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Burnout and psychological health amongst US plastic surgeons: risk factors and adverse outcomes.
Vinay Rawlani, MD, Gregory A. Dumanian, MD, Roshni Rawlani, Thomas A. Mustoe, MD, Donald W. Buck, III, MD, John YS Kim, MD.
Northwestern University, Chicago, IL, USA.

PURPOSE:  Recent studies by the American College of Surgeons (ACS) demonstrated that 40% of US surgeons exhibit high levels of burnout and 15% suffer from depression.1 Furthermore, the ACS found a clear association between burnout career satisfaction, patient care, and medical errors.2 There is no study which specifically evaluates burnout and psychological health in plastic surgeons. Therefore, the purpose of this study was to evaluate this in detail, with specific focus on identifying risk factors and adverse events related to surgeon burnout and depression.
METHODS: We distributed an online survey to all ASPS members residing in the US. The survey contained validated measures of burnout (Maslach Burnout Inventory), depression (PRIME-MD), quality of life (SF-8 Health Survey), and substance abuse (AUDIT). Additionally, the survey evaluated surgeon demographics, practice characteristics (practice type, subspecialty, academic rank, years in practice, hours worked, salary, reimbursement structure, time devoted to non-clinical academic activities), career satisfaction, and self-perceived medical errors. Survey data was collected over the course of 1 year.
RESULTS: 1754 actively practicing US plastic surgeons completed the survey. The incidence of high burnout was 26.7% (moderate 22.5%; mild 16.5%) and the incidence of depression was 14.7%. Risk factors for high burnout included subspecialty, academic practice, hours worked and calls per week and annual salary less than \,000 or greater than \,000.  Additionally, gender, junior academic rank and lack of protected time for research and teaching were associated with higher burnout.  Interestingly, the only risk factor associated with depression was hours worked per week. Surgeons who were burned out were more likely to report having made a major medical error in the past 6 months (23.2% vs. 13.3%, p <0.01) and have lower career satisfaction (p <0.01). However, neither medical errors or career satisfaction were associated with depression.
CONCLUSIONS: This survey demonstrates that a large number of our colleagues may suffer from burnout and/or depression. While burnout and depression are likely inter-related, it appears that burnout is more influenced by work-related risk factors and has greater adverse effects on patient care.
1 Shanafelt TD et al. Burnout and career satisfaction among American surgeons. Ann Surg. 2009 Sep;250(3):463-71.
2 Shanafelt TD et al. Burnout and medical errors among American surgeons. Ann Surg. 2010 Jun;251(6):995-1000.  


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