Clinical experience suggests that curbing physician burnout requires a combination of workplace redesigns, positive leadership behaviors, and resilience training that teaches practical applications from the fields of resilience, emotional intelligence, positive psychology, and relationship systems 1).
Neurosurgery is a challenging and stressful field. Excessive stress and professional dissatisfaction can lead to medical errors, negatively impact patient care, and cause physician burnout.
In the context of long hours and alternating shift and sleep cycles, the lack of exercise and poor dietary choices may have negative short- and long-term consequences on physician physical and mental health. Historically, “resident” physicians lived in the hospital and were entirely devoted to caring for their patients; thus, personal health was abandoned in the pursuit of a medical education. We now teach residents in the context of enforced duty-hour restrictions. However, it is commonplace for physicians (residents and faculty) to be “too busy” to frequent the doctor for routine visits such as health screenings that they themselves would outline for their own patients. Chronic diseases with courses that can be either modified or entirely prevented can thus go unnoticed for many years, causing irreparable damage; for example, undiagnosed hypertension or hypercholesterolemia leading to cardiovascular disease or stroke. In addition, there are increasing data suggesting that psychological distress and burnout are common among physicians and other health care providers. Approximately 45% to 70% of residents report burnout during training 3) 4) 5) 6) 7) 8) but these issues do not end with completion of residency. Nearly 50% of US physicians report symptoms of burnout 9) With an expanding understanding of the health consequences of medicine on the provider, there has been an increasing focus on improving physician well-being 10) 11) 12)
Thirty-one out of 79 (response rate 39 %) Lithuanian neurosurgeons participated in the study. Professional burnout was evaluated using the Maslach Burnout Inventory - General Survey. Participants also answered questions about professional stressors, sources of professional dissatisfaction, life-style factors, sickness absenteeism/presenteeism, and professional practice.
The majority of neurosurgeons were between 41 and 60 years of age (48 %), were married (97 %), had children (84 %). Most neurosurgeons had 20 or more years of professional experience (54.9 %), worked from 41 to 60 h per week (58 %), and performed up to 150 surgeries per year (77.4 %). Eight (26 %) neurosurgeons reported a high level of emotional exhaustion, five (16 %) reported high level of cynicism, and eight (26 %) reported low professional efficacy. Correlation analyses revealed that higher number of surgeries per year, more hours devoted to clinical work, opportunities for professional development, intellectual challenges at work, appreciation by the patients and prestige of the profession were related to lower level of burnout. Greater general workload, unpredictability of the work schedule, lack of necessary technical equipment, dissatisfaction with colleagues, and uncertainty about the future were related to a higher level of burnout.
Burnout was reported by one-quarter of neurosurgeons who chose to participate in the study. Personal, interpersonal, and organizational factors arising while fulfilling professional duties were important correlates of neurosurgeons' burnout.
Due to the moderate response rate, the results should be interpreted with caution. Larger studies evaluating burnout among European neurosurgeons are needed 13).
All US members (3247) of the American Association of Neurological Surgeons (AANS) were invited to participate in a survey between September and December 2012. Responses were evaluated through univariate analysis. Factors independently associated with burnout and career satisfaction were determined using multivariable logistic regression. Subgroup analysis of academic and nonacademic neurosurgeons was performed as well.
The survey response rate was 24% (783 members). The majority of respondents were male, 40-60 years old, in a stable relationship, with children, working in a group or university practice, and trained in a subspecialty. More than 80% of respondents reported being at least somewhat satisfied with their career, and 70% would choose a career in neurosurgery again; however, only 26% of neurosurgeons believed their professional lives would improve in the future, and 52% believed it would worsen. The overall burnout rate was 56.7%. Factors independently associated with both burnout and career satisfaction included achieving a balance between work and life outside the hospital (burnout OR 0.45, satisfaction OR 10.0) and anxiety over future earnings and/or health care reform (burnout OR 1.96, satisfaction OR 0.32). While the burnout rate for nonacademic neurosurgeons (62.9%) was higher than that for academic neurosurgeons (47.7%), academicians who had practiced for over 20 years were less likely to be satisfied with their careers.
The rates of burnout and career satisfaction were both high in this survey study of US neurosurgeons. The negative effects of burnout on the lives of surgeons, patients, and their families require further study and probably necessitate the development of interventional programs at local, regional, and even national levels 14).
A 107-item questionnaire was developed and sent to 169 American neurosurgeons to evaluate career satisfaction and stressors, quality of professional life, and burnout. Participants were also asked about the survey itself. Most variables were evaluated using the Likert-type scale. Burnout was measured using the validated Maslach Burnout Inventory.
The 85 (50%) respondents were typically male, full-time, board-certified neurosurgeons. Ninety-five percent were satisfied as neurosurgeons (73% very satisfied). Most (88%) would choose neurosurgery again as a career, but only 55% would recommend it to a child. Low salary/income, low collections/billing, and uncertainty regarding future earnings/health care reform were reported as stressful factors by the majority of participants. Compared with published norms, the median scores were lower for emotional exhaustion and depersonalization and higher for personal accomplishment. The burnout rate was 27%.
Our survey was well received and, according to respondents, encompassed the major issues associated with career stress, satisfaction, and burnout but needs to be shortened. Respondents were generally satisfied with their career but identified several major stressors. A larger study to identify predictors of career satisfaction/dissatisfaction will help generate dialogue on improving the quality of professional life for neurosurgeons 15).