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Keller DS, Narula N, Schwarz E, Mellinger JD, Feldman LS, Dort J, Asbun HJ, Romanelli J. A cross sectional survey on burnout and career satisfaction in surgeons: a joint work from the SAGES quality, outcomes, and safety and reimaging the practice of surgery burnout task forces. Surg Endosc 2024:10.1007/s00464-024-11123-z. [PMID: 39103663 DOI: 10.1007/s00464-024-11123-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION The growth of surgeon burnout is of significant concern. As we work to reimagine the practice of surgery, an accurate understanding of the extent of surgeon burnout is essential. Our goal was to define the current prevalence of burnout and quality of life (QOL) among SAGES surgeons. METHODOLOGY An electronic survey was administered to SAGES members to establish a current baseline for QOL, burnout, depression, and career satisfaction. To assess outcomes, we utilized the validated Maslach Burnout Inventory for Medical Personnel, the Medical Outcomes Study Short Form, and the Primary Care Evaluation of Mental Disorders. All scoring followed validated norm-based methods. RESULTS Of 4194 active members, 604 responded (14.40%). 69% met burnout threshold, with high levels of emotional exhaustion and depersonalization, and low personal accomplishment. 81% reported "being at the end of their rope", 74% felt emotionally drained, and 65% felt used up daily. Nearly all maintained caring about what happened to their patients (96%), easily understanding how their patients feel (84.3%) and being capable of dealing effectively with their patient's problems (87.6%). However, respondents never, rarely, or occasionally felt energetic (77.5%) or experienced a sense of professional accomplishment (57.8%). The overall QOL score was 69/100, with lower Mental than Physical scores (62.69 (SD 10.20) vs.77.27 (SD 22.24)). More than half of respondents met depression criteria. While 77% supported they would become a physician again, less than half would choose surgery again or recommend surgery to their children. Furthermore, less than a third felt work allowed sufficient time for their personal lives. CONCLUSIONS Participating SAGES surgeons reported alarmingly high rates of burnout and depression. Despite experiencing emotional exhaustion and depersonalization, they maintained a strong commitment to patient care. These findings likely reflect the broader state of surgeons, underscoring the urgent need for action to address this critical issue.
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Affiliation(s)
- Deborah S Keller
- Department of Digestive Surgery, University of Strasbourg, 1 Place de L'Hopital, 67000, Strasbourg, France.
| | - Nisha Narula
- Department of Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Erin Schwarz
- BSC Management and Vivacity Consulting, Los Angeles, CA, USA
| | | | - Liane S Feldman
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Jonathan Dort
- Department of Surgery, Inova Health System, Falls Church, VA, USA
| | | | - John Romanelli
- Department of Surgery, Baystate Health, Springfield, MA, USA
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Ochoa B, Lai K, Eldredge RS, Velazco CS, Weidler EM, van Leeuwen K. Prevalence and Associated Factors of Burnout in Pediatric General Surgery Fellows. J Surg Res 2024; 301:482-491. [PMID: 39042976 DOI: 10.1016/j.jss.2024.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 04/22/2024] [Accepted: 06/23/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Pediatric surgeons are experiencing burnout at similar rates to other subspecialists; however, little is known about the prevalence of burnout in pediatric general surgery fellows. This study aims to determine the prevalence of burnout in pediatric general surgery trainees. METHODS The Maslach Burnout Inventory and a survey of personal and training characteristics were distributed to current and recently graduated pediatric surgery fellows. Higher Maslach Burnout Inventory subscores of emotional exhaustion (EE) and depersonalization (DP) indicate higher levels of burnout. Descriptive statistics were used to describe respondent characteristics. Burnout, as a dichotomous variable, was compared by chi-square test, and subscale scores werecompared by nonparametric tests for a variety of factors. RESULTS The response rate was 41% (52/126); 15% were first-year fellows, 54% were second-year fellows, and 31% were recent graduates. The majority were 30-39 y old (83%) and female (71%). The median [IQR] scores for EE, DP, and personal accomplishment were 23 [17-36], 8 [2-12.3], and 38 [34-41], respectively, with no significant differences by training year. Eighteen percent of respondents met burnout criteria based on high-risk EE subscores in combination with high-risk DP subscores, and 44% and 23.1% of respondents had high-risk EE and DP subscores, respectively. Factors associated with higher EE subscores were fewer hours of sleep and taking home call. CONCLUSIONS Pediatric surgery fellows experience high levels of burnout along with a high frequency of high-risk EE and DP scores. Lack of sleep and home call may be contributory, and efforts to combat burnout should specifically address these factors.
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Affiliation(s)
| | - Krista Lai
- Phoenix Children's Hospital, Phoenix, Arizona
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Johnson BA, Callaway KJ, Vegiraju M, Ramakrishnan S, Ogola GO, Mohr DC, Waddimba AC. Study protocol of a systematic review and metaanalysis of stress and burnout among general surgery residents. Proc AMIA Symp 2024; 37:640-645. [PMID: 38910816 PMCID: PMC11188834 DOI: 10.1080/08998280.2024.2346398] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 04/05/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Chronic workplace stress and burnout are impediments to physicians' professional fulfillment, healthcare organizations' efficiency, and patient care quality/safety. General surgery residents are especially at risk due to the complexity of their training. We report the protocol of a metaanalysis of chronic stress and burnout among Accreditation Council for Graduate Medical Education (ACGME)-affiliated general surgery residents in the era after duty-hour reforms, plus downstream effects on their health and clinical performance. Methods The proposed systematic review and metaanalysis (PROSPERO registration CRD42021277626) will synthesize/pool data from studies of chronic stress and burnout among general surgery residents at ACGME-affiliated programs. The timeframe under review is subdivided into three intervals: (a) after the 2003 duty-hour restrictions but before 2011 reforms, (b) after the 2011 reforms but before the coronavirus pandemic, and (c) the first 3 years after the pandemic's outbreak. Only studies reporting outcomes based on validated instruments will be included. Qualitative studies, commentaries/editorials, narrative reviews, and studies not published in English will be excluded. Multivariable analyses will adjust for sample characteristics and the methodological quality of included studies. Conclusions The metaanalysis will yield evidence reflecting experiences of North American-based general surgery residents in the years after ACGME-mandated duty-hour restructuring.
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Affiliation(s)
- Brett A. Johnson
- Department of Surgery, General Medical Education, Baylor University Medical Center, Dallas, Texas, USA
| | - Kayla J. Callaway
- College of Medicine, Texas A&M University Health Sciences Center, Dallas, Texas, USA
- Houston Methodist Hospital, Texas Medical Center, Houston, Texas, USA
| | - Monica Vegiraju
- College of Medicine, Texas A&M University Health Sciences Center, Dallas, Texas, USA
| | - Sudha Ramakrishnan
- Baylor Health Sciences Library, Baylor Scott and White, Dallas, Texas, USA
| | - Gerald O. Ogola
- Department of Surgery, Division of Surgical Research, Baylor University Medical Center, Dallas, Texas, USA
- Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - David C. Mohr
- Veterans Health Administration, National Center for Organizational Development, Cincinnati, Ohio, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Anthony C. Waddimba
- College of Medicine, Texas A&M University Health Sciences Center, Dallas, Texas, USA
- Department of Surgery, Division of Surgical Research, Baylor University Medical Center, Dallas, Texas, USA
- Baylor Scott and White Research Institute, Dallas, Texas, USA
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Finn CB, Syvyk S, Bakillah E, Brown DE, Mesiti AM, Highet A, Bergmark RW, Yeo HL, Waljee JF, Wick EC, Shea JA, Kelz RR. Barriers and Facilitators to Clinical Practice Development in Men and Women Surgeons. JAMA Surg 2024; 159:43-50. [PMID: 37851422 PMCID: PMC10585584 DOI: 10.1001/jamasurg.2023.5125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/17/2023] [Indexed: 10/19/2023]
Abstract
Importance Many early-career surgeons struggle to develop their clinical practices, leading to high rates of burnout and attrition. Furthermore, women in surgery receive fewer, less complex, and less remunerative referrals compared with men. An enhanced understanding of the social and structural barriers to optimal growth and equity in clinical practice development is fundamental to guiding interventions to support academic surgeons. Objective To identify the barriers and facilitators to clinical practice development with attention to differences related to surgeon gender. Design, Setting, and Participants A multi-institutional qualitative descriptive study was performed using semistructured interviews analyzed with a grounded theory approach. Interviews were conducted at 5 academic medical centers in the US between July 12, 2022, and January 31, 2023. Surgeons with at least 1 year of independent practice experience were selected using purposeful sampling to obtain a representative sample by gender, specialty, academic rank, and years of experience. Main Outcomes and Measures Surgeon perspectives on external barriers and facilitators of clinical practice development and strategies to support practice development for new academic surgeons. Results A total of 45 surgeons were interviewed (23 women [51%], 18 with ≤5 years of experience [40%], and 20 with ≥10 years of experience [44%]). Surgeons reported barriers and facilitators related to their colleagues, department, institution, and environment. Dominant themes for both genders were related to competition, case distribution among partners, resource allocation, and geographic market saturation. Women surgeons reported additional challenges related to gender-based discrimination (exclusion, questioning of expertise, role misidentification, salary disparities, and unequal resource allocation) and additional demands (related to appearance, self-advocacy, and nonoperative patient care). Gender concordance with patients and referring physicians was a facilitator of practice development for women. Surgeons suggested several strategies for their colleagues, department, and institution to improve practice development by amplifying facilitators and promoting objectivity and transparency in resource allocation and referrals. Conclusions and Relevance The findings of this qualitative study suggest that a surgeon's external context has a substantial influence on their practice development. Academic institutions and departments of surgery may consider the influence of their structures and policies on early career surgeons to accelerate practice development and workplace equity.
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Affiliation(s)
- Caitlin B. Finn
- Department of Surgery, Weill Cornell Medicine, New York, New York
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
- Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Solomiya Syvyk
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
| | - Emna Bakillah
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
- Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Danielle E. Brown
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
| | - Andrea M. Mesiti
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | | | - Regan W. Bergmark
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School and Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Heather L. Yeo
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | | | | | - Judy A. Shea
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rachel R. Kelz
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
- Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Steiger K, Edwards MA, Spaulding A, Borkar S, Evans M, Farres H, Erben Y. Trainee Effect on Procedural Efficiency is Limited in Vascular Surgery Operations. Ann Vasc Surg 2023; 90:33-38. [PMID: 36442706 DOI: 10.1016/j.avsg.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical residents prepare during their training for independent operating experience. However, there is a fine balance between supervised intraoperative teaching and the need to keep operations short since this is associated with improved patient safety. We aim to understand if the composition of the vascular surgical team-presence of anesthesia and surgical trainees as well as the number of circulating nurses-affects elective operative times at our institution. As a secondary aim, we analyzed how time of day affects overall operative time. METHODS We performed a retrospective review of all vascular surgery elective operations occurring between January 1, 2019, and October 15, 2021. Our reference operation between procedures was the construction of an arteriovenous fistula (AVF). Reference teams included circulating staff (fewer than two nurses), anesthesia (anesthesiologist with certified registered nurse anesthetist [CRNA]), and surgery (surgeon with nurse practitioner). The primary dependent variable was the time interval in minutes from wheels-in to wheels-out of surgery, which was divided into three subintervals: wheels-in to cut, cut to close, and close to wheels-out. Univariate analysis was performed to examine each surgical procedure's distribution of wheels-in to wheels-out time interval. Linear regression was performed to determine the effect of team composition and time of day on operative durations. RESULTS We included a total of 853 vascular operations. Regarding overall operative time, different procedures took various amounts of time compared with the reference operation (AVF creation). Amputations and arteriograms were shorter (-30 min, P = 0.03, and -12 min, P = 0.05, respectively). Other procedures were longer: endarterectomy (+48 min, P < 0.01), rib resection (+78 min, P < 0.01), endovascular aorta repair (+120 min, P < 0.01), lower extremity bypass (+170 min, P < 0.01), and open aortic repair (+410 min, P < 0.01). No significant difference was found in carotid artery stent placement. Overall, there was a significant reduction in the close to wheels-out interval for anesthesiologists with a trainee (mean: -2.4 min; 95%; CI: -4.7, -0.12; P = 0.04). AVF took significantly more time with a surgical resident: wheels-in to cut time (mean: +4.2 min; 95%; CI: 0.92, 7.4; P = 0.01) and cut to close time (mean: +13 min; 3.2, 23; P < 0.01). Arteriogram wheels-in to cut time took longer with a surgeon alone (mean: +5.6; 95%; CI: 0.29, 11; P = 0.04). There were no other statistically significant findings with change in composition of the surgical team or changes in start time. CONCLUSIONS General surgery residents generally do not add time to vascular surgery cases but may do so in certain cases, perhaps when they are given more autonomy (i.e. AVF creation). Future studies should look at multiple centers, specific vascular procedures, and level of training to explore whether experience among residents (i.e., intern versus senior resident) and case complexity play a role in procedural length, as this may indirectly affect attending surgeon burnout and patient outcomes.
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Affiliation(s)
- Kyle Steiger
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL
| | - Michael A Edwards
- Division of Advanced Gastrointestinal and Bariatric Surgery, Mayo Clinic, Jacksonville, FL
| | - Aaron Spaulding
- Division of Health Care Delivery Research, Mayo Clinic, Jacksonville, FL
| | - Shalmali Borkar
- Division of Health Care Delivery Research, Mayo Clinic, Jacksonville, FL
| | - Matthew Evans
- Division of Practice Optimization & Acceleration, Jacksonville, FL, 32224, USA
| | - Houssam Farres
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL
| | - Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL.
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