Burnout is an occupational phenomenon and a syndrome resulting from unsuccessfully managed chronic workplace stress. The characteristic features of burnout include feelings of exhaustion, cynicism, and reduced professional efficacy.1 A career in surgery is associated with demanding and unpredictable work hours in a high-stress environment.2-8 Research indicates that surgeons are at an elevated risk for developing burnout and mental health problems that can compromise patient care. A survey of the fellows of the American College of Surgeons found that 40% of surgeons experience burnout, 30% experience symptoms of depression, and 28% have a mental quality of life (QOL) score greater than one-half an SD below the population norm.9,10 Surgeon burnout was also found to compromise the delivery of medical care.9,10
To prevent serious harm to surgeons and patients, it is critical to understand the causative factors of burnout among surgeons and how they can be addressed. We conducted this systematic review to identify factors linked to burnout across surgical specialties and to suggest ways to mitigate these risk factors.
To identify studies of burnout among surgeons, we conducted an electronic search of Ovid MEDLINE, Ovid PsycInfo, SCOPUS, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials. The headings and keywords used are listed in Supplemental Table 1. Studies met the inclusion criteria if they evaluated residents or attendings, used a tool to measure burnout, and examined any surgical specialty. Studies were excluded if they were published before 2010; were conducted outside the United States; were review articles, commentaries, or abstracts without full text articles; evaluated medical school students; were published in a language other than English; did not use a tool to measure burnout; or examined a nonsurgical specialty. Our analysis was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)11 and is outlined in the Supplemental Figure.
Surgical specialties and burnout
We identified 56 studies2-10,12-58 that focused on specific surgical specialties in relation to burnout. Supplemental Table 22-10,12-58 lists these studies and the surgical specialties they evaluated.
Work/life balance factors
Fifteen studies2-5,14,15,18,19,22,32,34,38,39,47,57 examined the role of work/life balance in burnout. Table 12-5,14,15,18,19,22,32,34,38,39,47,57 lists the work/life factors these studies identified as being linked to burnout. Six studies2,4,18,22,32,47 discussed how decreased leisure time was linked to burnout. Eleven studies2,4,14,15,19,22,34,38,39,42,57 associated inabilities to meet family commitments with burnout. A lack of time to spend with family and not having adequate time to raise children was more prevalent among women. Seven studies2,3,18,22,32,34,47 implicated increased time commitment to work as playing a role in burnout. This increased time commitment was also found to be a compounding variable for other factors, such as limited time for family and leisure.
Fifteen studies2,7,14,20,21,30,34,41,42,44-46,50,52,56 examined work hours and burnout. Of these, 142,7,14,20,21,30,34,42,44-46,50,52,56 found a correlation between increased work hours and burnout, while only 1 study41 found no correlation between these factors.
Six studies2,14,18,43,49,52 discussed the role of burnout in medical errors. Of these, 52,14,43,49,52 reported a correlation between burnout and medical errors, while 1 study18 found no link between burnout and medical errors. The medical errors were self-reported.14,49 They included actions that resulted in patient harm, sample collection error, and errors in medication orders and laboratory test orders.2
Continue to: Institutional and organizational factors