Background Concerns regarding preparation of residents for independent surgical practice are widespread and support for junior surgeons entering practice is variable across institutions and practices. The American College of Surgeons (ACS) Division of Education partnered with the Accreditation Council for Graduate Medical Education (ACGME) to convene a National Invitational Conference to define key issues relating to the transition to practice and develop recommendations to address various challenges. Outcomes of the National Invitational Conference Leaders from ACS, ACGME, certifying boards, residency review committees, program director organizations, and professional societies representing the breadth of surgical specialties, along with other key stakeholders, were invited to participate in the 1.5-day conference in July 2012. Key recommendations generated during the conference included the need to focus on the transition to practice within the context of the continuum of professional development; definition of specific levels of knowledge and skills expected of graduating surgery residents; development and adoption of competency-based methods for training, assessment, and advancement of residents; implementation of special interventions during the chief resident year to prepare residents for practice; robust evaluations of residents before graduation; intake assessments of junior surgeons during the onboarding processes; and effective mentorship for junior surgeons as they enter practice. Recommendations also highlighted major regulatory, legal, and financial issues. The key role of ACS and other national organizations in implementing the recommendations was underscored. Conclusion The recommendations from the conference should be of great help in addressing various challenges associated with the transition from surgery residency to independent practice.