Professional Burnout in United States Plastic Surgery Residents: Is It a Legitimate Concern?

Abstract

Background Physician burnout is intimately associated with institutional losses, substance abuse, depression, suicidal ideation, medical errors, and lower patient satisfaction scores. Objectives By directly sampling all US plastic and reconstructive surgery residents, this study examined burnout, medical errors, and program-related factors. Methods Cross-sectional study of data collected from current US plastic and reconstructive surgery residents at Accreditation Council for Graduate Medical Education–accredited programs during the 2018 to 2019 academic year. Previously validated survey instruments included the Stanford Professional Fulfillment and Maslach Burnout Indices. Additional data included demographics, relationship status, program-specific factors, and admission of medical errors. Results A total of 146 subjects responded. Residents from each postgraduate year (PGY) in the first 6 years were well represented. Overall burnout rate was 57.5%, and on average, all residents experienced work exhaustion and interpersonal disengagement. No relation was found between burnout and age, gender, race, relationship status, or PGY. Burnout was significantly associated with respondents who feel they matched into the wrong program, would not recommend their program to students, do not feel involved in program decisions, reported increasing hours worked in the week prior, feel that they take too much call, reported making a major medical error that could have harmed a patient, or reported making a lab error. Conclusions This study directly examined burnout, self-reported medical errors, and program suitability in US plastic and reconstructive residents based on validated scales and suggests that burnout and some medical errors may be related to program-specific, modifiable factors, not limited to, but including, involvement in program-related decisions and call structure.

Burnout in Surgical Trainees: a Narrative Review of Trends, Contributors, Consequences and Possible Interventions

“…Studies have linked higher burnout in surgeons with their overall attitude towards their training programme, reflected in poorer ratings on programme satisfaction [ 37 ] and their likelihood of recommending their programme to others [ 38 ]. Links have also been made with specific aspects of training programmes.…”

“…Links have also been made with specific aspects of training programmes. A recent study in US plastic surgery residents found that higher burnout was not linked with age, gender, race or relationship status but was linked with feeling less involved in programme-related decisions [ 38 ]. Similarly, a survey of US general surgery residents found no links between burnout and gender or relationship status, but did report that burnout was higher in residents reporting fewer programmatic social events and lower in residents receiving programme mentorship [ 30 ].…”

“…Higher burnout has been linked with greater number of working hours overall [ 38 , 40 , 42 , 43 ] and working more weekends per month [ 30 ]. One study in 665 US general surgery residents found that 69% of respondents were burnt out, and those reporting high burnout worked on average 3 h more per week than those reporting low burnout [ 40 ].…”

“…While some studies have reported that burnout overall [ 41 , 43 ] or the emotional exhaustion facet in particular is higher in women [ 40 , 49 ], this finding has not always replicated. Several studies have reported no association between gender and either emotional exhaustion [ 53 ] or overall burnout [ 27 , 30 , 38 ] and other studies have highlighted that burnout overall [ 45 ] or the depersonalisation facet is in fact higher in men [ 40 , 53 ]. As undergraduate medical degrees are increasingly taking higher proportions of female students [ 54 ] but surgical training remains a less popular choice among this group [ 4 ], understanding links between gender and burnout and making improvements based on this will be important for the sustainability of surgical disciplines in the future.…”

“…A range of studies have investigated family factors but findings have been mixed. While being single has been identified as a risk factor for burnout in attending and consultant surgeons [ 35 ] and this has occasionally replicated in studies of surgical trainees [ 27 , 50 ], several studies have reported no association between relationship status and burnout in trainee groups [ 38 , 40 , 44 , 60 ]. Furthermore, having children was found to be associated with lower levels of burnout in a study of surgical residents in Pakistan [ 45 ] but this has not always replicated [ 40 , 44 ].…”