Surgeon Burnout Research Articles

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.

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. 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. 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. 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.

Implementation of a vascular acute care surgery service model is associated with decreased surgeon burnout

ObjectiveVascular surgeons have one of the highest rates of burnout among surgical specialties, often attributed to high patient acuity and clinical workload. Acute Care Surgery models are a potential solution used among general and trauma surgeons. MethodsThis is a retrospective analysis of prospectively collected Accreditation Council for Graduate Medical Education survey results from faculty and residents before and after implementation of a vascular Acute Care Surgery (VACS) model. The VACS model assigns a weekly rotation of an attending surgeon with no elective cases or clinic responsibilities and a monthly rotating resident team. Residents and attendings are in-house to cover all urgent and emergent vascular daytime consultations and procedures, whereas nights and weekend coverage remain a typical rotating schedule. Survey question results were binned into domains consistent with the Maslach Burnout Inventory. ResultsBoth residents and faculty reported an increase in median scores in Maslach Burnout Inventory domains of emotional exhaustion (Faculty: 2.9 vs 3.4; P < .001; Residents: 3.1 vs 3.6; P < .001) and faculty reported higher personal accomplishment scores (Faculty: 3.3 vs 3.8; P = .005) after the VACS model implementation. ConclusionsA VACS model is a tangible practice change that can address a major problem for current vascular surgeons, as it is associated with decreased burnout for faculty and residents through improvement in both emotional exhaustion and personal accomplishment. Improved longitudinal assessment of resident and faculty burnout is needed and future work should identify specific practice patterns related to decreased burnout.

"I don't know if I can keep doing this": a qualitative investigation of surgeon burnout and opportunities for organization-level improvement.

Burnout is a pressing issue within surgical environments, bearing considerable consequences for both patients and surgeons alike. Given its prevalence and the unique contextual factors within academic surgical departments, it is critical that efforts are dedicated to understanding this issue. Moreover, active involvement of surgeons in these investigations is critical to ensure viability and uptake of potential strategies in their local setting. Thus, the purpose of this study was to explore surgeons' experiences with burnout and identify strategies to mitigate its drivers at the level of the organization. A qualitative case study was conducted by recruiting surgeons for participation in a cross-sectional survey and semi-structured interviews. Data collected were analyzed using reflexive thematic analysis, which was informed by the Areas of Worklife Model. Overall, 28 unique surgeons participated in this study; 11 surgeons participated in interviews and 22 provided responses through the survey. Significant contributors to burnout identified included difficulties providing adequate care to patients due to limited resources and time available in academic medical centers and the moral injury associated with these challenges. The inequitable remuneration associated with education, administration, and leadership roles as a result of the Fee-For-Service model, as well as issues of gender inequity and the individualistic culture prevalent in surgical specialties were also described as contributing factors. Participants suggested increasing engagement between hospital leadership and staff to ensure surgeons are able to access resources to care for their patients, reforming payment plans and workplace polities to address issues of inequity, and improving workplace social dynamics as strategies for addressing burnout. The high prevalence and negative sequalae of burnout in surgery necessitates the formation of targeted interventions to address this issue. A collaborative approach to developing interventions to improve burnout among surgeons may lead to feasible and sustainable solutions.

Home Is Not Always Where the Sleep Is: Effect of Home Call on Sleep, Burnout, and Surgeon Well-Being.

In-house calls contribute to loss of sleep and surgeon burnout. Although acknowledged to have an opportunity cost, home call is often considered less onerous, with minimal effects on sleep and burnout. We hypothesized home call would result in impaired sleep and increased burnout in acute care surgeons. Data from 224 acute care surgeons were collected for 6 months. Participants wore a physiological tracking device and responded to daily surveys. The Maslach Burnout Inventory was administered at the beginning and end of the study. Within-participant analyses were conducted to compare sleep, feelings of restedness, and burnout as a function of home call. One hundred seventy-one surgeons took 3,313 home calls, 52.5% were associated with getting called and 38.5% resulted in a return to the hospital. Home call without calls was associated with 3 minutes of sleep loss (p < 0.01), home call with 1 or more call resulted in a further 14 minutes of sleep loss (p < 0.0001), and home call with a return to the hospital led to an additional 70 minutes of sleep loss (p < 0.0001). All variations of home call resulted in decreased feelings of restedness (p < 0.0001) and increased feelings of daily burnout (p < 0.0001, Fig. 1). Home call is deleterious to sleep and burnout. Even home call without calls or returns to the hospital is associated with burnout. Internal assessments locally should incorporate frequency of calls and returns to the hospital when creating call schedules. Repeated nights of home call can result in cumulative sleep debt, with adverse effects on health and well-being.

Evaluating the Accuracy of ChatGPT and Google BARD in Fielding Oculoplastic Patient Queries: A Comparative Study on Artificial versus Human Intelligence.

This study evaluates and compares the accuracy of responses from 2 artificial intelligence platforms to patients' oculoplastics-related questions. Questions directed toward oculoplastic surgeons were collected, rephrased, and input independently into ChatGPT-3.5 and BARD chatbots, using the prompt: "As an oculoplastic surgeon, how can I respond to my patient's question?." Responses were independently evaluated by 4 experienced oculoplastic specialists as comprehensive, correct but inadequate, mixed correct and incorrect/outdated data, and completely incorrect. Additionally, the empathy level, length, and automated readability index of the responses were assessed. A total of 112 patient questions underwent evaluation. The rates of comprehensive, correct but inadequate, mixed, and completely incorrect answers for ChatGPT were 71.4%, 12.9%, 10.5%, and 5.1%, respectively, compared with 53.1%, 18.3%, 18.1%, and 10.5%, respectively, for BARD. ChatGPT showed more empathy (48.9%) than BARD (13.2%). All graders found that ChatGPT outperformed BARD in question categories of postoperative healing, medical eye conditions, and medications. Categorizing questions by anatomy, ChatGPT excelled in answering lacrimal questions (83.8%), while BARD performed best in the eyelid group (60.4%). ChatGPT's answers were longer and potentially more challenging to comprehend than BARD's. This study emphasizes the promising role of artificial intelligence-powered chatbots in oculoplastic patient education and support. With continued development, these chatbots may potentially assist physicians and offer patients accurate information, ultimately contributing to improved patient care while alleviating surgeon burnout. However, it is crucial to highlight that artificial intelligence may be good at answering questions, but physician oversight remains essential to ensure the highest standard of care and address complex medical cases.

Reported pain at work is a risk factor for vascular surgery trainee burnout

BackgroundWork-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. MethodsA confidential, voluntary survey was administered after the 2022 Vascular Surgery In-Service Examination to trainees in all Accreditation Council for Graduate Medical Education-accredited vascular surgery programs. Burnout was measured by a modified, abbreviated Maslach Burnout Inventory; pain after a full day of work was measured using a 10-point Likert scale and then dichotomized as “no to mild pain” (0-2) vs “moderate to severe pain” (3-9). Univariable analyses and multivariable regression assessed associations of pain with well-being indicators (eg, burnout, thoughts of attrition, and thoughts of career change). Pain management strategies were included as additional covariables in our study. ResultsWe included 527 trainees who completed the survey (82.2% response rate); 38% reported moderate to severe pain after a full day of work, of whom 73.6% reported using ergonomic adjustments and 67.0% used over-the-counter medications. Significantly more women reported moderate to severe pain than men (44.3% vs 34.5%; P < .01). After adjusting for gender, training level, race/ethnicity, mistreatment, and dissatisfaction with operative autonomy, 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 after adjustment. ConclusionsPhysical pain is prevalent among vascular surgery trainees and represents a risk factor for trainee burnout. Programs should consider mitigating this occupational hazard by offering ergonomic education and adjuncts, such as posture awareness and microbreaks during surgery, early and throughout training.

Burnout in hospital-based surgeons. Approaches for prevention?

Burnout among physicians is increasingly recognized as apublic health issue including its scientific, political, and societal relevance. The effects of burnout go far beyond physician health as they affect the quality of care, patient safety, medical errors, and efficiency of health care. Assessment of the risk of burnout for hospital-based surgeons as well as associations between surgeon burnout and several work-related and person-related factors. From the representative Saxony physician survey from 2019, we utilized the subsample of 231 hospital-based surgeons. We conducted aregression analysis with workload, job satisfaction, work-life balance (WLB), resilience, inability to recover and health complaints as predictors of burnout (Maslach burnout inventory-General survey, MBI-GS). Nearly half of the sample were female (49.4%), the average age was 42.0 years, 4.8% of participants exhibited burnout, 45.9% with some symptoms and 49.4% no burnout. Multivariate analysis showed significant positive associations between health complaints, inability to recover, alack of job-based self-fulfillment and burnout. There were significant negative connections between WLB, the wish to remain in the job and burnout. Burnout is aserious problem for surgeons. Preventive measures should focus on risk factors associated with the workplace and organization of work. Interventions targeted at the individual level should start at an early career stage.

Electronic Health Record Usage in an Academic Orthopaedic Sports Medicine Practice

Background While the relationship between electronic health record usage and physician burnout has been investigated in other specialties, no reports exist for orthopaedic surgery. The purpose of this study was to determine the amount of time spent on the electronic health record compared to actual patient interaction in four busy orthopaedic outpatient clinics. Hypothesis We hypothesized that surgeons would spend as much time on the electronic health record as they do interacting with patients on a typical clinic day. Methods Four busy academic orthopaedic surgeons (Surgeon 1, 2, 3, and 4) at a tertiary academic institution were each followed on clinic days to determine their total time spent on Epic Hyperspace electronic health record as compared to face-to-face interactions with patients. A research assistant recorded the amount of time each surgeon spent dictating notes, writing orders, or replying to clinical inbox messages (electronic health record time) and how much time was spent on loading screens or electronic health record buffering (loading time) during which no actions could be completed. Results Surgeon 1 spent an average of 63% of their clinic days using the electronic health record. Surgeon 2 spent 50% of their time on the computer. Surgeon 3 spent 35% of his days on the computer. Surgeon 4 spent 46% of his days on the computer. Conclusion Approximately half of each surgeon’s clinic time was spent using the electronic health record. Given the known influence of electronic health record usage on orthopaedic surgeon burnout, this is an issue that needs to be addressed. The solution likely involves a multifactorial approach, including changes to electronic health records, widespread use of scribes or advanced care teams, work hour limitations, and mindfulness training for residents and faculty. Information technology quality improvements can be made to EHRs that include reducing or eliminating unnecessary information displayed on screen, providing more abundant and accessible EHR training and on-site technical support, and a more streamlined software interface that eliminates unnecessary typing and clicks to improve charting flow and efficiency. Level of Evidence Level IV Descriptive Study

Surgeon Burnout: An Alarming Issue

No abstract available.

Sometimes Less Is More!

Commentary The thought-provoking and well-performed study by Lähdeoja et al. represents a retrospective review of 209 patients who sustained a proximal humeral fracture as adolescents and had an impressive follow-up ranging from 7 to 19 years and a thorough and rigorous methodology to assess outcomes. The authors did an outstanding job matching cohorts to make valid comparisons with a similar group without a fracture. The study found that patients who sustained a proximal humeral fracture as adolescents healed well and had good outcomes in long-term follow-up. The study also found no significant differences between patients treated operatively and those treated nonoperatively. It is well known that proximal humeral fractures heal well in young children; however, less is known in adolescents. A recent systematic review found that, since the 1946 inception date in the National Library of Medicine’s computer-based retrospective search service, there have only been 4 prospective cohort studies and 8 retrospective cohort studies examining proximal humeral fractures in children1. None has explicitly focused on fractures occurring during adolescence. The current study by Lähdeoja et al. will add to the growing mountain of evidence that shows that even adolescents do well after this kind of injury. Lähdeoja et al. believe that their findings will influence the practice of orthopaedics as they can help to guide the treatment of proximal humeral fractures in adolescence by using the idea that less is more and noting that most patients can be treated nonoperatively with minimally burdensome methods for the patients and that parents can be assured that the outcomes are good. However, one should note that the idea of less is more can have different interpretations. Dolly Parton once famously said, “People say that less is more, but I think more is more.” She was, of course, referring to the absurdity of noting that a qualifier (less) is opposite to its meaning. The architect Frank Lloyd Wright is correct in stating that “Less is more only when more is too much.” Based on the results of this study, a surgical procedure for proximal humeral fractures in adolescence seems “too much.” However, the incentive to operate in many health-care environments may create a substantial surgeon preference toward treating fractures operatively. There have been a decrease in some reimbursement schedules for orthopaedic procedures2 and a concern for surgeons being incentivized to perform more cases to maintain productivity goals3; decreased reimbursement is a known stressor contributing to surgeon burnout. From a purely orthopaedic viewpoint, this article confirms that nonoperative treatment yields similar or superior results to those of operative treatment of proximal humeral fractures in adolescents. This study comes from an economically highly developed Scandinavian country, Finland, where more than three-quarters of the population received health care through the public system, in 20194, higher than the mean of 71.7% for Organization for Economic Cooperation and Development (OECD) countries5. Finland is one of the most efficient public-sector health service producers, and its model should be applauded and analyzed for generalizability. To quote one final author, Yvon Chouinard, the founder of the apparel and equipment company Patagonia, in his book6, Let My People Go Surfing: The Education of a Reluctant Businessman, “The more you know, the less you need.” In the case of proximal humeral fractures in adolescence, the more we know and understand the long-term consequences of these injuries, the less we need to worry about treating them operatively.

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

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

Assessing the Prevalence of Burnout Among Female Microvascular Head and Neck Surgeons.

Background: Research has not explicitly explored differences between male and female microvascular head and neck (MHN) surgeon burnout, which should be identified and addressed to ensure career satisfaction and longevity. Objective: To measure and compare the prevalence of burnout among male versus female MHN surgeons. Methods: A prospective questionnaire based on the Maslach Burnout Inventory (MBI) was distributed through a web-based survey to the American Association of Facial Plastic and Reconstructive Surgeons and American Head and Neck Society in 2021 and 2022. Additional variables collected included demographics, relationship and parental status, academic rank, annual salary, and COVID-19-related questions. Results: One hundred thirteen surveys were collected. Twenty-nine (25.7%) were women and all completed MHN surgery fellowships. Women trended toward more emotional exhaustion than men (2.8 mean MBI vs. 2.3 mean MBI) but reported similar personal achievement (4.8 mean MBI vs. 4.9 mean MBI). Men experienced less workplace sexual harassment (p < 0.001). Women experienced more burnout (69% vs. 39%, p = 0.006) during the COVID-19 pandemic. Conclusion: Female MHN surgeons reported in this survey to experience more workplace sexual harassment and higher COVID-19-related burnout than their male counterparts.

Burnout and patient safety perceptions among surgeons in the United Kingdom during the early phases of the coronavirus disease 2019 pandemic: A two-wave survey.

Surgeons in the UK report high burnout levels. Burnout has been found to be associated with adverse patient outcomes but there are few studies that have examined this association in surgeons and even fewer which have examined this relationship over time. The main aim was to examine the relationships between surgeon burnout and surgeons' perceptions of patient safety cross-sectionally and longitudinally. The secondary aim was to test whether surgeons' burnout levels varied over the first six months of the coronavirus disease 2019 pandemic. This paper reports data from a two-wave survey (first wave from 5 May and 30 June 2020, the second wave 5 January to 30 February 2021). The dataset was divided into a longitudinal group (for surgeons who responded at both the time points) and two cross-sectional groups (for surgeons who responded at a one-time point, but not the other). The first key finding was that burnout was associated with patient safety outcomes measured at the same time point (Group 1 = 108, r = 0.309, p < 0.05 and Group 2 = 84, r = 0.238, p < 0.05). Second, burnout predicted poor patients' safety perceptions over time, and poor patient safety predicted burnout over time (Group 3 = 39, p < 0.05). Third, burnout increased between the first and second surveys (t = -4.034, p < 0.05). Burnout in surgeons may have serious implications for patient safety. Interventions to support surgeons should be prioritised, and healthcare organisations, surgeons and psychological specialists should collaborate on their development.

Stress and cataract surgery: A nationwide study evaluating surgeon burnout.

We aimed to evaluate the nationwide prevalence of stress induced burnout among cataract surgeons. We believe that knowledge of these factors can help formulate a solution to this underreported problem. A three-part nationwide cross-sectional survey was disseminated with via the Royal College of Ophthalmologists (RCOphth) in the United Kingdom(UK). All consultants, trainees and specialty doctors and associate specialists(SAS) were invited to participate. We evaluated burnout using the Maslach Burnout Inventory (MBI). Logistic regression modelling was completed to look at factors linked to high level burnout in certain domains. A total of 406 respondents completed our survey. Prevalence of cataract surgery-related high burnout was estimated at 3.45% (Section A and/or B) and 40% within Personal Accomplishment (PA)(Section C of the MBI). Multiple factors were associated with increased burnout within PA: Increasing age: 61+ OR: 2.99 (1.02-8.78, p = 0.05), Number of cataract operations completed: >3000 OR 2.98 (1.03-8.64, p = 0.04), Lists per week: 2: OR 2.99 (1.38-6.47, p < 0.01), 2.5: OR 8.95 (2.58-31.02, p < 0.01), 3 or more: OR 2.64 (1.07-6.54, p = 0.04). Sleeping 8 h or more was found to be protective OR 0.52 (0.28-0.96, p = 0.04). 17% of respondents indicated they would be willing to give up cataract surgery if given the opportunity. The prevalence of stress induced burnout by cataract surgery appears to be present in a minority of surgeons. There appears to be a significant reduction in the feeling of personal achievement within the profession. A large proportion of this cohort appears to be willing to give up surgical responsibilities.

Equity360: Gender, Race, and Ethnicity-All Orthopaedic Surgeon Burnout Is Not Created Equal.

1Professor of Orthopedic Surgery, NYU Langone Grossman School of Medicine, NYU Langone Orthopedics, New York, NY, USA 2Co-founder and Chief Medical Officer, Vori Health, Jacksonville Beach, FL, USA 3Professor Emerita of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA M. I. O’Connor ✉, Vori Health, Jacksonville Beach, FL 32250, USA, Email: [email protected] A note from the Editor-in-Chief: I am pleased to present the next installment of “Equity360: Gender, Race, and Ethnicity” written by Mary I. O’Connor MD, FAOA, FAAHKS, FAAOS. Dr. O’Connor is Chair of Movement is Life, a non-profit multistakeholder corporation committed to health equity, co-founder and Chief Medical Officer at Vori Health, Professor Emerita of Orthopedics at Mayo Clinic, and Past Professor of Orthopaedics and Rehabilitation at Yale School of Medicine. She has written extensively on increasing the number of women and underrepresented minorities in orthopaedics and about other social issues. Her column unravels the complex and controversial motives behind disparities in musculoskeletal medicine across sex, gender, race, and ethnicity. The authors certify that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

Ways of preventing surgeon burnout.

In surgical practice, numerous sources of stress (stressors) are unpredictable, two examples being daily workload and postoperative complications. They may help to explain surgeon burnout, of which the prevalence (34 to 53%) has been the subject of many studies. That said, even though assessments are legion, recommended solutions have been few and far between, especially insofar as by nature and training, surgeons are disinclined to interest themselves in burnout, which they are prone to consider as something experienced by "others". The objective of this attempt at clarification is to identify in the literature the strategies put forward in view of avoiding surgeon burnout, and to assess the impact of this phenomenon not only on the surgeon's professional and personal entourage, but also on patient safety. Prevention-based strategies, many of them focused on modifiable stressors, will be detailed.

Surgeon Burnout and Usage of Personal Communication Devices: Examining the Technology “Empowerment/Enslavement Paradox”

IntroductionAccess to patients’ electronic medical records (EMRs) on personal communication devices (PCDs) is beneficial but can negatively impact surgeons. In a recent op-ed, Cohen et al. explored this technology “empowerment/enslavement paradox” and its potential effect on surgeon burnout. We examined if there is a relationship between accessing EMRs on PCDs and surgeon burnout. MethodsThis was a cohort study with retrospective and prospective arms. Trainees and attendings with a background in general surgery completed the Maslach Burnout Index for Medical Personnel, a validated survey scored on three areas of burnout (emotional exhaustion, depersonalization, and low personal accomplishment). Data on login frequency to EMRs on PCDs over the previous 6 mo were obtained. Pearson correlation coefficients were calculated to determine if burnout and login frequency were associated. ResultsThere were 52 participants included. Residents were 61.5% (n = 32) of participants. The mean login frequency over 6 mo was 431.0 ± 323.9. The mean scores (out of 6) for emotional exhaustion, depersonalization, and personal accomplishment were 2.3 ± 1.1, 1.9 ± 1.2, and 4.9 ± 0.8, respectively. There was no correlation between burnout and logins. Residents had higher median depersonalization scores (2.3 versus 1.2, P = 0.03) and total logins (417.5 versus 210.0, P < 0.001) than attendings. Participants who overestimated logins had higher median emotional exhaustion and depersonalization scores than those who underestimated (2.6 versus 1.4, P = 0.03, and 2.4 versus 0.8, P = 0.003, respectively). ConclusionsUsing EMRs on PCDs is common, but frequency of logins did not correlate with burnout scores in this study. However, perception of increased workload may contribute to experiencing burnout.

Addressing Surgeon Burnout Through a Multi-level Approach: A National Call to Action.

Physician burnout is an epidemic and there are unique aspects of surgery that dictate rates of burnout among general surgeons and surgical trainees. This review characterizes the scope of burnout and its drivers within the field of surgery and advocates for strategies to address burnout at the individual, institutional, and national levels. Rates of burnout in surgery are increasing with higher numbers of young and female surgeons affected. Contributing factors are generally related to work-life balance, longer hours, and mistreatment in the workplace. Attempts have been made at implementing structured initiatives in an effort to combat work dissatisfaction and emotional exhaustion. Still, rates of burnout continue to increase. General surgeons and trainees are at high risk for burnout with resulting attrition, depression, and suicidal ideation. The solution to burnout must be addressed at individual, institutional, and national levels. Further research into the factors leading to surgeon burnout and enactment of effective strategies to mitigate burnout must be pursued.

Are We There Yet? No. Gender Disparities Still Exist and Affect Surgeon Burnout

Are We There Yet? No. Gender Disparities Still Exist and Affect Surgeon Burnout

Trainee Effect on Procedural Efficiency is Limited in Vascular Surgery Operations

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. 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. 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 (-30min, P=0.03, and -12min, P=0.05, respectively). Other procedures were longer: endarterectomy (+48min, P<0.01), rib resection (+78min, P<0.01), endovascular aorta repair (+120min, P<0.01), lower extremity bypass (+170min, P<0.01), and open aortic repair (+410min, 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: -2.4min; 95%; CI: -4.7, -0.12; P=0.04). AVF took significantly more time with a surgical resident: wheels-in to cut time (mean: +4.2min; 95%; CI: 0.92, 7.4; P=0.01) and cut to close time (mean: +13min; 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. 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.