Burnout and Career Satisfaction Among American Surgeons

Tait D. Shanafelt, MD; Charles M. Balch, MD; Gerald J. Bechamps, MD; Thomas Russell, MD; Lotte Dyrbye, MD; Daniel Satele, BA; Paul Collicott, MD; Paul J. Novotny, MS; Jeff Sloan, PhD; Julie A. Freischlag, MD

Disclosures

Annals of Surgery. 2009;250(3):463-471. 

In This Article

Abstract and Introduction

Abstract

Objective: To determine the incidence of burnout among American surgeons and evaluate personal and professional characteristics associated with surgeon burnout.
Background: Burnout is a syndrome of emotional exhaustion and depersonalization that leads to decreased effectiveness at work. A limited amount of information exists about the relationship between specific demographic and practice characteristics with burnout among American surgeons.
Methods: Members of the American College of Surgeons (ACS) were sent an anonymous, cross-sectional survey in June 2008. The survey evaluated demographic variables, practice characteristics, career satisfaction, burnout, and quality of life (QOL). Burnout and QOL were measured using validated instruments.
Results: Of the approximately 24,922 surgeons sampled, 7905 (32%) returned surveys. Responders had been in practice 18 years, worked 60 hours per week, and were on call 2 nights/wk (median values). Overall, 40% of responding surgeons were burned out, 30% screened positive for symptoms of depression, and 28% had a mental QOL score > 1/2 standard deviation below the population norm. Factors independently associated with burnout included younger age, having children, area of specialization, number of nights on call per week, hours worked per week, and having compensation determined entirely based on billing. Only 36% of surgeons felt their work schedule left enough time for personal/family life and only 51% would recommend their children pursue a career as a physician/surgeon.
Conclusion: Burnout is common among American surgeons and is the single greatest predictor of surgeons' satisfaction with career and specialty choice. Additional research is needed to identify individual, organizational, and societal interventions that preserve and promote the mental health of American surgeons.

Introduction

Despite its virtues, a career in surgery brings with it significant challenges that can lead to substantial personal distress for the individual surgeon and their family. Training for and practicing of the specialty of surgery are stressful endeavors.[1,2,3] A study of the graduates of a single academic medical center suggest that approximately one third of U.S. surgeons may experience burnout.[4] Similarly, national samples of member surgeons of surgical subspecialty societies suggest burnout rates ranging from 30-38%.[5,6] Burnout is a syndrome of emotional exhaustion and depersonalization that leads to decreased effectiveness at work.[7] Treating patients as objects rather than human beings and becoming emotionally depleted are common symptoms of burnout. Burnout can effect both physicians' satisfaction with their work and the quality of medical care they provide.[8,9,10] Additional data suggests surgeon distress may contribute to their plans to take an early retirement.[3,4] Studies suggest that difficulty balancing personal and professional life, administrative tasks, lack of autonomy, and patient volume are the greatest sources of surgeon stress.[2,3,4,5]

A limited amount of information exists about the relationship between specific demographic and practice characteristics with burnout among American surgeons. The available evidence suggests that younger physicians[11] and female surgeons[4,6] are at higher risk for burnout than their older colleagues. Although trials in internal medicine related specialties suggest physicians in private practice may be at greater risk for burnout,[12,13] the available studies of surgeons have found no difference in burnout based on practice setting.[4,6] Although limited evidence also suggests differences in burnout may exist between different surgical subspecialties,[4] there are not adequate data to derive firm conclusions.

We conducted a survey of the membership of the American College of Surgeons (ACS) to determine the incidence of burnout among American surgeons and to evaluate personal and professional characteristics associated with surgeon burnout. The hypothesis of this cross-sectional study was that burnout is prevalent among American surgeons and that specific personal and professional characteristics may place surgeons at risk for experiencing the burnout syndrome. The specific objectives of this study were to: 1) measure burnout and quality of life among surgeons who are members of the ACS utilizing validated instruments; 2) evaluate the personal and practice characteristics of American surgeons; 3) determine the relationship between specific personal and practice characteristics and burnout among American surgeons.

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