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Professional Burnout Among Plastic Surgeons: Who’s At Risk?
Rachel E. Streu, MS, MD, Paul Abrahamse, MA, Amy Alderman, MPH, MD.
Oregon Health Sciences University, Portland, OR, USA.
Purpose: Professional burnout is associated with career dissatisfaction, sub-optimal patient care and early physician retirement. This is especially problematic with the expected future shortages in the surgical workforce. Little is known about burnout among plastic surgeons. Our purpose is to describe the prevalence of professional burnout among a large national sample of plastic surgeons and identify contributing factors.
Methods: A mailed, self-administered survey was sent to 708 plastic surgeons that were randomly sampled from the American Society of Plastic Surgeons national membership (71% response rate). The dependent variable was professional burnout, measured by three subscales from the validated Maslach Burnout Inventory-Human Services Survey (MBI-HSS): emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA). “High” scores in either the emotional exhaustion (EE) or depersonalization (DP) subscale categories or “low” scores in personal accomplishment (PA) predict professional burnout. The independent variables included surgeon socio-demographic (age, gender, marital status, number of children, and physician health ) and professional characteristics (work hours, practice type, practice size, operative distribution and involvement in resident education). Chi-square was used for the bivariate analyses.
Results: Nearly one-third (29%) of surgeons scored high in EE, 16% scored high in DP, and 5% scored low in PA, thus meeting the criteria predictive of professional burnout. Factors associated with high EE included age (highest EE among those 40-50 yrs, p = 0.03); physician health (highest EE among those with fair/poor health, p < 0.01); ER call (vs. no ER call) (p < 0.01); >60 work hrs/week (vs. < 60 hrs) (p = 0.03); primarily reconstructive practice (vs. cosmetic) (p < 0.01); private practice (vs. academic) (p = 0.01); and group practice (vs. solo) (p = 0.02). Factors associated with high DP included physician health (highest DP among those with fair/poor health, p= 0.01); ER call (vs. no ER call) (p < 0.01); private practice (vs. academic) (p = 0.01); and group practice (vs. solo) (p = 0.02). Factors associated with low PA included physician health (lowest PA among those with fair/poor health, p < 0.01); ER call (vs. no ER call) (p = 0.04); and a primarily reconstructive practice (vs. cosmetic) (p < 0.01).
Conclusions: Our results suggest that nearly one-third of plastic surgeons have signs of professional burnout. Those most at risk are mid-career surgeons (between 40-50 years of age) and those with poor health. Several practice-level factors also appear associated with professional burnout, such as having a mostly reconstructive, non-cosmetic practice, long work hours, ER call responsibility, non-academic settings and group practices. The impending surgical workforce shortages and efforts aimed at improving healthcare quality must focus on ways to mitigate burnout among surgeons.
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