Distress and Career Satisfaction Among 14 Surgical Specialties, Comparing Academic and Private Practice Settings

Charles M. Balch, MD; Tait D. Shanafelt, MD; Jeffrey A. Sloan, PhD; Daniel V. Satele, BS; Julie A. Freischlag, MD.


Annals of Surgery. 2011;254(4):558-568. 

In This Article

Abstract and Introduction


Objective(s): We compared distress parameters and career satisfaction from survey results of surgeons from 14 specialties practicing in an academic versus private practice environment.
Methods: The 2008 American College of Surgeons survey evaluated demographic variables, practice characteristics, career satisfaction, and distress parameters using validated instruments.
Results: The practice setting (academic vs. private practice) was independently associated with burnout in a multivariate (MV) analysis (odds ratio [OR] 1.172, P = 0.02). Academic surgeons were less likely to experience burnout compared to those in private practice (37.7% vs. 43.1%), less likely to screen positive for depression (27.6% vs. 33%) or to have suicide ideation (4.7% vs. 7.4%; all P < 0.0001). They were also more likely to have career satisfaction (77.4% of academic surgeons would become a surgeon again vs. 64.9% for those in private practice; P < 0.0001)) and to recommend a medical career to their children (61.3% vs. 43.7%, P < 0.0001). For academic surgeons, the most significant positive associations with burnout were: (1) trauma surgery (OR 1.513, P = 0.0059), (2) nights on call (OR 1.062, P = 0.0123), and (3) hours worked (OR 1.019, P < 0.0001), whereas the negative associations were: (1) having older children (>22 years; OR 0.529, P < 0.0001), (2) pediatric surgery (OR 0.583, P = 0.0053), (3) cardiothoracic surgery (OR 0.626, P = 0.0117), and (4) being male (OR 0.787, P = 0.0491). In a private practice setting, the most significant positive associations with burnout were: (1) urologic surgery (OR 1.497, P = 0.0086), (2) having 31% to 50% time for nonclinical activities (OR 1.404, P = 0.0409), (3) incentive based pay (OR 1.344, P < 0.0001), (4) nights on call (OR 1.045, P = 0.0029), and (5) hours worked (OR 1.015, P < 0.0001), whereas the negative associations were: (1) older children (OR 0.677, P = 0.0001), (2) physician spouse (OR 0.753, P = 0.0093), and (3) older age (OR 0.989, P = 0.0158). The independent factors relating to career satisfaction for surgeons in private practice and academic practice were also different.
Conclusions: Factors associated with burnout were distinct for academic and private practice surgeons. Distress parameters were lower and career satisfaction higher for academic surgeons.


Burnout among surgeons has been reported at a rate of 28% to 42%, depending upon the size and composition of the surveys analyzed.[1–3] Recent reports have confirmed these results at the individual institution level.[4,5] Increasing evidence suggests that physician burnout can adversely affect patient safety, quality of patient care, and even contribute to medical errors.[6–9] Major medical errors reported by surgeons are strongly related to a surgeon's degree of burnout and their mental quality of life (QOL).[6] Surgeon burnout can also have potentially profound personal consequences for the individual surgeon of which suicide is perhaps the most tragic example.[10]

We have previously reported on the overall results of burnout and career satisfaction among 7905 surgeons as well as the professional and personal factors associated with them.[2,6,11] In a multivariate (MV) analysis, surgical subspecialty was an independent factor associated with both burnout (odds ratio [OR] 1.2–1.6, P < 0.001) and career satisfaction (OR 1.4–2.6, all P < 0.02).[2] In this analysis, we explore in depth the relative associations of burnout, depression, and career satisfaction for surgeons among 14 surgical subspecialties. In addition, the practice setting (academic vs. private) are analyzed separately based on a hypothesis that the factors associated with distress and career satisfaction may differ in these 2 practice settings.


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