Reported Pain at Work Is a Risk Factor for Vascular Surgery Trainee Burnout

Abstract

Work-related pain is a known risk factor for vascular surgeon burnout. It risks early attrition from our workforce and is a recognized threat to the specialty. Our study aimed to understand whether work-related pain similarly contributed to vascular surgery trainee well-being. A confidential, voluntary survey was administered after the 2022 Vascular Surgery In-Training Exam. Trainees in all Accreditation Council for Graduate Medical Education-accredited vascular surgery programs were asked to complete a modified, abbreviated Maslach Burnout Inventory. Pain after a full day of work was measured using a 10-point Likert scale and dichotomized into none to mild pain (0-2) vs moderate to severe pain (3-9). Univariable and multivariable regression analyses were used to assess associations of pain with well-being indicators such as burnout, thoughts of attrition, and career change. Pain management strategies were included as covariables in our study. There were 527 who trainees completed the survey (82.2% response rate). After a full day of working, 38% reported moderate to severe discomfort/pain. Among those who reported moderate to severe pain, 73.6% reported using ergonomic adjustments and 67.0% over-the-counter medications. More women tended to report moderate to severe pain than men (44.3% vs 34.5%; P < .01) (Table I). After adjusting for gender, training level, race/ethnicity, mistreatment, and lack of operative autonomy (a proxy for loss of meaning in work), moderate-to-severe pain (odds ratio, 2.52; 95% confidence interval, 1.48-4.26) and using physiotherapy as pain management (odds ratio, 3.06; 95% confidence interval, 1.02-9.14) were risk factors for burnout. Moderate to severe pain was not a risk factor for thoughts of attrition or career change following adjustment (Table II). Physical pain is prevalent among vascular surgery trainees and represents a risk factor for trainee burnout. Programs should provide ergonomic education and adjuncts, such as posture awareness and microbreaks during surgery, early and throughout training.Table IUnivariable associations of vascular surgery trainee characteristics and well-being with moderate to severe painModerate to severe painP valueYes (n = 200, %)No (n = 327, %)Male118 (34.5)224 (65.6)Female82 (44.3)103 (55.7).03Race/ethnicity Non-Hispanic White109 (41.8)152 (58.4) Non-Hispanic Black10 (35.7)18 (64.3) Hispanic/Latinx14 (33.3)28 (66.7) Asian45 (33.8)88 (66.2) Other12 (41.4)17 (58.6) Prefer not to say10 (37.0)17 (63.0).69Postgraduate year 123 (36.5)40(63.5) 2-344 (34.7)83 (65.3) 5-7133 (39.5)204 (60.5).62Did not feel they had appropriate level of OR autonomy16 (59.3)11 (40.7).06Thoughts of attrition29 (54.7)164 (40.4).047Thoughts of career change28 (14.5)21 (7.8).02Burnout125 (54.1)75 (25.3)<.001Mistreatment147 (79.9)132 (54.1)<.001 Open table in a new tab Table IIMultivariable associations of risk factors with burnout, thoughts of attrition, and thoughts of career change in vascular surgery traineesBurnoutAttritionCareer changeOR95% CIP valueOR95% CIP valueOR95% CIP valueModerate to severe pain2.521.48-4.260.0011.690.77-3.700.192.100.92-4.820.08Gender MaleRefRefRef Female0.960.53-2.740.900.540.22-1.320.180.540.22-1.360.19Race NH WhiteRefRefRef NH Black1.040.29-3.740.950.330.02-4.510.411.470.22-9.720.69Hispanic/Latinx0.430.16-1.180.100.850.20-3.650.830.650.12-3.450.62 Asian0.800.43-1.490.491.540.62-3.820.360.910.32-2.610.84 Other0.590.36-4.060.361.640.31-8.570.561.790.33-9.720.50 Prefer not to say1.210.36-4.060.761.140.25-5.110.872.330.56-9.620.24Postgraduate year level 1RefRefRef 2-31.760.70-4.410.230.690.20-2.400.560.810.21-3.110.76 4-71.150.50-2.640.740.670.22-2.040.490.910.27-3.020.88Pain management OTC medications1.270.75-2.170.370.540.24-1.200.130.590.26-1.350.21Orthotics (eg, brace, footware, etc)1.350.72-2.530.350.910.37-2.200.832.200.77-6.320.14 Yoga/Pilates0.790.43-1.450.440.950.39-2.290.910.510.21-1.240.14 Physiotherapy3.061.02-9.140.0453.950.44-35.40.223.650.41-32.700.25Massage/chiropractic/acupuncture0.770.43-1.400.400.540.23-1.270.160.830.35-1.980.67Ergonomic adjustments0.700.40-1.230.211.520.68-3.410.310.980.42-2.310.96Did not feel they had appropriate level of operative autonomy9.892.02-48.40.0111.856.07-35.54<0.0019.993.31-30.11<0.001Any form of mistreatment2.621.42-4.800.0025.201.40-19.310.015.501.21-25.080.03CI, Confidence interval; OR, odds ratio; Ref, reference; OTC, over the counter; NH, non-Hispanic/Latinx. Open table in a new tab