Burnout Rate and Risk Factors Among Anesthesiologists in the United States

Anoushka M. Afonso, M.D.; Joshua B. Cadwell, M.B.A., M.S.; Steven J. Staffa, M.S.; David Zurakowski, Ph.D.; Amy E. Vinson, M.D.

Disclosures

Anesthesiology. 2021;134(5):683-696. 

In This Article

Abstract and Introduction

Abstract

Background: Physician burnout, widespread across medicine, is linked to poorer physician quality of life and reduced quality of care. Data on prevalence of and risk factors for burnout among anesthesiologists are limited. The objective of the current study was to improve understanding of burnout in anesthesiologists, identify workplace and personal factors associated with burnout among anesthesiologists, and quantify their strength of association.

Methods: During March 2020, the authors surveyed member anesthesiologists of the American Society of Anesthesiologists. Burnout was assessed using the Maslach Burnout Inventory Human Services Survey. Additional survey questions queried workplace and personal factors. The primary research question was to assess rates of high risk for burnout (scores of at least 27 on the emotional exhaustion subscale and/or at least 10 on the depersonalization subscale of the Maslach Burnout Inventory Human Services Survey) and burnout syndrome (demonstrating all three burnout dimensions, consistent with the World Health Organization definition). The secondary research question was to identify associated risk factors.

Results: Of 28,677 anesthesiologists contacted, 13.6% (3,898) completed the survey; 59.2% (2,307 of 3,898) were at high risk of burnout, and 13.8% (539 of 3,898) met criteria for burnout syndrome. On multivariable analysis, perceived lack of support at work (odds ratio, 6.7; 95% CI, 5.3 to 8.5); working greater than or equal to 40 h/week (odds ratio, 2.22; 95% CI, 1.80 to 2.75); lesbian, gay, bisexual, transgender/transsexual, queer/questioning, intersex, and asexual status (odds ratio, 2.21; 95% CI, 1.35 to 3.63); and perceived staffing shortages (odds ratio, 2.06; 95% CI, 1.76 to 2.42) were independently associated with high risk for burnout. Perceived lack of support at work (odds ratio, 10.0; 95% CI, 5.4 to 18.3) and home (odds ratio, 2.13; 95% CI, 1.69 to 2.69) were most strongly associated with burnout syndrome.

Conclusions: The prevalence of burnout among anesthesiologists is high, with workplace factors weighing heavily. The authors identified risk factors for burnout, especially perceived support in the workplace, where focused interventions may be effective in reducing burnout.

Introduction

Burnout is more common in physicians than in the general population.[1–4] Burnout syndrome is a condition characterized by the dimensions of emotional exhaustion, depersonalization, and low sense of personal accomplishment[5,6] (Figure 1). Burnout is a clinically meaningful condition that is intricately linked with decreased quality of life, physician health, patient satisfaction, quality of care, and unprofessional behavior; and increased medical errors.[7–9]

Figure 1.

Burnout versus burnout syndrome. High risk for burnout is classified as reaching threshold levels of either emotional exhaustion and/or depersonalization as described in the Materials and Methods. Burnout syndrome is a condition characterized by the dimensions of emotional exhaustion, depersonalization, and low sense of personal accomplishment.

Studies suggest that anesthesiologists and critical care physicians have a high risk for burnout,[10,11] with approximately half reporting at least one major dimension of burnout.[1] Anesthesiologists routinely lead teams that care for patients across a wide variety of medical settings. This responsibility is rewarding and impactful but also leaves those in the field more vulnerable to stress related to the job's intensity.[11] These challenges have been amplified during the coronavirus disease 2019 (COVID-19) pandemic, with anesthesiologists often performing on the front lines.

Currently, data on the prevalence of burnout and predictors of burnout among anesthesiologists are limited. Several studies have shown high rates of burnout among anesthesia residents and/or attendings in the United States,[7,12] Europe,[10,13–15] Africa,[16] and Asia.[17] However, to our knowledge, no large-scale studies have focused specifically on burnout among practicing anesthesiologists in the United States. Further, a recent report from the National Academy of Medicine (Washington, D.C.) outlines approaches to improving well-being on a more systemic level. This is in line with our desire to determine specific risk factors for burnout in the anesthesiologist community, thereby identifying where such interventions could initially be best targeted.[18]

Our objective was to improve our understanding of anesthesiologist-specific risk factors for burnout, with a hypothesis that certain workplace and personal demographic factors may be more associated with burnout symptoms than others. We hope to identify risk factors in practicing anesthesiologists for burnout and burnout syndrome to guide potential preventative strategies in the future.

We conducted a large, nationwide study of anesthesiologists in the United States. The American Society of Anesthesiologists (ASA; Schaumburg, Illinois) Committee on Physician Well-being endorsed the study and gave advice on its design; then, the ASA Executive Committee approved this survey for distribution to the membership. Neither group was directly involved in the analysis methodology, although one of the authors is the current Chair of the Committee on Physician Well-being.

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