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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.

Abstract

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.

References
1.
Shanafelt  TD, Balch  CM, Bechamps  GJ,  et al.  Burnout and career satisfaction among American surgeons.  Ann Surg. 2009;250(3):463-471.PubMedGoogle Scholar
2.
Maslach  C, Jackson  SE, Leiter  MP.  Maslach Burnout Inventory. 3rd ed. Palo Alto, CA: Consulting Psychologists Press; 1996.
3.
Shanafelt  TD, Balch  CM, Bechamps  G,  et al.  Burnout and medical errors among American surgeons.  Ann Surg. 2010;251(6):995-1000.PubMedGoogle ScholarCrossref
4.
Firth-Cozens  J, Greenhalgh  J.  Doctors’ perceptions of the links between stress and lowered clinical care.  Soc Sci Med. 1997;44(7):1017-1022.PubMedGoogle ScholarCrossref
5.
Shanafelt  TD, Bradley  KA, Wipf  JE, Back  AL.  Burnout and self-reported patient care in an internal medicine residency program.  Ann Intern Med. 2002;136(5):358-367.PubMedGoogle ScholarCrossref
6.
West  CP, Huschka  MM, Novotny  PJ,  et al.  Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study.  JAMA. 2006;296(9):1071-1078.PubMedGoogle ScholarCrossref
7.
Dyrbye  L, Shanafelt  T, Timbros  J,  et al.  Protecting and Promoting the Well-being of Surgeons: Basics of Surgery. Maarssen, Germany: Elsevier Gezondheidzorg; 2007:177-184.
8.
Green  A, Duthie  HL, Young  HL, Peters  TJ.  Stress in surgeons.  Br J Surg. 1990;77(10):1154-1158.PubMedGoogle ScholarCrossref
9.
Kent  GG, Johnson  AG.  Conflicting demands in surgical practice.  Ann R Coll Surg Engl. 1995;77(5)(suppl):235-238.PubMedGoogle Scholar
10.
Sargent  MC, Sotile  W, Sotile  MO, Rubash  H, Barrack  RL.  Quality of life during orthopaedic training and academic practice: part 2: spouses and significant others.  J Bone Joint Surg Am. 2012;94(19):e145, 1-6).PubMedGoogle ScholarCrossref
11.
Dodson  TF, Webb  AL.  Why do residents leave general surgery? the hidden problem in today’s programs.  Curr Surg. 2005;62(1):128-131.PubMedGoogle ScholarCrossref
12.
Scheurer  D, McKean  S, Miller  J, Wetterneck  T.  US physician satisfaction: a systematic review.  J Hosp Med. 2009;4(9):560-568.PubMedGoogle ScholarCrossref
13.
Campbell  DA  Jr, Sonnad  SS, Eckhauser  FE, Campbell  KK, Greenfield  LJ.  Burnout among American surgeons.  Surgery. 2001;130(4):696-702.PubMedGoogle ScholarCrossref
14.
Moher  D, Liberati  A, Tetzlaff  J, Altman  DG; PRISMA Group.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.  Int J Surg. 2010;8(5):336-341.PubMedGoogle ScholarCrossref
15.
Kravitz  RL, Leigh  JP, Samuels  SJ, Schembri  M, Gilbert  WM.  Tracking career satisfaction and perceptions of quality among US obstetricians and gynecologists.  Obstet Gynecol. 2003;102(3):463-470.PubMedGoogle Scholar
16.
Leigh  JP, Kravitz  RL, Schembri  M, Samuels  SJ, Mobley  S.  Physician career satisfaction across specialties.  Arch Intern Med. 2002;162(14):1577-1584.PubMedGoogle ScholarCrossref
17.
Antiel  RM, Reed  DA, Van Arendonk  KJ,  et al.  Effects of duty hour restrictions on core competencies, education, quality of life, and burnout among general surgery interns.  JAMA Surg. 2013;148(5):448-455.PubMedGoogle ScholarCrossref
18.
Hill  JD, Smith  RJH.  Monitoring stress levels in postgraduate medical training.  Laryngoscope. 2009;119(1):75-78.PubMedGoogle ScholarCrossref
19.
Salles  A, Cohen  GL, Mueller  CM.  The relationship between grit and resident well-being.  Am J Surg. 2014;207(2):251-254.PubMedGoogle ScholarCrossref
20.
Lindeman  BM, Sacks  BC, Hirose  K, Lipsett  PA.  Multifaceted longitudinal study of surgical resident education, quality of life, and patient care before and after July 2011.  J Surg Educ. 2013;70(6):769-776.PubMedGoogle ScholarCrossref
21.
Balch  CM, Shanafelt  TD, Sloan  JA, Satele  DV, Freischlag  JA.  Distress and career satisfaction among 14 surgical specialties, comparing academic and private practice settings.  Ann Surg. 2011;254(4):558-568.PubMedGoogle ScholarCrossref
22.
Becker  JL, Milad  MP, Klock  SC.  Burnout, depression, and career satisfaction: cross-sectional study of obstetrics and gynecology residents.  Am J Obstet Gynecol. 2006;195(5):1444-1449.PubMedGoogle ScholarCrossref
23.
Fletcher  AM, Pagedar  N, Smith  RJH.  Factors correlating with burnout in practicing otolaryngologists.  Otolaryngol Head Neck Surg. 2012;146(2):234-239.PubMedGoogle ScholarCrossref
24.
Gabbe  SG, Melville  J, Mandel  L, Walker  E.  Burnout in chairs of obstetrics and gynecology: diagnosis, treatment, and prevention.  Am J Obstet Gynecol. 2002;186(4):601-612.PubMedGoogle ScholarCrossref
25.
Garza  JA, Schneider  KM, Promecene  P, Monga  M.  Burnout in residency: a statewide study.  South Med J. 2004;97(12):1171-1173.PubMedGoogle ScholarCrossref
26.
Golub  JS, Johns  MM  III, Weiss  PS, Ramesh  AK, Ossoff  RH.  Burnout in academic faculty of otolaryngology–head and neck surgery.  Laryngoscope. 2008;118(11):1951-1956.PubMedGoogle ScholarCrossref
27.
Golub  JS, Weiss  PS, Ramesh  AK, Ossoff  RH, Johns  MM  III.  Burnout in residents of otolaryngology–head and neck surgery: a national inquiry into the health of residency training.  Acad Med. 2007;82(6):596-601.PubMedGoogle ScholarCrossref
28.
Govardhan  LM, Pinelli  V, Schnatz  PF.  Burnout, depression and job satisfaction in obstetrics and gynecology residents.  Conn Med. 2012;76(7):389-395.PubMedGoogle Scholar
29.
Guest  RS, Baser  R, Li  Y, Scardino  PT, Brown  AE, Kissane  DW.  Cancer surgeons’ distress and well-being, I: the tension between a culture of productivity and the need for self-care.  Ann Surg Oncol. 2011;18(5):1229-1235.PubMedGoogle ScholarCrossref
30.
Johns  MM  III, Ossoff  RH.  Burnout in academic chairs of otolaryngology–head and neck surgery.  Laryngoscope. 2005;115(11):2056-2061.PubMedGoogle ScholarCrossref
31.
Keeton  K, Fenner  DE, Johnson  TR, Hayward  RA.  Predictors of physician career satisfaction, work-life balance, and burnout.  Obstet Gynecol. 2007;109(4):949-955.PubMedGoogle ScholarCrossref
32.
Klimo  P, DeCuypere  MG, Ragel  BT, McCartney  S, Couldwell  WT, Boop  FA.  Career satisfaction and burnout among US neurosurgeons: a feasibility and pilot study.  Neurosurgery. 2012;71(2):E576.Google ScholarCrossref
33.
Kuerer  HM, Eberlein  TJ, Pollock  RE,  et al.  Career satisfaction, practice patterns and burnout among surgical oncologists: report on the quality of life of members of the Society of Surgical Oncology.  Ann Surg Oncol. 2007;14(11):3043-3053.PubMedGoogle ScholarCrossref
34.
Saleh  KJ, Quick  JC, Conaway  M,  et al.  The prevalence and severity of burnout among academic orthopaedic departmental leaders.  J Bone Joint Surg Am. 2007;89(4):896-903.PubMedGoogle ScholarCrossref
35.
Sargent  MC, Sotile  W, Sotile  MO, Rubash  H, Barrack  RL.  Stress and coping among orthopaedic surgery residents and faculty.  J Bone Joint Surg Am. 2004;86-A(7):1579-1586.PubMedGoogle Scholar
36.
Sargent  MC, Sotile  W, Sotile  MO, Rubash  H, Barrack  RL.  Quality of life during orthopaedic training and academic practice, part 1: orthopaedic surgery residents and faculty.  J Bone Joint Surg Am. 2009;91(10):2395-2405.PubMedGoogle ScholarCrossref
37.
Bertges Yost  W, Eshelman  A, Raoufi  M, Abouljoud  MS.  A national study of burnout among American transplant surgeons.  Transplant Proc. 2005;37(2):1399-1401.PubMedGoogle ScholarCrossref
38.
Promecene  PA, Monga  M.  Occupational stress among obstetrician/gynecologists.  South Med J. 2003;96(12):1187-1189.PubMedGoogle ScholarCrossref
39.
Schneider  KM, Monga  M, Kerrigan  AJ.  Stress in residency: reality or myth?  Am J Obstet Gynecol. 2002;186(5):907-909.PubMedGoogle ScholarCrossref
40.
Bendorf  DC, Helmer  SD, Osland  JS, Tenofsky  PL.  Income, productivity, and satisfaction of breast surgeons.  Am J Surg. 2010;199(3):405-409.PubMedGoogle ScholarCrossref
41.
Caniano  DA, Sonnino  RE, Paolo  AM.  Keys to career satisfaction: insights from a survey of women pediatric surgeons.  J Pediatr Surg. 2004;39(6):984-990.PubMedGoogle ScholarCrossref
42.
Davenport  DL, Henderson  WG, Hogan  S, Mentzer  RM  Jr, Zwischenberger  JB; Participants in the Working Conditions of Surgery Residents and Quality of Care Study.  Surgery resident working conditions and job satisfaction.  Surgery. 2008;144(2):332-338.e5.PubMedGoogle ScholarCrossref
43.
Esposito  TJ, Leon  L, Jurkovich  GJ.  The shape of things to come: results from a national survey of trauma surgeons on issues concerning their future.  J Trauma. 2006;60(1):8-16.PubMedGoogle ScholarCrossref
44.
Foley  PJ, Roses  RE, Kelz  RR,  et al.  The state of general surgery training: a different perspective.  J Surg Educ. 2008;65(6):494-498.PubMedGoogle ScholarCrossref
45.
Johnson  JT, Wagner  RL, Rueger  RM, Goepfert  H.  Professional burnout among head and neck surgeons: results of a survey.  Head Neck. 1993;15(6):557-560.PubMedGoogle ScholarCrossref
46.
Katz  A, Mallory  B, Gilbert  JC,  et al.  State of the practice for pediatric surgery—career satisfaction and concerns: a report from the American Pediatric Surgical Association Task Force on Family Issues.  J Pediatr Surg. 2010;45(10):1975-1982.PubMedGoogle ScholarCrossref
47.
O’Meara  AT, Averette  HE.  Job satisfaction among gynecologic oncologists practicing in the United States.  Gynecol Oncol. 2000;76(2):163-169.PubMedGoogle ScholarCrossref
48.
Rohrich  RJ, McGrath  MH, Lawrence  TW; ASPS Plastic Surgery Workforce Task Force; AAMC Center for Workforce Studies.  Plastic surgeons over 50: practice patterns, satisfaction, and retirement plans.  Plast Reconstr Surg. 2008;121(4):1458-1474.PubMedGoogle ScholarCrossref
49.
Schroen  AT, Brownstein  MR, Sheldon  GF.  Women in academic general surgery.  Acad Med. 2004;79(4):310-318.PubMedGoogle ScholarCrossref
50.
Streu  R, Hawley  S, Gay  A, Salem  B, Abrahamse  P, Alderman  AK.  Satisfaction with career choice among US plastic surgeons: results from a national survey.  Plast Reconstr Surg. 2010;126(2):636-642.PubMedGoogle ScholarCrossref
51.
Tsinberg  M, Duh  QY, Cisco  RM,  et al.  Practice patterns and job satisfaction in fellowship-trained endocrine surgeons.  Surgery. 2012;152(6):953-956.PubMedGoogle ScholarCrossref
52.
Yeo  H, Viola  K, Berg  D,  et al.  Attitudes, training experiences, and professional expectations of US general surgery residents: a national survey.  JAMA. 2009;302(12):1301-1308.PubMedGoogle ScholarCrossref
53.
McAbee  JH, Ragel  BT, McCartney  S,  et al.  Factors associated with career satisfaction and burnout among US neurosurgeons: results of a nationwide survey.  J Neurosurg. 2015;123(1):161-173.PubMedGoogle ScholarCrossref
54.
Qureshi  HA, Rawlani  R, Mioton  LM, Dumanian  GA, Kim  JYS, Rawlani  V.  Burnout phenomenon in US plastic surgeons: risk factors and impact on quality of life.  Plast Reconstr Surg. 2015;135(2):619-626.PubMedGoogle ScholarCrossref
55.
Streu  R, Hansen  J, Abrahamse  P, Alderman  AK.  Professional burnout among US plastic surgeons: results of a national survey.  Ann Plast Surg. 2014;72(3):346-350.PubMedGoogle ScholarCrossref
56.
West  CP, Shanafelt  TD, Kolars  JC.  Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents.  JAMA. 2011;306(9):952-960.PubMedGoogle ScholarCrossref
57.
James  JT.  A new, evidence-based estimate of patient harms associated with hospital care.  J Patient Saf. 2013;9(3):122-128.PubMedGoogle ScholarCrossref
58.
Calland  JF, Adams  RB, Benjamin  DK  Jr,  et al.  Thirty-day postoperative death rate at an academic medical center.  Ann Surg. 2002;235(5):690-696.PubMedGoogle ScholarCrossref
59.
Debas  HT.  Surgery: a noble profession in a changing world.  Ann Surg. 2002;236(3):263-269.PubMedGoogle ScholarCrossref
60.
Bell  RH  Jr, Banker  MB, Rhodes  RS, Biester  TW, Lewis  FR.  Graduate medical education in surgery in the United States.  Surg Clin North Am. 2007;87(4):811-823, v-vi.PubMedGoogle ScholarCrossref
61.
Chopra  SS, Sotile  WM, Sotile  MO.  STUDENTJAMA: physician burnout.  JAMA. 2004;291(5):633.PubMedGoogle ScholarCrossref
62.
Wai  PY, Dandar  V, Radosevich  DM, Brubaker  L, Kuo  PC.  Engagement, workplace satisfaction, and retention of surgical specialists in academic medicine in the United States.  J Am Coll Surg. 2014;219(1):31-42.PubMedGoogle ScholarCrossref
63.
Drolet  BC, Christopher  DA, Fischer  SA.  Residents’ response to duty-hour regulations: a follow-up national survey.  N Engl J Med. 2012;366(24):e35.PubMedGoogle ScholarCrossref
64.
Lee  CJ.  Federal regulation of hospital resident work hours: enforcement with real teeth.  J Health Care Law Policy. 2006;9(1):161-216.Google Scholar
65.
Association of American Medical Colleges. Center for Workforce Studies. 2014 Physician Specialty Data Book. https://members.aamc.org/eweb/upload/14-086%20Specialty%20Databook%202014_711.pdf. November 2014. Accessed May 26, 2015.
66.
Ahmadiyeh  N, Cho  NL, Kellogg  KC,  et al.  Career satisfaction of women in surgery: perceptions, factors, and strategies.  J Am Coll Surg. 2010;210(1):23-28.PubMedGoogle ScholarCrossref
67.
AAMC. Medical student education: debt, costs, and loan repayment fact card. http://members.aamc.org/eweb/upload/2015 Debt Fact Card.pdf. October 2013. Accessed August 15, 2013.
68.
Clifton  J, Bradley  C, Cadeliña  R, Hsiang  Y.  The effect of clinical academic service contracts on surgeon satisfaction.  Can J Surg. 2007;50(3):175-180.PubMedGoogle Scholar
69.
Sittig  DF, Singh  H.  Electronic health records and national patient-safety goals.  N Engl J Med. 2012;367(19):1854-1860.PubMedGoogle ScholarCrossref
70.
Kane  L, Chesanow  N. Medscape EHR Report 2014. http://www.medscape.com/features/slideshow/public/ehr2014#1. July 15, 2014. Accessed March 10, 2016.
71.
Centers for Medicare & Medicaid Services. CMS Medicare and Medicaid EHR incentive programs https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html. Updated April 14, 2016. Accessed June 11, 2016.
72.
Blumenthal  D.  Stimulating the adoption of health information technology.  N Engl J Med. 2009;360(15):1477-1479.PubMedGoogle ScholarCrossref
73.
Kay  M, Mitchell  G, Clavarino  A, Doust  J.  Doctors as patients: a systematic review of doctors’ health access and the barriers they experience.  Br J Gen Pract. 2008;58(552):501-508.PubMedGoogle ScholarCrossref
74.
Wells  KB, Lewis  CE, Leake  B, Ware  JE  Jr.  Do physicians preach what they practice? a study of physicians’ health habits and counseling practices.  JAMA. 1984;252(20):2846-2848.PubMedGoogle ScholarCrossref
75.
HR 2—Medicare Access and CHIP Reauthorization Act, Pub L No. 114-10. https://www.congress.gov/bill/114th-congress/house-bill/2/all-info#summary. April 16, 2016. Accessed May 26, 2015.
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