Burnout among Orthopedic Residents

Introduction: Burnout can be defined as the combination of signs and symptoms concerning a particular professional activity involving mental, physical, and emotional exhaustion with a lack of self-worth or personal accomplishment, along with dissociated personality disorder [1]. Freudenberger described burnout as a collection of psychological signs and symptoms due to prolonged, continuous response to work-induced interpersonal stress [2,3]. Burnout has been found to be responsible for clinical errors by healthcare practitioners, thereby resulting in adverse patient outcomes and patient dissatisfaction [1,4]. Burnout rates among surgeons seem to be high, as shown by a study conducted by the American College of Surgeons, according to which 40% of surgeons experience burnout due to sleep-deprived overwork, followed by 28–30% of surgeons struggling with depression, leading to poor mental and emotional quality of life [1,4]. This stress due to burnout and sleep-deprived overwork has become a serious health hazard to healthcare professionals [3]. This has also resulted in increased stress on economic resources due to the increased cost of employing another surgeon at twice the average salary [5]. Rate of Burnout among Orthopedic Surgeons A recent study performed in the UK has shown some of the highest incidences of burnout among orthopedic surgeons, with around 22% of the orthopedic surgeons experiencing burnout [6,7]. Thompson et al. showed an overall rate of 22% burnout rates, especially among those who were employed in hospitals [7,8]. In a multinational cohort survey study, Mir et al. estimated the relative risk rate of burnout among surgeons as 0.93% in the United States, followed by 1.23% in Canada, 1.22% in New Zealand, and 1.04% in the UK [9]. Risk Factors These can be personal, residential, and professional risk factors [7]. Evidence shows the incidence of reduced burnout after surgeons were exposed to physical activities and health optimization efforts [6-8,10-12]. However, according to a study by Thompson et al., only 31% of the surgeons were meeting the standards recommended by the Centres for Disease Control and Prevention physical exercise guidelines and were less likely to experience burnout [7,8]. Alcohol abuse and substance abuse were found to increase the risk of burnout with increased risks of depersonalization burnout disorders [7,12-14]. Emotional exhaustion was also found to have a profound risk factor effect on burnout resulting from career choice regrets thereby leading to burnouts, whereas the presence of active hobbies with regular engagements with a mental health support team has been found to reduce the rates of emotional exhaustion and in turn burnouts [7,8,10,13,15-17]. It has also been shown in recent studies that burnout rates are found to be less likely to occur in surgeons with solid family unit support [6-8,11,13,18-20]. Sargent et al. published a study involving 648 patients that showed a direct correlation between a lower incidence of burnout and the presence of supportive parents and family [7,13]. Spending quality time with partners in a relationship is highly fruitful in reducing burnout rates due to a better family support system in place [7,13,15,18,20-22]. Long stressful, unregulated working hours with over-stretched on-call hours result in these residential and family support systems crumbling, thereby increasing the risk of burnout among surgeons and other healthcare professionals [6,7,11,12,16,18,21-26]. However, workplace circumstances surrounding an individual, such as disorganized and improper feedback and mentorship, have also been found to play a major role as one of the risk factors for professional burnout, although it could be very subjective [6,7,11,13,15,21,27]. On the contrary, low incidences of burnout were observed among surgeons who received training with high-quality feedback and an organized mentorship [7,13]. However, recent evidence also supports the fact that burnout rates are more commonly observed among junior trainee surgeons working in the public sector in comparison to the senior surgeons and those working in a mixed private and public healthcare sector [7,10,16-18,20,23,25,28]. Overall, surgical specialties continue to have a higher incidence of burnout, with orthopedic surgery having 58.8% burnout rate, second only to general surgery, which had a burnout rate of 66.7% with urology in third place with an incidence of 40.0% [7]. Consequences of Burnout Burnout does have many adverse effects on patients, healthcare professionals, and hospitals, most common of which are compromised patient and team safety, depression, and increased possibility of medical errors [3,4,29]. Compromised patient care and patient and team safety have not only been reported among surgeons but also among other healthcare professionals across specialties [1,30-32]. However, evidence suggests that burnout not only affects the surgeon’s professional life but also has a profound impact on his personal life and other aspects of his family life [1]. This possibly resulted in surgeons carrying the stress of work back home, leading to a domino effect in the family, so much so that similar incidences of psychological stress were observed among the family members of resident surgeons as well [1,13]. There is also evidence of a breakdown in personal lifestyle among surgeons as a direct and consequential result of work burnout [1,33]. Recent evidence also suggests that surgical specialists and surgeons, especially, have experienced widespread burnout rates and career dissatisfaction [1,34]. This increasing rate of burnout may result in instances of worsening team and patient safety with reduced patient satisfaction and outcomes due to unprofessional behaviors of surgeons [7,30,32,35]. Recent evidence suggests the increasing susceptibility of surgeons to losing their temper during surgeries, thereby leading to conflict situations among co-workers, compromising the overall team safety and output of the healthcare system as a whole [7,22,36]. In severe cases, studies have shown instances of suicidal ideation among surgeons as a result of burnout [7,18,37,38]. Conclusion: Burnouts are common among surgeons, and orthopedic surgeons have high rates of burnouts, second only to general surgeons. Trainee surgeons, especially those who are on the junior rota, seem to be more affected. However, burnout among trainees also seems to have a direct correlation to the mentoring and feedback one gets from their seniors. In some cases, burnout has been found to affect families as well. In the worst-case scenario, surgeons have also been susceptible to violent behavior and have had suicidal ideation. However, the presence of hobbies, a strong family, and partner support has been found to play an important role in alleviating stress levels and the effects of burnout. Although the literature suggests heterogeneity in the findings and inference, we recommend the need for further research in this regard so that it could reduce workplace burnout and, in turn, result in better outcomes and improved team and patient safety, resulting in better patient outcomes and satisfaction. Clinical message: The article highlights the crucial need for well-organized mentorship and support systems to mitigate burnout among orthopedic surgeons. Engaging in physical activities and having mental health support play a vital role in reducing burnout risks and improving the overall well-being of surgeons. A strong family support system is essential in minimizing the risk of burnout, highlighting the interconnectedness of personal and professional life for surgeons.

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