents worry about strain on peers. Parity evidence comes from one specialty. Career-path differences after leave need more study. We make no blanket medical claim about six weeks.
Leaders can help by publishing one clear policy, planning coverage before leave starts, and welcoming returners back.
Sources: ACGME leave answers (6-week floor) · JAMA Surgery leave survey (PMC6686777) · Ophthalmology leave study, via AMA.
Childcare math
Stated scope: single income, one child. Across 295 surgical programs, 290 left a single-parent resident with negative net income after living costs plus childcare — 98.3% — within the paper’s single-income, single-child model[44]. Parents of infants in the West averaged negative $21,278; mean infant care costs ranged $9,694 to $14,792 across regions[45]. Context: 28.6% of surgical residents have or expect children while working a cited mean of 84.3 hours a week[46].
We apply this math only inside its stated scope. Dual incomes, family help, subsidies, and regional pay differences change results. The finding still signals a structural gap worth leadership attention.
Sources: Surgical childcare study (PMC11907318) · AMA summary.
Who leaves surgical training
A literature review across 20-plus studies and 19,821 residents pooled general-surgery attrition at 18%: 25% for women versus 15% for men, with 48% of leavers exiting after the first year[57]. The top reported cause was uncontrollable lifestyle. About 20% of leavers moved to another surgery program and 13% moved to anesthesia[58].
The other side: attrition is not all loss to medicine. A fifth switch programs, often for family or geography, while others switch specialties. Surgery sits at the high-attrition end; rates run lower in ophthalmology, ENT, and orthopedics. Causes are self-reported and multifactorial, spanning performance, dismissal, family, health, and finances.
On cost: one widely cited figure sizes burnout near $4.6B a year, about $7,600 per physician[59]. That figure covers employed attending physicians only. It is context, never a resident number, and we present no resident replacement-cost figure.
Sources: Surgery attrition review, via Medical Design (Al-Omran) · Burnout cost context, via AMA (attendings only).
Send the figures on
Share the childcare math with a program director. Send the attrition figures to a policymaker shaping surgical workforce policy.