Burnout in Academic Surgery – #SurgWellness

Burnout can be defined as “a syndrome of emotional exhaustion and depersonalization that leads to decreased effectiveness at work”.¹ The concept of burnout in academic surgery has been recognized for well over a decade, with several notable studies drawing attention to the rising incidence. A survey of the American College of Surgeons (ACS) in 2008 found that 40% of respondents reported professional burnout, with 30% screening positive for symptoms of depression.¹ Perhaps the most telling finding of this study was that only 51% of responding surgeons would recommend their children pursue a career as a surgeon.¹ Since 2011, burnout has increased in all medical specialties, with surgical specialties having rates of burnout exceeding 50%.^2-3 It should be no surprise that burnout during surgical residency has also continued to increase. Martini et al⁴ found that 40% of surgical residents had burnout in 2004, while nearly 70% of surgical residents reported burnout in 2016 survey.⁵

Why should we care about physician burnout? Aside from the obvious negative impact that burnout has on an individual physician and their family, physician burnout also impairs the delivery of optimal patient care. The ACS found a direct association between surgeon burnout (in particular emotional exhaustion and depersonalization) and an increased likelihood of committing a major medical error.⁶ It should come as no surprise that physician burnout leads to lower career satisfaction and an earlier retirement age.⁷ Additionally, recent research proposes that wellbeing is a skill that can be taught, breaking down well-being into 4 domains: resilience, attention, outlook, and generosity.⁸

What can be done to address workplace burnout amongst academic surgeons? At the individual level, several techniques can lower the burnout risk. These include maintaining a work/life balance and using mindfulness techniques.⁹ Further, recent literature suggests that both resilience and emotional intelligence are skills that can be taught to surgical residents and are predictors of resident burnout. ^7,10 At the institutional level, peer support programs, mentorship, adequate staffing, and assistance to alleviate the administrative/non-clinical physician workload all are strategies that can help reduce physician burnout. Specifically, peer support programs have been initiated to address clinician vulnerability following major adverse events, malpractice litigation, the death of a colleague, and caring for a mass casualty event.¹¹

The August #AASchat will explore these issues through facilitated questions led by our distinguished moderator:

Dr. Max Wohlauer (@doctormaxw), Vascular Surgeon, University of Colorado

In the chat, scheduled on August 28 @ 8PM EST using the hashtag #SurgWellness, we will explore the following questions:

1. What are your biggest work-related stressors? How do you deal with stress?
2. What changes/resources would help reduce burnout in academic surgery? Does your institution have a physician wellness program?
3. Do you know how to help a colleague who may be showing signs of depression or burnout?
4. Does your residency program screen or discuss burnout with residents? What can/should we do to prepare surgical trainees for a successful long-term career?
5. Is the concept of work/life balance the “unicorn” of academic surgery?

References

1. Shanafelt TD, et al. Burnout and career satisfaction among American surgeons. Ann Surg 2009; 250(3): 463-71.
2. Shanafelt TD, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Archives of Internal Medicine.2012;172(18): 1377-85.
3. Shanafelt TD, et al. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clinic Proceedings.2015;90(12): 1600-13.
4. Martini S, et al. Burnout comparison among residents in different medical specialties.Academic Psychiatry. 2004;28(3): 240-2.
5. Elmore LC, et al. National survey of burnout among US general surgery residents.Journal of the American College of Surgeons. 2016;223(3): 440-451.
6. Shanafelt, TD, et al. Longitudinal Study Evaluating the Association Between Physician Burnout and Changes in Professional Work Effort. Mayo Clinic Proceedings. 2016;91(4): 422-31.
7. Epstein RM and MS Krasner. Physician resilience: what it means, why it matters, and how to promote it.Academic Medicine. 2013;88(3): 301-303.
8. Tlaka S. How Science Reveals That “Well Being” Is a Skill. 2016, February 5. Retrieved from https://www.mindful.org/science-reveals-well-skill/
9. Davidson RJ, McEwen BS. Social influences on neuroplasticity: stress and interventions to promote well-being. Nat Neurosci. 2012 Apr 15;15(5):689-95.
10. Lin DT, et al. Emotional intelligence as a predictor of resident well-being.Journal of the American College of Surgeons. 2016;223(2): 352-358.
11. Shapiro J, Galowitz P. Peer Support for Clinicians: A Programmatic Approach. Acad Med. 2016 Sep;91(9):1200-4.