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

Results

Physician Characteristics

Of 28,677 anesthesiologists contacted via email, 4,147 (14.5%) opened the provided link and were considered to have participated. Of the survey respondents, 3,898 (94.0%) completed the survey in its entirety and were included in the statistical analyses, yielding an effective 13.6% response rate. We received 2,357 complete responses (60.5%) before March 14, 887 (22.8%) between March 14 and 20, and 654 (16.8%) after March 20, 2020. Only 19 responses (0.5%) were received after March 24. The survey link was officially closed on March 30.

Participant characteristics and rates of burnout are presented in Table 1. The ASA provided the investigators with basic demographic data for the membership contemporaneous with the study period for the purpose of establishing how representative the study cohort was to the whole. The median age of respondents was 52 yr (interquartile range, 42 to 60 yr), compared with 48 yr (interquartile range, 40 to 58 yr) for the overall ASA population (difference, 4 yr; 95% CI, 3.2 to 4.8 yr). Of the respondents, 33.6% were women, compared with 29.2% of the ASA population (difference, 4.4%; 95% CI, 2.8 to 6%). The most common practice environments among respondents were hospital-based private practice (34%), community hospital (28%), and university hospital or academic appointment (26.2%). The median time since completion of training was 18 yr (interquartile range, 10 to 28 yr), compared with 14.8 yr (interquartile range, 7.8 to 25.8 yr) for the ASA population (difference, 3.2 yr; 95% CI, 2.7 to 3.8 yr). Of the respondents, 86.4% worked at least 40 h/week, 35.1% experienced staffing shortages, 46.6% felt little support in work-life, and 20.2% felt little support in home life. The majority of respondents had caregiving responsibilities of at least one person (85.4%). Respondents identified as underrepresented on the basis of race (10.2%); religion (4.9%); lesbian, gay, bisexual, transgender/transsexual, queer/questioning, intersex, and asexual status (2.7%); and English as a second language (6.1%).

Prevalence of High Risk for Burnout and Burnout Syndrome

On the basis of the Maslach Burnout Inventory Human Services Survey, the rate of high risk of burnout among anesthesiologists was 59.2% (2,307 of 3,898). Emotional exhaustion, depersonalization, and reduced feelings of personal accomplishment were experienced by 53.3%, 37.2%, and 25.9% of respondents, respectively. The mean ± SD scores in the cohort were 27 ± 13 for emotional exhaustion, 8 ± 6 for depersonalization, and 38 ± 8 for personal accomplishment. The rate of burnout syndrome was 13.8% (Figure 2). The rates of high risk for burnout were not significantly different across the three survey waves (59.8%, 59.9%, and 56%, respectively; P = 0.185), and neither were the rates of burnout syndrome (14.7%, 12.4%, and 12.5%, respectively; P = 0.135).

Figure 2.

Dimensions associated with burnout. Methodology: Risk factors were determined by multivariable logistic regression based on 3,898 anesthesiologists who completed the survey in March 2020. High risk for burnout is defined as reaching threshold levels of either emotional exhaustion and/or depersonalization. Burnout syndrome is a condition characterized by the dimensions of emotional exhaustion, depersonalization, and low sense of personal accomplishment.

Factors Associated With Burnout

Results of the univariate analysis for high risk of burnout and burnout syndrome are presented in Table 2. After univariate testing for screening of variables, multivariable logistic regression analyses were performed. After adjustment for all other variables in the model, the following were identified as independent risk factors for high risk of burnout: working more than 40 h/week (odds ratio, 2.22; 95% CI, 1.80 to 2.75; P < 0.001), experiencing staffing shortages (odds ratio, 2.06; 95% CI, 1.76 to 2.42; P < 0.001), perception of a low level of support in work-life (a lot or a great deal; not at all or a little support: odds ratio, 6.7; 95% CI, 5.3 to 8.5; P < 0.001; a moderate amount of support: odds ratio, 2.29; 95% CI, 1.85 to 2.83; P < 0.001), perception of a low level of support at home (a lot or a great deal; not at all or a little support: odds ratio, 1.77; 95% CI, 1.44 to 2.18; P < 0.001; a moderate amount of support: odds ratio, 1.37; 95% CI, 1.15 to 1.64; P < 0.001), not having someone to talk to about concerns at work (odds ratio, 1.56; 95% CI, 1.31 to 1.84; P < 0.001), age younger than 50 yr (odds ratio, 1.48; 95% CI, 1.27 to 1.72; P < 0.001), and identifying as underrepresented on the basis of lesbian, gay, bisexual, transgender/transsexual, queer/questioning, intersex, and asexual status (odds ratio, 2.21; 95% CI, 1.35 to 3.63; P = 0.002; Figure 3; Supplemental Digital Content 1 [http://links.lww.com/ALN/C560] and 2 [http://links.lww.com/ALN/C561]).

Figure 3.

Independent risk factors associated with burnout and burnout syndrome. Methodology: Risk factors were determined by multivariable logistic regression based on 3,898 anesthesiologists who completed the survey in March 2020. High risk for burnout is reaching threshold levels of emotional exhaustion and/or depersonalization. Burnout syndrome is a condition characterized by the dimensions of emotional exhaustion, depersonalization, and low sense of personal accomplishment. Multivariable logistic regression analyses in high risk for burnout (A) and burnout syndrome (B).

The following were identified as independent risk factors for burnout syndrome: hospital-based private practice environment (odds ratio, 1.88; 95% CI, 1.21 to 2.93; P = 0.005; private practice outpatient based), experiencing staffing shortages (odds ratio, 1.61; 95% CI, 1.32 to 1.96; P < 0.001), perception of a low level of support in work-life (a lot or a great deal; not at all or a little support: odds ratio, 10.0; 95% CI, 5.4 to 18.3; P < 0.001; a moderate amount of support: odds ratio, 3.63; 95% CI, 1.96 to 6.7; P < 0.001), perception of a low level of support at home (a lot or a great deal; not at all or a little support: odds ratio, 2.13; 95% CI, 1.69 to 2.69; P < 0.001; a moderate amount of support: odds ratio, 1.55; 95% CI, 1.22 to 1.97; P < 0.001), not having someone to talk to about concerns at work (odds ratio, 1.66; 95% CI, 1.26 to 2.37; P < 0.001), and age younger than 50 yr (odds ratio, 1.94; 95% CI, 1.59 to 2.37; P < 0.001; Figure 3, Supplemental Digital Content 1 [http://links.lww.com/ALN/C560] and 2 [http://links.lww.com/ALN/C561]). Supplemental multivariable linear regression analyses for each subscale (emotional exhaustion, depersonalization, and personal accomplishment) are summarized in Supplemental Digital Content 3 (http://links.lww.com/ALN/C562) and 4 (http://links.lww.com/ALN/C563), and 5 (http://links.lww.com/ALN/C564).

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