Surgeons have critical, intense jobs. On top of working long hours, nights, and weekends, surgeons deal with life-and-death scenarios every day, so it comes as little surprise that a sizable portion of practicing surgeons experience symptoms of burnout in the course of their careers.
Burnout has been defined as “a syndrome of emotional exhaustion and depersonalization that leads to decreased effectiveness at work.”1 Common symptoms of burnout are as follows:2
- Treating patients or coworkers as objects rather than human beings
- Feeling emotionally depleted or physically exhausted
- Showing poor judgment, cynicism, guilt, or feelings of ineffectiveness
A study to determine the frequency of burnout in surgery was published in Annals of Surgery in September 2009. The report was based on an anonymous survey of nearly 25,000 members of the American College of Surgeons (ACS) that asked respondents to provide information about the following:3
- Practice characteristics
- Career satisfaction
- Quality of life
A total 7,905 ACS members responded with the following insights:3
- 40 percent scored positively for burnout
- 30 percent showed symptoms of depression, with 10–15 percent of respondents likely meeting the criteria for a major depressive disorder
- 49 percent would not recommend that their children pursue a career in medicine or surgery
The study listed several independent factors associated with burnout, such as younger age, having children, and workload.3
A previous study by Campbell in 2001 found that 32 percent of surgeons in active practice at several University of Michigan, Ann Arbor, surgical resident training programs and members of the Midwest Surgical Association “showed ‘high’ levels of emotional exhaustion.”4 This study also found that younger surgeons were “more susceptible to burnout.”4
Pathways to well-being, resiliency
Reducing health care provider stress and burnout—with the goal of improving career satisfaction and patient care—was the focus of two articles published in the May 2018 issue of The Joint Commission Journal on Quality and Patient Safety.
In “Developing a medical scribe program at an academic hospital: The Hennepin County Medical Center experience,” Martel and colleagues describe a medical scribe program that was deployed in nine clinics at the Hennepin County Medical Center, Minneapolis, MN. The medical scribes supported both physicians and advanced practice clinicians (APCs) by charting physician-patient encounters. The study showed the following:5
- A decrease from 75 percent to 24 percent of health care professionals who reported documentation time at the office was “poor” or “marginal”
- A decrease from 64 percent to 32 percent of health care professionals who rated time spent on electronic health records (EHR) at home as “excessive” or “moderately high”
- Health care professionals reported greater satisfaction with their role in the clinic, improvements in how much time they spent on documentation, and better ability to listen to patients
Entering data into the EHR—a task that many surgeons and other health care professionals find particularly time-consuming—is positively affected by the presence of a scribe. Thus, the intervention used in this study—employing medical scribes—should decrease at least one of the sources of burnout and fatigue. The fact that health care professionals felt less documentation meant they could spend their time more meaningfully with patients also is a potential contributor to satisfaction with the profession, which decreases the risk of burnout.
The second article, “Focus on the quadruple aim: Development of a resiliency center to promote faculty and staff wellness initiatives,” by Morrow and colleagues describes the creation of a resiliency center at the University of Utah Health, Salt Lake City, to support health care providers. The steps taken were as follows:6
- Appointing a chief wellness officer
- Implementing wellness initiatives, as well as communication skills training, peer support, and an on-site employee assistance program
The authors note that future research will measure the effectiveness of the resiliency center on health care professionals.6
Keeping our workforce from experiencing burnout and developing resilience among our physicians and other providers is a major focus of attention for leaders of health care systems. Both of these articles are available online.
The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.
- Maslach C, Jackson S, Leiter M. Maslach Burnout Inventory Manual, 3rd edition. Palo Alto, CA: Consulting Psychologists Press; 1996.
- Balch CM, Freischlag JA, Shanafelt TD. Stress and burnout among surgeons: Understanding and managing the syndrome and avoiding the adverse consequences. Arch Surg. 2009;144(4):371-376.
- Shanafelt TD, Balch CM, Bechamps GJ, et al. Burnout and career satisfaction among American surgeons. Ann Surg. 2009;250(3):463-471.
- Campbell DA Jr., Sonnad SS, Eckhauser FE, Campbell KK, Greenfield LJ. Burnout among American surgeons. Surgery. 2001;130(4):696-702.
- Martel ML, Imdieke BH, Holm KM, et al. Developing a medical scribe program at an academic hospital: The Hennepin County Medical Center experience. Jt Comm J Qual Patient Saf. 2018;44(5):238-249.
- Morrow E, Call M, Marcus R, Locke A. Focus on the quadruple aim: Development of a resiliency center to promote faculty and staff wellness initiatives. Jt Comm J Qual Patient Saf. 2018;44(5):293-298.