Overworking is a trend that exists in almost all professions in a society as fast-paced as ours, but it is especially stressful for surgeons who must learn to juggle their work life and their personal life while risking losing both.
Recently, a group of researchers in the Department of Surgery at Hopkins Hospital studied the relationships between working hours and nights on call per week with various parameters of distress among practicing surgeons.
Previous studies done by the American College of Surgeon’s Committee on Physician Health and Competency in 2008 have shown 40 percent of participating American surgeons as meeting the criteria for burnout, 30 percent screening positive for depression, and 28 percent having a statistically lower mental quality of life. They found that the more nights a surgeon was on call, the more “burnout” they experienced and the lower they rated their career satisfaction. Similar studies also showed findings consistent with these studies in surgical and medicine residents working over 80 hours/week.
Other literature in this field revealed relationships between decreased physical wellness, especially depression and burnout, with decreased productivity, medical errors, early retirement, addictive behavior and suicidal behaviors.
“Increasing hours and nights on call results in surgeon distress using every variable we have,” Charles M. Balch, lead author of the study and a professor of surgery at the Hopkins School of Medicine, was quoted as saying in a press release concerning this major study.
A survey that included 61 questions about a wide range of variables, including demographic information, practice characteristics and career satisfaction to evaluate burnouts and quality of life among American surgeons was conducted in 2008. The surveys were distributed to a total of 24,922 American College of Surgeons members, of which 7,905, or 32 percent, returned the surveys.
Out of all the surgeons studied, general surgeons worked the most — more than 80 hours a week. Surgeons working between 60 to 80 hours a week seemed to experience the greatest number of personal life disruptions, including divorces, conflicts between work and personal life in the last 3 weeks and resolving work and personal conflict in favor of work.
Overall, surgeons with increased hours and increased nights on call saw negative consequences professionally as well as personally. These consequences included increased burnout rate, decreased quality of life, decreased career satisfaction and increased work and home conflict.
Despite the high level of intensity required from surgeons, looking after the well-being of both the personal and professional life of individual surgeons is an important aspect to maintain a high quality of care in hospitals, to counsel them when their jobs are particularly stressful, and for planning surgical workloads among surgical groups or departments.
Furthermore, studies have shown that burnouts put the surgeon at higher risk of making a major medical errors, so it is crucial to find a way to effectively reduce burnout as a quality-improvement mechanism.
Overall, in this study, surgeons practicing trauma, cardiovascular surgery, transplantation surgery and urology worked the longest hours and reported the most nights on call. Through other studies, it is known that these surgical subspecialties are the ones that have higher overall risk for burnout.
Additionally, burnout is the single greatest predictor of surgeons’ satisfaction with career and specialty choice. For example, although American surgeons are personally satisfied with a career in surgery overall, only half would recommend their children pursue a career as a physician or surgeon and only one third believe their career left enough time for personal and family life.
On the other hand, two thirds of surgeons surveyed were not in favor of having limits put on their hours. Specifically, more surgeons who received salaries supported restrictions, while surgeons who were paid entirely on billing were less likely to support restrictions. Therefore, efforts to address individual concerns was seen as a very important component to an overall solution.
Maintaining career satisfaction is a decisive factor in maintaining the high quality of medical care we currently boast of in the United States. Career satisfaction is important, not only for maximizing productivity, but for enhancing personal quality of life and avoiding early retirement. A shortage of physicians and surgeons has been predicted for future generations, and taking initiatives to address the work hour schedules of surgeons to provide them with a more balanced work and personal life is needed.
“Part of it is just trying to get this issue of personal wellness on people’s radar screens. Burnouts have no single simple cause and therefore there’s not going to be a simple solution,” Balch was quoted as saying in the press release.
