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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; 38:4776-4787. [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] [MESH Headings] [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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Hoefer L, Tatebe LC, Patel P, Tyson A, Kingsley S, Chang G, Kaminsky M, Doherty J, Hampton D. Trauma surgeons experience compassion fatigue: A major metropolitan area survey. J Trauma Acute Care Surg 2024; 97:183-188. [PMID: 38197666 DOI: 10.1097/ta.0000000000004223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Compassion fatigue (CF), the physical, emotional, and psychological impact of helping others, is composed of three domains: compassion satisfaction (CS), secondary traumatic stress (STS), and burnout (BO). Trauma surgeons (TSs) experience work-related stress resulting in high rates of CF, which can manifest as physical and psychological disorders. We hypothesized that TSs experience CF and there are potentially modifiable systemic factors to mitigate its symptoms. METHODS All TSs in a major metropolitan area were eligible. Personal and professional demographic information was obtained. Each participant completed six validated surveys: (1) Professional Quality of Life scale, (2) Perceived Stress Scale, (3) Multidimensional Scale of Perceived Social Support, (4) Adverse Childhood Events Questionnaire, (5) Brief Coping Inventory, and (6) Toronto Empathy Questionnaire. Compassion fatigue subscale risk scores (low, <23; moderate, 23-41; high, >41) were recorded. Linear regression analysis assessed the demographic and environmental factors association with BO, STS, and CS. Variables significant on univariate analysis were included in multivariate models to determine the independent influence on BO, STS, and CS. Significance was p ≤ 0.05. RESULTS There were 57 TSs (response rate, 75.4% [n = 43]; White, 65% [n = 28]; male, 67% [n = 29]). Trauma surgeons experienced CF (BO, 26 [interquartile range (IQR), 21-32]; STS, 23 [IQR, 19-32]; CS, 39 [IQR, 34-45]). The Perceived Stress Scale score was significantly associated with increased BO (coefficient [coef.], 0.52; 95% confidence interval [CI], 0.28-0.77) and STS (coef., 0.44; 95% CI, 0.15-0.73), and decreased CS (coef., -0.51; 95% CI, -0.80 to -0.23) ( p < 0.01). Night shifts were associated with higher BO (coef., 1.55; 95% CI, 0.07-3.03; p = 0.05); conversely, day shifts were associated with higher STS (coef., 1.94; 95% CI, 0.32-3.56; p = 0.03). Higher Toronto Empathy Questionnaire scores were associated with greater CS (coef., 0.33; 95% CI, 0.12-0.55; p < 0.01). CONCLUSION Trauma surgeons experience moderate BO and STS associated with modifiable system- and work-related stressors. Efforts to reduce CF should focus on addressing sources of workplace stress and promoting empathic care. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Lea Hoefer
- From the Department of Surgery (L.H.), University of Chicago Medicine, Chicago, IL; Department of Surgery (L.C.T.), Northwestern University, Chicago, IL; Department of Surgery (P.P.), Loyola University Medical Center, Maywood, IL; Department of Surgery (A.T.), Northshore University Health System, Evanston, IL; Department of Surgery (S.K.), Advocate Health Care, Chicago, IL; Department of Surgery (G.C.), Mount Sinai Hospital, Chicago, IL; Department of Trauma and Burn Surgery (M.K.), John H. Stroger Jr. Hospital of Cook County, Chicago, IL; Department of Surgery (J.D.), Advocate Christ Medical Center, Chicago, IL; and Department of Surgery (D.H.), University of Chicago Medicine and Section of Trauma and Acute Care Surgery, Chicago, IL
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Hanson MN, Hughes D, Alseidi A, Bittner JG, Romanelli J, Vassiliou M, Feldman LS, Asbun H. The joy of surgery: how gender influences surgeons' experiences. Surg Endosc 2024:10.1007/s00464-024-10976-8. [PMID: 38902408 DOI: 10.1007/s00464-024-10976-8] [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: 04/29/2024] [Accepted: 05/30/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Burnout in medicine is an epidemic, and surgeons are not immune. Studies often focus on negative factors leading to burnout, with less emphasis on optimizing joy. The purpose of this study, conducted by the SAGES Reimagining the Practice of Surgery Task Force, was to explore how gender may influence surgeon well-being to better inform organizational change. METHODS The study team developed a survey with the domains: facilitators of joy, support for best work, time for work tasks, barriers to joy, and what they would do with more time. The survey was emailed to 5777 addresses on the SAGES distribution list. Results were analyzed by calculating summary statistics. RESULTS 223 surgeons completed the survey; 62.3% identified as men, 32.3% as women, and 5.4% did not indicate gender. Female compared to male respondents were younger (41.6 vs 52.5 years) and had practiced for fewer years (8.4 vs 19.4 years). The three greatest differences in facilitators of joy were being a leader in the field, leading clinical teams, and teaching, with a > 10 percentage point difference between men/women rating these highly (score of ≥ 8). Women generally perceived less support from their institutions than men. The greatest gender difference was in support for teaching, with 52.8% of men rating this highly compared to 30.2% of women. Only 52% of women felt respected by coworkers most of the time compared to 68.3% of men. Most (96.0%) respondents (men 95.7% and women 98.6%) reported wanting more time with family and friends. CONCLUSION This study demonstrates the complexity of the personal and professional factors that influence joy in surgery, highlight gender differences that impact joy and suggests opportunities for improved gender-based support. These results can inform potential organization-level changes and further research to better understand emerging differences in joy across gender identities.
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Affiliation(s)
- Melissa N Hanson
- Department of Surgery, Guelph General Hospital, Guelph, ON, Canada.
| | - Dorothy Hughes
- Departments of Population Health and Surgery, University of Kansas School of Medicine- Salina, Salina, KS, USA
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - James G Bittner
- Department of Surgery, Sentara Obici Hospital, Suffolk, VA, USA
| | - John Romanelli
- Department of Surgery, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, MA, USA
| | | | - Liane S Feldman
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Horacio Asbun
- Department of Hepato-Pancreato-Biliary Surgery, Miami Cancer Institute, Miami, FL, USA
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Mansour MA. Address to the Midwestern Surgical Association "On the shoulders of giants". Am J Surg 2024; 230:2-6. [PMID: 38101979 DOI: 10.1016/j.amjsurg.2023.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/22/2023] [Indexed: 12/17/2023]
Affiliation(s)
- M Ashraf Mansour
- Department of Surgery, Corewell Health West and Michigan State University, College of Human Medicine, Grand Rapids, MI, 49503, USA.
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Jayroe H, Weaver L, Velazquez G, Nelson P, Jennings W, Henning N, Edmonds J, Nsa W, Zamor K, Kempe K. Vascular Surgery Training Positions and Applicant 10-Year Trends with Consideration for Further Expansion. Ann Vasc Surg 2023; 95:291-296. [PMID: 37247836 DOI: 10.1016/j.avsg.2023.05.003] [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: 02/01/2023] [Revised: 04/28/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND There is a significant shortage of vascular surgeons in the United States and projections for these practicing surgical specialists continue to worsen. Annual appraisal of our workforce recruitment and growth is imperative. MATERIALS AND METHODS Retrospective data were analyzed using the National Resident Matching Program from 2012-2022 applicant appointment years (specialty code for vascular surgery 450). Simple linear trend analysis was performed for the number of positions available and the number of applicants, stratified by fellowship or residency. RESULTS Over the 10-year study period, the total vascular surgery trainee positions expanded from 161 to 202. Integrated residency positions increased (41 positions in 2012 vs. 84 in 2022) while available fellowship positions remained stagnant (120 in 2012 vs. 118 in 2022). Total applicants rose as well, from 213 to 311. In 2022, unmatched applicants have increased for both paradigms (25 fellowship and 84 residency applicants) and 100% of programs filled. On average, the number of residency positions offered increased by 4 each year (P < 0.0001) and the number of fellowship positions increased by 0.5 each year (P = 0.1617). The number of integrated residency applicants increased by approximately 9 per year (P = 0.001), while the number of fellowships applicants increased by approximately 1.5 per year (P = 0.121). CONCLUSIONS Applicants for both vascular tracks have increased since 2012 indicating successful recruitment; however, all 2022 programs filled, leaving many applicants unmatched. Residency positions have continued to expand while fellowship positions have not. With the demonstrated surge among applicants, the disproportionate lack of increasing training positions, and the existing shortage of vascular surgeons, there is an urgency to meet the increasing demand. A concerted effort should be made toward adding additional residency and fellowship positions where feasible.
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Affiliation(s)
- Hannah Jayroe
- Division of Vascular Surgery, Department of General Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Libby Weaver
- Division of Vascular and Endovascular Surgery, School of Medicine, University of Virginia, Charlottesville, VA
| | - Gabriela Velazquez
- Department of Vascular and Endovascular Surgery, Medical Center Boulevard, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Peter Nelson
- Division of Vascular Surgery, Department of General Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - William Jennings
- Division of Vascular Surgery, Department of General Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Nolan Henning
- University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Joseph Edmonds
- University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Wato Nsa
- Department of Medical Informatics Tulsa, The University of Oklahoma Health Sciences Center, School of Community Medicine, Tulsa, OK
| | - Kimberly Zamor
- Division of Vascular Surgery, Department of General Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Kelly Kempe
- Division of Vascular Surgery, Department of General Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK.
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Sarwar A, Shanafelt TD, Sze DY, Jaff MR. The Threat to the Soul of Interventional Radiology Escalated by COVID-19. J Vasc Interv Radiol 2023; 34:945-949. [PMID: 37236702 DOI: 10.1016/j.jvir.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 05/28/2023] Open
Affiliation(s)
- Ammar Sarwar
- Division of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Tait D Shanafelt
- Division of Hematology, Department of Internal Medicine, Stanford University School of Medicine, Stanford, California
| | - Daniel Y Sze
- Division of Interventional Radiology, Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Michael R Jaff
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Forsythe RO, Van Herzeele I, Zayed H, Argyriou A, Stavroulakis K, Saratzis A. International Cross-Sectional Survey of Bullying, Undermining, and Harassment in the Vascular Workplace. Eur J Vasc Endovasc Surg 2023; 65:748-755. [PMID: 36871928 DOI: 10.1016/j.ejvs.2023.02.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/06/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Bullying, undermining behaviour, and harassment (BUH) may exist in healthcare settings, impacting on patient care. The aim of this international study was to evaluate the characteristics of BUH experienced by physicians treating vascular diseases at various career stages. METHODS This was an anonymous international structured non-validated cross-sectional survey distributed via relevant professional societies in collaboration with the Research Collaborative in Peripheral Artery Disease. The survey was disseminated through societies' newsletters, emails, and social media. Data were collected online, allowing free text entries alongside structured multiple choice questions based on previous surveys. Demographics, geographical information, and data relating to stage and training environment were collected. RESULTS Of 587 respondents from 28 countries, 86% were working in vascular surgery, mostly at a university hospital (56%); 81% were aged between 31 and 60 years, 57% were working as a consultant, and 23% as a resident. Respondents were mostly white (83%), male (63%), heterosexual (94%), and without disability (96%). Overall, 253 (43%) reported experiencing BUH personally, 75% had witnessed BUH toward colleagues, and 51% witnessed these in the last 12 months. Female sex and non-white ethnicity were associated with BUH (53% vs. 38% and 57% vs. 40% respectively; p < .001 in both cases). While working as a consultant, 171 (50%) reported experiencing BUH, more often among females, non-heterosexuals, those who were not working in their country of birth, and non-white people. Specialty and hospital type were not associated with BUH. CONCLUSION BUH remains a major problem in the vascular workplace. Female sex, non-heterosexuality, and non-white ethnicity are associated with BUH at various career stages.
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Affiliation(s)
- Rachael O Forsythe
- Centre for Cardiovascular Science, University of Edinburgh and Department of Vascular Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Hany Zayed
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Angeliki Argyriou
- Institute for Vascular Research, St. Franziskus Hospital, Münster, Germany
| | | | - Athanasios Saratzis
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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Drudi LM, D'Oria M, Bath J, Van Nispen J, Smeds MR. Postoperative complications and their association with post-traumatic stress disorder in academic vascular surgeons. J Vasc Surg 2023; 77:899-905.e1. [PMID: 36402248 DOI: 10.1016/j.jvs.2022.10.056] [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: 03/31/2022] [Revised: 10/22/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Postoperative complications are an inherent component of surgical practice. This study seeks to address their association with emotional responses of academic vascular surgeons. METHODS An anonymous electronic survey was sent to all vascular surgery program directors in North America with a request to disseminate to their faculty. The survey captured data on demographics and practice type and used imbedded validated measures to determine emotional responses to postoperative complications and to assess coping mechanisms. Univariate analysis was performed to determine differences between those who reported at least partial symptoms of post-traumatic stress disorder (PTSD) following their worse major complication over the previous year and those who did not. Multivariable logistic regression analysis was performed for all covariates found significant on univariate analysis, and those deemed clinically relevant. RESULTS The survey was distributed to 267 faculty at 128 institutions in the United States and 10 institutions in Canada and completed by 65 participants (response rate, 32%). Twenty of 65 (31%) identified as female, and the total group had a mean age of 47 ± 10.2 years. Most respondents (43/65; 66%) reported a major complication within 3 months of the survey, with the majority of respondents (45/65; 69%) reporting the outcome of patient mortality. Of respondents, 20 of 65 (31%) demonstrated at least partial symptoms of PTSD in response to the worst complication from the previous year, with 12 of 65 (19%) meeting the clinical diagnosis of PTSD. Respondents in the PTSD group were more likely to criticize/blame themselves following the complication (P = .0028); less likely to identify the complication as "expected" (P = .048) or to believe causes of their complications were due to others/external factors; and more likely to identify as a female (55% vs 20%; P = .008). Regarding support following major complications, most respondents (57/65; 88%) desired the ability to discuss details of the case with a respected peer. The most common external pressure influencing their emotional responses to complications was maintaining reputation and a sense of honor (66%). Gender differences persisted on multivariate analysis (P = .016). CONCLUSIONS Emotional responses following major postoperative complications in vascular surgery are common and may pose a risk for PTSD. This may occur more commonly following complications that are unexpected or in cases in which the cause of the complication was due to a perceived or actual surgical mistake. The ubiquitous nature and severity of the emotional toll of major complications for vascular surgeons is poorly described and under-recognized. Gender-related differences may exist, and most surgeons desire a support network of respected peers with whom to discuss complications.
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Affiliation(s)
- Laura M Drudi
- Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Carrefour de l'Innovation, Centre de Rechercher du CHUM, Montreal, Quebec, Canada
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Jonathan Bath
- Division of Vascular Surgery, University of Missouri, Columbia, MO
| | - Johan Van Nispen
- Division of Vascular Surgery, St. Louis University, St. Louis, MO
| | - Matthew R Smeds
- Division of Vascular Surgery, St. Louis University, St. Louis, MO.
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Are We There Yet? No. Gender Disparities Still Exist and Affect Surgeon Burnout. CURRENT TRAUMA REPORTS 2023. [DOI: 10.1007/s40719-022-00250-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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