Leaving the Operating Room: Voices of Residents and Program Directors on Canadian Neurosurgical Attrition.

OBJECTIVE: This study aimed to determine the current level of attrition from neurosurgical residency programs in Canada and to identify the factors contributing to this phenomenon. DESIGN: The study employed a mixed-methods approach. First, a national cross-sectional descriptive survey collected program-level data from all 14 Canadian neurosurgery residency programs to determine resident attrition rates across Canada between 2013 and 2023. Subsequently, guided by critical constructivist theory, semistructured virtual interviews were conducted and iteratively coded through reflexive interpretivist analysis to construct an analytical framework. SETTING: Fourteen accredited neurosurgical residency programs across Canada, representing a national postgraduate medical education setting. PARTICIPANTS: Attrition data were requested from all 14 Canadian neurosurgery residency programs. Semistructured interviews were conducted with 7 neurosurgery program directors and 7 former neurosurgery residents who had left training between 2013 and 2023, representing 7 Canadian residency programs. RESULTS: Data from 8 of 14 programs revealed an average institutional attrition rate of 14.1% (range, 0%-28.6%). Interviews identified several key contributors to attrition, most frequently high workload, poor work-life balance, gender-related challenges for women, evolving career aspirations, limited employment opportunities in Canada, and high levels of responsibility. CONCLUSIONS: Attrition from neurosurgical residency is a multifaceted issue shaped by structural, cultural, and individual factors. Applying this holistic perspective enables a systematic approach to formulating interventions. Structurally, efforts should optimize resident workload, protect educational time, and support women and minoritized trainees through mentorship and equitable policies. Culturally, programs should promote role modeling, address gender inequities, and prioritize well-being alongside professional demands. Individually, mentorship, career counseling, and transparent communication about training realities can help align expectations and strengthen retention.