Burnout: A quality-of-life issue that can particularly affect orthopedic surgeons

Orthopedic surgeons with stress and demands that exceed their emotional reserves may suffer burnout.

Have you ever wondered if you were starting to get burnout or do you have a partner or friend you thought might be burnt out? It is more common problem among orthopedic surgeons then most of us recognize.

For this month’s Four Question interview I turned to Wayne M. Sotile, PhD, and M. Catherine Sargent, MD, to share their insights into this problem and some ideas that might help us all.

Douglas W. Jackson, MD
Chief Medical Editor

Douglas W. Jackson, MD: What is “burnout” and how might it impact orthopedic surgeons during their careers?

M. Catherine Sargent

Wayne M. Sotile

Wayne M. Sotile, PhD; and M. Catherine Sargent, MD: Burnout, as defined by Maslach and Jackson in the Maslach Burnout Inventory Manual, is a syndrome of emotional exhaustion, depersonalization and reduced sense of personal accomplishment occurring among individuals who work in human services. It manifests as a drained, depleted feeling and/or a tendency to view one’s patients, colleagues and co-workers in a detached, cynical manner. Affected individuals may come to resent the routine demands that come with one’s primary work roles.

Burned-out physicians can also suffer personal and professional consequences. Elevated burnout scores have been associated with physical and emotional illness, including increased risk of cardiovascular disease, male infertility, type 2 diabetes mellitus, and elevated rates of substance abuse, according to publications by Melamed and Campbell.

Barden and Shanafelt and their colleagues wrote that among medical professionals, high levels of burnout have been correlated with poor performance, decreased quality of medical care, and, among resident physicians, increased risk of patient care errors.

Jackson: Is burnout a frequent problem or are only certain individuals at risk?

Sotile and Sargent: Any orthopedic surgeon who encounters stresses and demands that exceed his or her emotional reserves may suffer burnout. Depersonalization, in particular, appears to be more prevalent among practicing orthopedists than in other surgical disciplines as reported by Campbell and colleagues.

Perhaps the tendency to describe our patients according to their skeletal pathology, eg, the infected knee, the frozen shoulder, etc. promotes detachment.

Overall, 58% of our orthopedic resident subjects and 28% of the orthopedic faculty group showed elevated levels of burnout. Some subsets showed significantly higher rates of burnout than others.

As a group, residents showed higher levels of burnout than faculty. Individually, PGY-2s and female residents appear to be at greater risk of burnout than their peers.

Trainees in larger programs, those training more than six residents per class, also appear to be at greater risk. Younger faculty — those in practice less than 10 years — showed greater burnout than more-experienced faculty.

Jackson: Is there a science and/or a methodology for assessing one’s quality of life?

Sotile and Sargent: Quality of life and subjective well-being have long been targets of study in the social sciences. Ferrins and Powers wrote that while standardized measures of these constructs do exist, there is no universally recognized measurement tool. Assessment of quality of life generally targets variables such as life satisfaction and marital satisfaction, lack of negative emotions and moods, and presences of positive moods and emotions, according to Pavot.

In addition to our own novel question sets, our survey included the Maslach Burnout Inventory (MBI), the General Psychological Health Questionnaire – 12 (GHQ-12), and the Revised Dyadic Adjustment Scale (RDAS). These three instruments have been validated as measuring burnout, psychological distress, and marital discord, respectively.

Jackson: What suggestions can you make to our readers on improving their quality of life and avoiding burnout?

Sotile and Sargent: There appear to be steps that the individual can take to lower his or her risk of burnout. General strategies include remaining cognizant of the higher meaning of one’s work and striving to routinely counter daily hassles with daily uplifts. Making time for hobbies, exercise, and quality time with one’s significant other correlated with lower levels of burnout, psychological dysfunction, and marital distress for our respondents.

Peer support is also important. Maintaining high levels of collegiality and collaboration in the medical workplace is crucial. Contact with a mentor and support from colleagues and their families correlated with decreased distress for both faculty and resident groups. For faculty, participation in national specialty organizations decreased burnout primarily by boosting personal accomplishment levels.

Sleep deprivation was common among the residents in our study and correlated positively with every distress measure as did regular alcohol use.

Given the correlations between burnout and decreased quality of patient care, seeking, encouraging and promoting better self-care may reduce burnout and prove healthier for ourselves and our patients.

For more information:

• M. Catherine Sargent, MD, can be reached at 601 N. Caroline St., Suite 5260, Baltimore, MD 21287; 410-955-4005; e-mail: msargen1@jhmi.edu.
• Wayne M. Sotile, PhD, can be reached at 1396 Old Mill Circle, Winston-Salem, NC 27103; 336-794-0230; e-mail: wsotile@attglobal.net.

References:

• Barden CB, et al. Effects of limited work hours on surgical training. J Am Coll Surg. 2002;195(4):531-538.
• Campbell DA Jr, et al. Burnout among American surgeons. Surgery, 2001;130(4):696-702; discussion 702-705.
• Ferrans CE, Powers MJ. Quality of life index: development and psychometric properties. Adv Nurs Sci. 1985;8(1):15-24.
• Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. 3rd Edition. Palo Alto, CA: Consulting Psychologists Press; 1996.
• Melamed S, et al. Burnout and risk of cardiovascular disease: evidence, possible causal paths, and promising research directions. Psychol Bull. 2006;132(3):327-353.
• Pavot W, Diener E. Review of the satisfaction with life scale. Psychological Assessment. 1993;5(2):164-172.
• Shanafelt TD, et al. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med, 2002;136(5):358-367.
• To access Sargent and Sotile’s survey, go to: http://www.ejbjs.org/cgi/content/full/91/10/2395/DC1