A Scoping Review of Burnout in Neurosurgery

Abstract

BACKGROUND Burnout is a negative workplace syndrome of emotional exhaustion, cynicism, and perceived professional inefficacy that risks the patient-provider relationship, patient care, and physician well-being. OBJECTIVE To assimilate the neurosurgical burnout literature in order to classify burnout among domestic and international neurosurgeons and trainees, identify contributory factors, and appraise the impact of wellness programs. METHODS A scoping review identified the available literature, which was reviewed for key factors related to burnout among neurosurgeons. Two researchers queried PubMed, Embase, Google Scholar, Cochrane, and Web of Science for articles on burnout in neurosurgery and reduced 1610 results to 32 articles. RESULTS A total of 32 studies examined burnout in neurosurgery. A total of 26 studies examined prevalence and 8 studies detailed impact of wellness programs. All were published after 2011. Burnout prevalence was measured mostly through the Maslach Burnout Inventory (n = 21). In 4 studies, participants defined their own understanding of “burnout.” Domestically, burnout prevalence was 11.2% to 67% among residents and 15% to 57% among attendings. Among trainees, poor operative experience, poor faculty relationships, and social stressors were burnout risks but not age, sex, or marital status. Among attendings, the literature identified financial or legal concerns, lack of intellectual stimulation, and poor work-life balance as risks. The impact of wellness programs on trainees is unclear but group exercises may offer the most benefit. CONCLUSION Noticeable methodological differences in studies on trainee and attending burnout contribute to a wide range of neurosurgery burnout estimates and yield significant knowledge gaps. Environment may have greater impact on trainee burnout than demographics. Wellness programs should emphasize solidarity.

Resident Burnout and Well‐being in Otolaryngology and Other Surgical Specialties: Strategies for Change

“…Hours worked 49,80,83 High workload (United States and Canada) 37,49 Frequency of being on-call 49 PGY-2 10,52 Inadequate operating time 10,[36][37][38] Lack of independence 37 Workplace violence/bullying 51,80,83 Stressful work relationships 83 Feeling underappreciated 37 Coresident attrition 37 Unstable work routine 37,52 Lack of work-life balance 36,52 Lack of sleep 80,83 Lack of leisure time 37,83 Insufficient exercise 83 Divorced 80 Stressful social relationships 10,38,84,85 Mentorship 10,36,38 Operative caseload 49 End of rotation/year 52 Wellness education, exercise program 68 Program-led social events, outdoor activities 52 Meaningful relationships with colleagues 52 Adequate sleep 52 Marriage and/or children 84 Grit 84 Strong sense of purpose 52 Urology Hours worked 39,<...…”

The Impacts of Work-Life Balance on the Emotional Exhaustion and Well-Being of College Teachers in China

“…EE is a stress response caused by excessive mental exertion and extreme fatigue under pressure [ 61 ]. Studies have demonstrated that WLB helps alleviate EE [ 62 , 63 , 64 ], and one of the consequences of work-life imbalance is EE [ 65 ]. For example, those who experienced more difficulties in WLB reported higher EE [ 66 , 67 ].…”

“…This finding suggests that EE may play a certain role between the other two variables. Studies have demonstrated that WLB is positively correlated with WB [ 57 , 58 ] and negatively correlated with EE [ 63 , 67 ], which is a negative factor related to WB [ 71 , 74 ]. It follows that EE may mediate the relationship between WLB and WB.…”

Moral Distress and Moral Injury Among Attending Neurosurgeons: A National Survey

“…Neurosurgeons currently considering leaving their position because of moral distress were 26.6%, a subgroup suffering "moral injury." "Morally injured" neurosurgeons had higher scores (33, Q1-Q3 16-56) than neurosurgeons who had left positions of moral distress (18, Q1-Q3 [14][15][16][17][18][19][20][21][22] or denied moral distress (16.5, Q1-Q3 7-28) (P < .001). Two important thresholds for moral injury were identified on the moral distress survey.…”