Burnout among surgeons continues to be problematic for the medical community. In addition to the psychological unpleasantness that is associated with burnout, the phenomenon can lead to more severe problems, including professional and personal dysfunction. In severe cases, the results can negatively impact patient care and potentially put patients at risk for harm.
Previously published studies have defined burnout syndrome by three work-related occurrences:
1. High emotional exhaustion (EE): the feeling of being emotionally overextended and exhausted by work.
2. High depersonalization (DP): the adoption of a callous or dehumanized perception of others.
3. A low sense of personal accomplishment (PA): the feeling of dissatisfaction with one’s job-related achievements.
Collectively, these components can be helpful for establishing the degree of burnout among surgeons.
Cause & Effect
In an effort to understand more completely the cause and effect of burnout on outcomes, my colleagues and I published a study in the October 2010 Archives of Otolaryngology—Head & Neck Surgery in which we administered a questionnaire to 60 microvascular free-flap (MVFF) head and neck surgeons. Our goal was to determine the prevalence of professional burnout among MVFF surgeons using EE, DP, and PA as key components. We also wanted to identify modifiable risk factors with the intent of reducing burnout in MVFF surgeons.
Our investigation showed that 2% of responding MVFF surgeons experienced high burnout, while 73% had moderate burnout and 25% had low burnout. When compared with other otolaryngology academic faculty and department chairs, MVFF surgeons had similar or lower levels of burnout. Although MVFF surgeons experienced high personal accomplishment, they also had low-to-moderate scores that assessed EE and DP. High EE was associated with:
Inadequate administration time.
Work that invaded family life.
An inability to care for their personal health.
A poor perception of control over their professional life.
Frequent irritable behaviors toward loved ones.
Hours worked did not appear to have an association with higher burnout, a finding that is consistent with previous studies of general surgeons but was contrary to what has been observed in otolaryngology residents. Overall, it appears that MVFF surgeons experience marginally higher burnout than all other sub-specialists in otolaryngology. While more research is warranted, it’s important that surgeons recognize this correlation and make efforts to avoid burnout.
Prevention is Key
In order to prevent burnout among surgeons—especially those in high-pressure specialties like otolaryngology—it behooves academic medical centers and hospitals to educate surgeons and staff about burnout and strategies to overcome it. Surgery departments should take additional measures by finding ways to protect physician time, identify preferred work activities, and measure and reduce excess workloads. These efforts may require restructuring in some cases, but they are well worth the effort in improving quality of life for surgeons and enhancing outcomes for patients.
Surgeons should also be supported professionally and on-site whenever possible. Providing easy access to mentorships, counseling, and support groups can be of benefit. The key is to promote a positive balance between professional and personal life goals. Surgeons should be encouraged to cultivate and maintain personal support systems inside and outside of work, and to pursue personal goals in order to better protect against professional burnout.
Readings & Resources (click to view)
Contag SP, Golub JS, Teknos TN, et al. Professional burnout among microvascular and reconstructive free-flap head and neck surgeons in the United States. Arch Otolaryngol Head Neck Surg. 2010;136:950-956. Available at: http://archotol.ama-assn.org/cgi/content/full/136/10/950#AUTHINFO.
Johns MM III, Ossoff RH. Burnout in academic chairs of otolaryngology: head and neck surgery.Laryngoscope. 2005;115(11):2056-2061.
Balch CM, Freischlag JA, Shanafelt TD. Stress and burnout among surgeons: understanding and managing the syndrome and avoiding the adverse consequences. Arch Surg. 2009;144(4):371-376.
Shanafelt T. A career in surgical oncology: finding meaning, balance, and personal satisfaction. Ann Surg Oncol. 2008;15(2):400-406.
Linzer M, Manwell LB, Williams ES; et al, MEMO (Minimizing Error, Maximizing Outcome) Investigators. Working conditions in primary care: physician reactions and care quality. Ann Intern Med. 2009;151(1):28-36.