Pushing Surgeons Away: The Role of Resident Mistreatment in Career Migration in the Dominican Republic

Background: Negative perceptions of surgical training environments may contribute to declining interest in surgery and increased migration among medical students in low- and middle-income countries (LMICs). This study explores how punitive treatment of surgical residents influences specialty and geographic career decisions in the Dominican Republic. Methods: A survey was conducted among 100 final-year medical students who had completed a surgical rotation in the past six months. The survey assessed students' perceptions of resident mistreatment, their willingness to pursue surgery under improved conditions, and their preferences for training and practice locations. Results: Medical students who chose not to pursue surgery cited concerns about personal well-being and work-life balance (60.9%), fear of a toxic work environment and abuse (20.7%), and the belief that such practices reflect poor training conditions (10.9%). When asked if they would reconsider surgery if working conditions improved, 63% said yes, 21% said no, and 16% were unsure. Regarding preferred training locations, 49% preferred to train abroad but return to practice in the Dominican Republic, 28% favored both training and practicing abroad, 12% wanted to stay for both, and 11% were uncertain. Finally, 84% believed that mistreatment discourages students from choosing surgery, while 7% felt it had no impact, and 9% were unsure. Conclusion: Resident mistreatment not only dissuades students from surgical careers but also contributes to emigration of future surgeons away from their home countries, especially LMICs like the Dominican Republic, to seek better training and working conditions. Addressing toxic training environments is key to building resilient surgical systems and retaining future surgeons within LMICs.