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


Methods and Statistics


All surgeons who were members of the American College of Surgeons (ACS), had an e-mail address on file with the College, and permitted their e-mail to be used for correspondence with the College were eligible for participation in this study. Participation was elective and all responses were anonymous. The study was commissioned by the ACS Governor's Committee on Physician Competency and Health with Institutional Review Board (IRB) oversight with respect to protection of human subjects by the Mayo Clinic IRB.

Data Collection

Surgeons were surveyed electronically in June of 2008. Participants were blinded to any specific hypothesis of the study. The survey included 61 questions about a wide range of characteristics including demographic information, practice characteristics, burnout, quality of life, symptoms of depression, and career satisfaction. Validated survey tools were used to identify burnout, mental and physical QOL, and symptoms of depression as described previously.[2] Burnout was measured using the Maslach Burnout Inventory (MBI), a validated 22-item questionnaire considered a standard tool for measuring burnout.[2] The MBI has 3 subscales to evaluate the 3 domains of burnout: emotional exhaustion, depersonalization, and low personal accomplishment. We considered surgeons with a high score for medical professionals on either the depersonalization and/or emotional exhaustion subscales as having at least 1 manifestation of professional burnout.[2] Symptoms of depression were identified using the 2-item Primary Care Evaluation of Mental Disorders (PRIME MD), a standardized depression screening tool which performs as well as longer instruments.[12,13] Mental and physical QOL were measured using the Medical Outcomes Study Short Form (SF-12), with norm-based scoring methods used to calculate mental and physical QOL summary scores.[14,15] The average mental and physical QOL summary scores for the U.S. population are 50 (scale 0–100; standard deviation = 10).[15]

Statistical Analysis

Prevalence of burnout, a positive depression screen, and mental and physical QOL by sex was compared using χ2 tests or Kruskal-Wallis tests. All tests were 2-sided tests with type I error rates of 0.05. We performed logistic regression to evaluate independent associations of the independent variables with burnout and specialty choice satisfaction. Both forward and backward elimination methods were used to select significant variables for the models where the directionality of the modeling did not impact the results. The independent variables utilized in the modeling process included: age, relationship status, spouse/partner current profession, having children, age of children, subspecialty, years in practice, hours worked per week, hours per week spent in the operating room, number of nights on call per week, practice setting, current academic rank, primary method of compensation, percentage of time dedicated to nonpatient care activities, commitment to raising children slowed career advancement, who cares for youngest child when the child is ill or has a nonschool day, experienced a work-home conflict within the past 3 weeks, how the work-home conflict was resolved, experienced a career conflict with partner/spouse, how the career conflict was resolved, depression, and burnout. All analyses were done using SAS version 9 (SAS Institute Inc., Cary, NC) or R (R Foundation for Statistical Computing, Vienna, Austria; http://www.r-project.org.)


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: