The AMA’s most recent National Resident Comparison Report puts a number on something most residents feel intuitively: intent to stay at your training institution declines the longer you’re there. Roughly 40% of PGY-1s say they’d likely stay at their program after graduation. By PGY-5, that number drops to about 29%. Something about training changes people’s willingness to stay put — and it’s worth understanding what, before you make the call for yourself.

Why the number drops the longer you stay

The AMA’s own analysis points to cumulative experience as the driver — the version of your program you fall in love with in July of intern year isn’t necessarily the version you’re evaluating by your final year, once you’ve absorbed several years of its actual workload, culture, and systems friction. That’s not cynicism, it’s information. The declining numbers by year suggest that more time in a place generally produces a more accurate, less rose-tinted picture of what staying would actually mean — which is exactly the picture you want before signing a contract.

Comfort is a real factor — but it’s not automatically the wrong one

A lot of the online discussion around this data frames staying as the “comfort” choice and leaving as the “strategic” one. That framing undersells what comfort actually buys you. Staying at your training institution means known EHR systems, known colleagues, known referral patterns, and no restart on the local reputation and trust you’ve spent years building. Those aren’t small things — they’re real professional capital that a new attending walking into an unfamiliar system doesn’t have on day one. The mistake isn’t valuing comfort. The mistake is choosing it by default, without weighing it against what you’d be trading away.

What staying actually costs you

The trade-offs worth naming honestly:

• You may never see yourself as a full attending in that building. Staff, nurses, and colleagues who watched you as an intern don’t always fully recalibrate how they see you once you’re the attending — and it can take real, sustained effort on your part to shift that dynamic, if it shifts at all.
• You skip the forced adaptability of a new system. Learning a second institution’s culture and workflow is uncomfortable, but it’s also a skill — one that makes you more resilient and more marketable for the rest of your career. Staying put means you may not build it until later, under worse conditions.
• Compensation and negotiating leverage can be weaker. A program that already has you may have less incentive to offer a highly competitive package than an outside employer actively recruiting you. It’s worth benchmarking your offer against the outside market even if you intend to stay, so you know what “staying” is actually costing you financially.
• You may be choosing the familiar over the better fit. The AMA’s own data shows what would most influence residents to stay — higher pay, more consistent staffing, better workflow, less documentation burden. If your program is genuinely strong on those fronts, staying may be the correct strategic call, not just the comfortable one. If it isn’t, familiarity can quietly substitute for a real answer to “is this actually the best place for me?”

What leaving actually costs you

The other side of the ledger, equally worth being honest about:

• A real restart. New EHR, new colleagues, new referral patterns, and a period — often six months to a year — of being the newest, least-known attending in the building instead of a known quantity.
• The fear residents describe is legitimate, not irrational. Being a brand-new attending in an unfamiliar place, without the built-in support network of people who trained you, is a genuinely harder first year than staying somewhere familiar. That’s a real cost, not just a feeling to push through.
• You’re betting on unknowns. A new institution’s culture, workload, and leadership can look great in interviews and turn out different in practice — a risk staying avoids almost entirely, since you already know exactly what you’re getting.

A more deliberate way to decide

Rather than defaulting to whichever option feels less effortful, run the decision through a few direct questions:

1. If a recruiter from an unfamiliar hospital offered me my current program’s exact terms, would I say yes? If the honest answer is no, that’s worth sitting with — it suggests the appeal is the specific place, not just avoiding the hassle of a search.
2. What does my program actually offer on the things that would make residents want to stay — compensation, staffing, workflow, documentation burden — compared to what I could reasonably get elsewhere? Get an actual outside offer or two if you can, even if you lean toward staying. A real comparison beats an assumed one.
3. Am I choosing this because it’s genuinely the strongest option, or because a search feels exhausting after years of training? Both are valid inputs. Only one of them should be the deciding factor.

There’s no version of this decision that’s universally right. Staying can be the smart, well-reasoned choice, or it can be the path of least resistance dressed up as one. The data suggests most residents lean toward figuring that difference out the longer they stay — you don’t have to wait until PGY-5 to ask yourself the same question now.