Several personal, professional factors may contribute to burnout among orthopedic surgeons
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Key takeaways:
- Although common among orthopedic surgeons, the rate of burnout was variable across reviews.
- Some evidence supported work-hour restrictions to prevent and manage burnout.
Several personal and professional factors, including sex, race and work hours, may contribute to a higher risk of burnout among orthopedic surgeons, according to published results.
“I think this paper gives a good foundation of creating awareness to burnout and who may be at untoward risk, so then we can take it a step further and figure out different things we can do to prevent and mitigate burnout,” Alfred Atanda Jr., MD, pediatric orthopedic surgeon and director of clinician well-being at Nemours Children’s Health in Wilmington, Delaware, told Healio.
In an umbrella review, Atanda and colleagues searched Ovid Medline, Ovid PsychINFO, EBSCO CINAHL and CENTRAL from database inception to July 16, 2022, for full-text review studies that aimed to summarize evidence of burnout in orthopedic surgery or had a clear subgroup on orthopedic surgeons. Researchers performed quality assessments using the PASS checklist and identified eight systematic reviews and eight narrative reviews for inclusion.
Although burnout was common among orthopedic surgeons, results showed reviews reported variable rates, precluding definitive conclusions. Researchers found residents to be particularly at risk for experiencing burnout, with estimates of one in two residents being affected. Atanda noted personal-related factors that contributed to burnout included identifying as a woman or as a person from a historically underrepresented group, experiencing work-life imbalances and not having spousal support.
“In terms of professional-related factors, being a trainee, ie, a resident and a junior-level resident, was a big factor of having burnout and also being in a program where they didn’t have a formal infrastructure for addressing burnout,” Atanda said.
He added long work hours, stressful work relationships and underlying mental health issues, such as anxiety, depression and substance abuse, were also professionally related factors for burnout.
While there was limited literature on interventions for preventing and managing burnout, researchers found there was some evidence supporting work-hour restrictions for residents.
“When I was coming up, we worked about 36-hour shifts. Now the residents work about 20- to 24-hour shifts, which I still think is not ideal,” Atanda said. “If you’re taking care of human beings, doing a lot of procedures, doing surgeries, running around the emergency room, you probably shouldn’t work more than 12 to 16 hours at a time. There’s a lot of discussion about that, and that has to come from the Accreditation Council for Graduate Medical Education and different cultural discussions. But hopefully, this paper can spark some of that debate to see how we can address work-duty restrictions.”
Perspective
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I want first to congratulate not only the authors of this work but also the Pediatric Orthopedic Society of North America. This is an outstanding paper that every orthopedic surgeon should read. The authors found only two papers that explicitly focused on burnout in orthopedic surgeons. For a problem that clearly begins on day one of residency and affects 50% of the orthopedic community, how are there only two studies looking at this? We must follow the leadership role POSNA has taken to make a difference. Two general orthopedic studies are not enough. We need other subspecialty-specific data as each of our groups work and personal-related factors vary greatly.
What also stood out to me is that even though we are all at high risk for burnout, residents and attendings up to 10 years out of practice seem more highly affected. What are we doing for our young surgeons? Do we have the infrastructure put in place to truly support one another? Why are we allowing anyone to be trained in an environment that does not value caring for each other as well as we care for our patients?
I know orthopedic surgeons have the capacity to raise the bar not only for patient care, but for one another. We need to do better and join the few who are calling us to action.
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