Resident Burnout and Well-being in Otolaryngology and Other Surgical Specialties: Strategies for Change

OBJECTIVE

To perform a literature review on burnout prevalence, factors that affect burnout and well-being, and solutions to address burnout in otolaryngology-head and neck surgery (OTO-HNS) residents and residents in other surgical specialties.

DATA SOURCES

Ovid Medline, Embase, and article reference lists.

REVIEW METHODS

A literature search was performed to identify articles on resident burnout, distress, wellness, well-being, and quality of life. Articles deemed outside the scope of the current work were excluded. Search was limited to the past 5 years.

CONCLUSIONS

Moderate to high burnout has been reported in 35% to 86% of OTO-HNS residents. Among other surgical specialties, resident burnout ranges between 58% and 66% in plastics, 11% and 67% in neurosurgery, 38% and 68% in urology, and 31% and 56% in orthopedics. Highest burnout rates were seen in postgraduate year 2 residents. Factors significantly associated with burnout included hours worked (>80 h/wk), level of autonomy, exercise, and program support. Reported resident work hours have steadily increased: 8% of OTO-HNS residents in 2005 vs 26% in 2019 reported averaging >80 h/wk. Practical implications of resident burnout include decreased empathy, moral distress and injury, poor health, decreased quality of life, increased attrition, decreased desire to pursue fellowship, and increased likelihood of medical errors. Structured mentorship programs, wellness initiatives, and increased ancillary support have been associated with lower burnout rates and improvements in resident well-being across specialties.

IMPLICATIONS FOR PRACTICE

Addressing burnout, which is prevalent in OTO-HNS residents, is critical to improving patient care and physician well-being. Surgical specialties can share strategies to effectively address resident burnout through institutional interventions, which can be essential quality improvement initiatives, to promote well-being.

Satisfaction and attrition in the UK healthcare sector over the past decade

Existing literature has highlighted concerns over working conditions in the UK National Health Service (NHS), with healthcare workers frequently citing work-life balance issues and stress as being drivers of attrition and burnout. However, we do not know whether these problems have become worse over time, particularly over the past decade, during which there have been multiple shocks to the UK healthcare system. To investigate this, we analysed data from NHS monthly workforce statistics and the UK Household Longitudinal Study. Three times as many workers left the NHS in 2021 for work-life balance reasons than in 2011, while estimated satisfaction with one's amount of leisure time for healthcare workers fell by three times the amount that it fell for non-healthcare workers. Both satisfaction with amount of leisure time and satisfaction with income have remained lower for healthcare workers than for other public sector workers. By 2020, a worker that had low satisfaction with their amount of leisure time was as much as 22 percentage points less likely than in 2010 to remain in healthcare in the following year. Overall, working conditions in UK healthcare have deteriorated between 2010 and 2020, especially relative to the private sector. However, overall job satisfaction has fallen faster in other areas of the public sector than it has in healthcare, which may indicate wider issues within the UK public sector as a whole.