EXECUTIVE SUMMARY

Surgeons and other physicians increasingly experience burnout, which can affect their well-being as well as patient safety and satisfaction. Several researchers who have studied the phenomenon offer some suggestions for how to prevent and reduce burnout.

  • Surgeons demonstrate high rates of emotional exhaustion and depersonalization.
  • Mindfulness and proper rest, exercise, and nutrition are great habits for individuals to employ, but organizations also must tackle the problem.
  • Time stress also is an increasing problem for surgeons.

Physician burnout is on a steep rise, with the prevalence increasing by 10% between 2011 and 2014, and it cuts across specialties, with more than half of general surgeons reporting symptoms of burnout.1,2,3

“Over 50% of surgeons surveyed in our systematic review have reported burnout,” says Francesca Maria Dimou, MD, MS, senior surgical resident, fourth year of residency, at the University of South Florida in Tampa.

Burnout in the study was described commonly as exhibiting symptoms of emotional exhaustion, depersonalization (detaching from work and things that the person might care about), and a belief that one cannot achieve personal goals. Physicians suffering from burnout might believe that what they’re doing is not worthwhile, Dimou says.

“What we commonly found in these studies and surveys is that a lot of surgeons had high rates of emotional exhaustion and depersonalization, but they still felt good about their jobs,” she notes. “Medicine is a long road that requires a lot of training, so we love it, and we can’t think of doing anything else, but surgeons reporting burnout are feeling strain and burdened.”

Surgery centers must address this issue because of its potential effect on patient safety and patient care. Burnout is associated with medical errors, Dimou says.

“One study showed that physicians with burnout are more likely to think they did a medical error,” she says. “When you’re working in a high-stress environment, the last thing we want is to jeopardize patient care.”

Some of the literature found that surgeons who reported burnout still were satisfied with their careers.

“It’s an odd inconsistency,” Dimou notes. “But the job of taking care of patients is so rewarding, and we do realize it’s such a privilege.”

Studies on surgeons and burnout mostly were conducted through surveys of members of the American College of Surgeons. A couple of studies examined residents and whether changing their workflow helped them, but that area of research remains controversial, Dimou says.

“Most of the studies used the most consistent survey, the Maslach Burnout Inventory (MBI), which is the most reliable and has been validated and used in physicians and students,” Dimou says.

The MBI addresses three scales: emotional exhaustion or emotional overextension because of work; depersonalization, which is lacking in feeling or an impersonal response toward recipients of service, care treatment, or instruction; and personal accomplishment, which measures feelings of success and competence in work.

Symptoms of burnout might display as disruptive behavior at the surgery center. Changes in tone and behavior can be subtle, such as withdrawing from others. Substance abuse can play a role in burnout and is a possible correlating factor, Dimou says.

“Educate your staff on identifying signs of burnout and whether something is wrong with a colleague,” she suggests. “Learn how to recognize it and talk about it.”

One of the chief barriers to healthcare organizations successfully addressing physician burnout is that healthcare executives mistakenly believe that individual physicians are responsible for their own burnout and professional satisfaction.4

“This was the historical mindset,” says Tait D. Shanafelt, MD, a hematologist at Mayo Clinic in Rochester, MN, and a researcher at the Mayo Clinic Program on Physician Well-Being.

Shanafelt and colleagues conducted a survey in 2009 of 24,922 surgeons — members of the American College of Surgeons. About 32% responded, and half of the respondents were age 50 or older. Half were in private practice, and based on MBI, 40% met criteria for burnout, and 30% screened positive for depression.1,5

Dimou’s research found that the prevalence of burnout among surgeons has increased. According to the recent Medscape Physician Lifestyle report, there were documented burnout rates among various specialties, ranging from 37-53%, with general surgeons at 50%.1,3

Physician burnout affects patient safety and quality of care, as well as physician turnover. These facts would suggest that it is a problem that should be addressed within a system and not left to individuals.4 (See article “Here’s How Mayo Addresses Burnout Issue” in this issue.)

“It has taken some time for the evidence regarding the impact on quality of care and the organizational factors that influence it to be appreciated,” Shanafelt says. “Many organizations mistakenly interpreted variation among their people — some burned out, some not — to imply individual factors were the main source of variation, which may have created a blind spot to the organization/system factors that drive the problem.”

When data show across-the-board increases in physician burnout, surgery centers and others must pay attention. “This is not a problem of resilience in individual doctors, but a system problem,” says Bryan Bohman, MD, interim director of the Well MD Center at Stanford University in Palo Alto, CA. (For more information, see story about Stanford’s efforts to combat burnout in this issue.)

“What we’re trying to battle against is the approach to doing wellness is for the individual to do more meditation, sleep well, eat well,” Bohman says.

That approach lets a healthcare facility off the hook if surgery centers and other healthcare facilities are not doing what they can to provide a practice environment that makes it possible for doctors to provide great patient care without it taking a Herculean effort, Bohman adds.

“That’s where we’re at now. Medicine is so complex, and the electronic medical record is so complex to use, and documentation is so intense that in order to provide good care to your patients, you have to provide a superhuman effort,” he says. “We have great people in medicine, doctors and nurses who provide outstanding care, but we’re running up against the limits of human capability.”

So surgery centers should not think mindfulness classes are the only answer to preventing burnout.

“People are burning themselves out, trying to give good care in a system that doesn’t support them adequately,” Bohman says.

Younger surgeons often experience burnout due to loan debt and other outside stressors. Paperwork and administrative duties and finding time to take care of those things also can contribute to stress and burnout, Dimou says.

“If surgeons are in an academic setting, they want time to do research,” she adds. “So time is a stressor.”

Time stress is worsening from physicians’ perspective, she notes.

“I don’t think it is acceptable,” Dimou says. “It’s going to be an increasing problem, and what will end up happening is we’ll lose physicians.”

There are considerably more studies about the problem of physician burnout than there are studies showing solutions, she notes.

“Studies are reporting that there is a problem, but the next step is for us, as physicians and surgeons, is to come together to determine how we’ll fix this and how we can make things better,” Dimou says.

Medical schools and residency programs can begin the process of preventing physician burnout by instilling in surgeons and physicians that everyone must work together to take care of each other, Dimou says.

“That’s what we went into medicine to do is to help people, and that’s what I did in my career,” she says. “So I think it’s important to instill this in future surgeons.”

REFERENCES

  1. Dimou FM, Eckelbarger D, Riall TS. Surgeon burnout: A systematic review. J Am Coll Surg 2016;222:1230-1239.
  2. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc 2015;90:1600-1613.
  3. Peckham C. Medscape Physician Lifestyle Report 2015. Available at: http://wb.md/1yNvvj7.
  4. Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc 2016 Nov 18. Epub ahead of print.
  5. Shanafelt TX, Balch CM, Bechamps GJ, et al. Burnout and career satisfaction among American surgeons. Ann Surg 2009;250:463-471.