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Quality of Life and Burnout Rates Across Surgical SpecialtiesA Systematic Review

Educational Objective
To compare the quality of life and burnout by surgical specialty and identify potential factors associated with burnout.
1 Credit CME
Key Points

Question  How do factors influencing quality of life (QOL) and burnout of surgeons differ among surgical specialties?

Findings  Surgeon QOL and burnout constitute a multifactorial process, with a variable impact of sex and a significantly higher risk for burnout among residents than attending surgeons across specialties. Hours worked per week were a statistically significant predictor of burnout, decreased career satisfaction, and poorer QOL and vary among surgical specialties.

Meaning  Surgeons in certain subspecialties should aim to identify those at risk for burnout and decreased QOL and explore strategies to minimize the burden to current and future surgeons.


Importance  Establishing strategies to minimize the burden of burnout and poor quality of life (QOL) on surgeons relies on a thorough understanding of QOL and burnout among the various surgical specialties.

Objectives  To systematically review the literature across multiple surgical specialties and provide a comprehensive understanding of QOL and burnout among all surgeons, to delineate variation in rates of burnout and poor QOL, and to elucidate factors that are commonly implicated in these outcomes.

Evidence Review  An OVID electronic search encompassing MEDLINE, PsycInfo, and EMBASE was completed using the following MeSH search terms: quality of life, burnout, surgeon, surgical specialty, and United States. Full articles published in English from January 1, 1980, to June 10, 2015, that evaluated US surgical specialists and included more than 1 question related to QOL were included. Review articles and evaluations that included medical students or nonsurgical health care professionals were excluded. Of 1420 titles, 41 articles met these criteria. The standardized methodologic principles of PRISMA for reporting systematic reviews guided analysis. Primary end points were QOL scores and burnout rates that compared sex, age, level of training (resident vs attending), surgical specialty, and the type of assessment tool. Secondary outcomes included proposed work hours and income as factors contributing to burnout. Owing to the heterogeneity of data reporting among articles, qualitative analysis was also reported.

Findings  Of the 16 specialties included, pediatric (86% to 96%) and endocrine (96%) surgeons demonstrated the highest career satisfaction, whereas a portion of plastic surgeons (33%) and vascular surgeons (64%) were least satisfied. The effect of sex was variable. Residents demonstrated a significantly higher risk for burnout than attending surgeons across multiple specialties, including obstetrics and gynecology, otolaryngology, and orthopedic surgery. One-third of the studies found hours worked per week to be a statistically significant predictor of burnout, decreased career satisfaction, and poorer QOL.

Conclusions and Relevance  Burnout and QOL vary across all surgical specialties. Whether sex affects burnout rates remains unclear. Residents are at an increased risk for burnout and more likely to report a poor QOL than attending surgeons.

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Article Information

Corresponding Author: Michael Sosin, MD, Department of Surgery, Medstar Georgetown University Hospital, 3800 Reservoir Rd NW, Fourth Floor, Pasquerilla Healthcare Center, Washington, DC 20007 (sosinmi@gmail.com).

Accepted for Publication: March 22, 2016.

Published Online: July 13, 2016. doi:10.1001/jamasurg.2016.1647

Author Contributions: Dr Sosin had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: All authors.

Acquisition, analysis, or interpretation of data: Pulcrano, Sosin.

Drafting of the manuscript: Pulcrano, Sosin.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Pulcrano, Sosin.

Administrative, technical, or material support: Pulcrano, Sosin.

Study supervision: Evans, Sosin.

Conflict of Interest Disclosures: None reported.

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