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Kang SH, Mirka GA. Effects of a Passive Back-Support Exosuit on Erector Spinae and Abdominal Muscle Activity During Short-Duration, Asymmetric Trunk Posture Maintenance Tasks. HUMAN FACTORS 2024; 66:1830-1843. [PMID: 37635094 DOI: 10.1177/00187208231197264] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
OBJECTIVE To examine the effects of asymmetry and lower extremity mobility restrictions on the effectiveness of a passive back-support exosuit in short-duration, static trunk flexion postures. BACKGROUND The effectiveness of trunk exoskeletons/suits for sagittally symmetric trunk posture maintenance has been investigated, but there has been limited study of the effects of asymmetric trunk postures or lower extremity motion restriction. METHOD Sixteen participants held trunk flexion postures involving trunk flexion (20°, 40°, 60°), asymmetry (0°, 30°), and lower extremity mobility (Free, Restricted) for 3 s. Participants held these postures with and without an exosuit while erector spinae and abdominal muscle activities were collected. RESULTS There were no significant interactions between exosuit and asymmetry or exosuit and lower extremity motion restrictions, indicating no significant effects of these factors on the effectiveness of the exosuit at reducing trunk muscle activity. The exosuit was found to be effective at reducing erector spinae muscle activity regardless of asymmetry of posture or lower extremity restrictions (average 21%, from 11.2% MVC to 8.8% MVC). The magnitude of the erector spinae activity at 60° of trunk flexion with the exosuit was similar to that seen at 20° without the exosuit. CONCLUSION The exosuit consistently provided biomechanical benefit through reduced activation of the erector spinae muscles and neither asymmetry of trunk posture nor lower extremity restriction influenced this effectiveness. APPLICATION Trunk exoskeletons/suits can reduce trunk muscle activation and understanding how characteristics of the trunk postures assumed impact these responses may help target tasks wherein these devices may be effective.
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Geiger JT, Lehane DJ, Nithipalan V, Kedwai BJ, Stoner MC, Ellis JL, Glocker RJ, Newhall KA, Doyle AJ. Implementation of a Vascular Acute Care Surgery Service Model is Associated with Decreased Surgeon Burnout. J Vasc Surg 2024:S0741-5214(24)01219-9. [PMID: 38796030 DOI: 10.1016/j.jvs.2024.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/17/2024] [Accepted: 05/17/2024] [Indexed: 05/28/2024]
Abstract
Vascular surgeons have one of the highest rates of burnout among surgical specialties, often attributed to high patient acuity and clinical workload. Acute Care Surgery (ACS) models are a potential solution used among general and trauma surgeons. This is a retrospective analysis of prospectively collected Accreditation Council for Graduate Medical Education (ACGME) survey results from faculty and residents before and after implementation of a vascular ACS (VACS) model. The VACS model assigns a weekly rotation of an attending surgeon with no elective cases or clinic responsibilities and a monthly rotating resident team. Residents and attendings are in-house to cover all urgent and emergent vascular daytime consultations and procedures, while nights and weekend coverage remain a typical rotating schedule. Survey question results were binned into domains consistent with the Maslach Burnout Inventory (MBI). Both residents and faculty reported an increase in median scores in MBI domains of Emotional Exhaustion (Faculty:2.9 vs. 3.4, p<0.001; Residents:3.1 vs. 3.6, p<0.001) and faculty reported higher Personal Accomplishment scores (Faculty:3.3 vs. 3.8, p=0.005) after the VACS model implementation. A VACS model is a tangible practice change that can address a major problem for current vascular surgeons as it is associated with decreased burnout for faculty and residents through improvement in both emotional exhaustion and personal accomplishment. Improved longitudinal assessment of resident and faculty burnout is needed and future work should identify specific practice patterns related to decreased burnout.
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Affiliation(s)
- Joshua T Geiger
- University of Rochester Medical Center, Department of Surgery, Division of Vascular Surgery, Rochester, NY
| | - Daniel J Lehane
- University of Rochester Medical Center, Department of Surgery, Division of Vascular Surgery, Rochester, NY
| | - Vivek Nithipalan
- University of Rochester Medical Center, Department of Surgery, Division of Vascular Surgery, Rochester, NY
| | - Baqir J Kedwai
- University of Rochester Medical Center, Department of Surgery, Division of Vascular Surgery, Rochester, NY
| | - Michael C Stoner
- University of Rochester Medical Center, Department of Surgery, Division of Vascular Surgery, Rochester, NY
| | - Jennifer L Ellis
- University of Rochester Medical Center, Department of Surgery, Division of Vascular Surgery, Rochester, NY
| | - Roan J Glocker
- University of Rochester Medical Center, Department of Surgery, Division of Vascular Surgery, Rochester, NY
| | - Karina A Newhall
- University of Rochester Medical Center, Department of Surgery, Division of Vascular Surgery, Rochester, NY
| | - Adam J Doyle
- University of Rochester Medical Center, Department of Surgery, Division of Vascular Surgery, Rochester, NY.
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Norasi H, Kim J, Hallbeck MS, Cerri PE, Elli EF, Tollefson MK, Harold KL, Pathak RA, Pak R. Surgeons' dominant surgical modality: Impacts on wellbeing, burnout, and interventions for neuromusculoskeletal disorders. Am J Surg 2024:115769. [PMID: 38796376 DOI: 10.1016/j.amjsurg.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/10/2024] [Accepted: 05/17/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND This study investigated the impact of surgical modalities on surgeon wellbeing with a focus on burnout, job satisfaction, and interventions used to address neuromusculoskeletal disorders (NMSDs). METHODS An electronic survey was sent to surgeons across an academic integrated multihospital system. The survey consisted of 47 questions investigating different aspects of surgeons' wellbeing. RESULTS Out of 245 thoracic and abdominopelvic surgeons, 79 surgeons (32.2 %) responded, and 65 surgeons (82 %) were able to be categorized as having a dominant surgical modality. Compared to robotic surgeons, laparoscopic (p = 0.042) and open (p = 0.012) surgeons reported more frequent feelings of burnout. The number of surgeons who used any treatment/intervention to minimize the operative discomfort/pain was lower for robotic surgeons than the other three modalities (all p < 0.05). CONCLUSIONS NMSDs affect different aspects of surgeons' lives and occupations. Robotic surgery was associated with decreased feelings of burnout than the other modalities.
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Affiliation(s)
- Hamid Norasi
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Joseph Kim
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - M Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA; Department of Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Petrine E Cerri
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Enrique F Elli
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Matthew K Tollefson
- Department of Surgery, Mayo Clinic, Rochester, MN, USA; Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | - Ram A Pathak
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
| | - Raymond Pak
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
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Narayanan A, Musicki K, Aitken SJ, Taumoepeau L, Khashram M. Restoring flow to the Aotearoa New Zealand vascular workforce pipeline requires tangible strategic interventions. ANZ J Surg 2024; 94:782-784. [PMID: 38553886 DOI: 10.1111/ans.18990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 02/29/2024] [Accepted: 03/14/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Anantha Narayanan
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
- Department of Vascular Surgery, Wellington Hospital, Wellington, New Zealand
| | - Korana Musicki
- Department of Vascular Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sarah J Aitken
- Institute of Academic Surgery, Vascular Department, Concord Repatriation General Hospital, Concord, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Lupe Taumoepeau
- Department of Vascular Surgery, Wellington Hospital, Wellington, New Zealand
| | - Manar Khashram
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
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Li RD, Pillado E, DiLosa K, Chia MC, Visenio M, Zhan T, Eng JS, Amortegui D, Johnson JK, Sheahan MG, Bilimoria KY, Hu YY, Coleman DM. Perception of shared learning environment differs between vascular surgery and general surgery residents. J Vasc Surg 2024; 79:1224-1232. [PMID: 38070784 DOI: 10.1016/j.jvs.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND An enriching learning environment is integral to resident wellness and education. Integrated vascular (VS) and general surgery (GS) residents share 18 months of core GS rotations during the postgraduate years 1-3 (PGY1-3); differences in their experiences may help identify practical levers for change. METHODS We used a convergent mixed-methods design. Cross-sectional surveys were administered after the 2020 American Board of Surgery In-Training Examination and Vascular Surgery In-Training Examination, assessing eight domains of the learning environment and resident wellness. Multivariable logistic regression models identified factors associated with thoughts of attrition between categorical PGY1-3 residents at 57 institutions with both GS and VS programs. Resident focus groups were conducted during the 2022 Vascular Annual Meeting to elicit more granular details about the experience of the learning environment. Transcripts were analyzed using inductive and deductive logics until thematic saturation was achieved. RESULTS Surveys were completed by 205 VS and 1198 GS PGY1-3 residents (response rates 76.8% for VS and 82.5% for GS). After adjusting for resident demographics, PGY level, and program type, GS residents were more likely than their VS peers to consider leaving their programs (odds ratio [OR]: 2.61, 95% confidence interval [CI]: 1.37-4.99). This finding did not persist after adjusting for differences in perceptions of the learning environment, specifically: GS residents had higher odds of mistreatment (OR: 1.99, 95% CI: 1.36-2.90), poorer work-life integration (OR: 2.88, 95% CI: 1.41-5.87), less resident camaraderie (OR: 3.51, 95% CI: 2.26-5.45), and decreased meaning in work (OR: 2.94, 95% CI: 1.80-4.83). Qualitative data provided insight into how the shared learning environment was perceived differently: (1) vascular trainees expressed that early specialization and a smaller, more invested faculty allow for an apprenticeship model with early operative exposure, hands-on guidance, frequent feedback, and thus early skill acquisition (meaning in work); (2) a smaller program is conducive to closer relationships with co-residents and faculty, increasing familiarity (camaraderie and work-life integration); and (3) due to increased familiarity with program leadership, vascular trainees feel more comfortable reporting mistreatment, allowing for prompt responses (mistreatment). CONCLUSIONS Despite sharing a learning environment, VS and GS residents experience training differently, contributing to differential thoughts of attrition. These differences may be attributable to intrinsic features of the integrated training paradigm that are not easily replicated by GS programs, such as smaller program size and higher faculty investment due to early specialization. Alternative strategies to compensate for these inherent differences should be considered (eg, structured operative entrustment programs and faculty incentivization).
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Affiliation(s)
- Ruojia Debbie Li
- Division of Vascular and Endovascular Surgery, Department of Surgery, Loyola University Medical Center, Maywood, IL; Northwestern Quality Improvement, Research, and Education in Surgery (NQUIRES), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Eric Pillado
- Northwestern Quality Improvement, Research, and Education in Surgery (NQUIRES), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kathryn DiLosa
- Department of Surgery, University of California Davis, Sacramento, CA
| | - Matthew C Chia
- Northwestern Quality Improvement, Research, and Education in Surgery (NQUIRES), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michael Visenio
- Northwestern Quality Improvement, Research, and Education in Surgery (NQUIRES), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Tiannan Zhan
- Northwestern Quality Improvement, Research, and Education in Surgery (NQUIRES), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Joshua S Eng
- Surgical Outcomes and Quality Improvement Center, Indiana University, Indianapolis, IN
| | - Daniela Amortegui
- Surgical Outcomes and Quality Improvement Center, Indiana University, Indianapolis, IN
| | - Julie K Johnson
- Northwestern Quality Improvement, Research, and Education in Surgery (NQUIRES), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Malachi G Sheahan
- Division of Vascular and Endovascular Surgery, Louisiana State University, New Orleans, LA
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center, Indiana University, Indianapolis, IN
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center, Indiana University, Indianapolis, IN; Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL
| | - Dawn M Coleman
- Division of Vascular and Endovascular Surgery, Duke University, Durham, NC.
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Pillado E, Li RD, Chia MC, Eng JS, DiLosa K, Grafmuller L, Conway A, Escobar GA, Shaw P, Sheahan MG, Bilimoria KY, Hu YY, Coleman DM. Reported pain at work is a risk factor for vascular surgery trainee burnout. J Vasc Surg 2024; 79:1217-1223. [PMID: 38215953 DOI: 10.1016/j.jvs.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/30/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Work-related pain is a known risk factor for vascular surgeon burnout. It risks early attrition from our workforce and is a recognized threat to the specialty. Our study aimed to understand whether work-related pain similarly contributed to vascular surgery trainee well-being. METHODS A confidential, voluntary survey was administered after the 2022 Vascular Surgery In-Service Examination to trainees in all Accreditation Council for Graduate Medical Education-accredited vascular surgery programs. Burnout was measured by a modified, abbreviated Maslach Burnout Inventory; pain after a full day of work was measured using a 10-point Likert scale and then dichotomized as "no to mild pain" (0-2) vs "moderate to severe pain" (3-9). Univariable analyses and multivariable regression assessed associations of pain with well-being indicators (eg, burnout, thoughts of attrition, and thoughts of career change). Pain management strategies were included as additional covariables in our study. RESULTS We included 527 trainees who completed the survey (82.2% response rate); 38% reported moderate to severe pain after a full day of work, of whom 73.6% reported using ergonomic adjustments and 67.0% used over-the-counter medications. Significantly more women reported moderate to severe pain than men (44.3% vs 34.5%; P < .01). After adjusting for gender, training level, race/ethnicity, mistreatment, and dissatisfaction with operative autonomy, moderate-to-severe pain (odds ratio, 2.52; 95% confidence interval, 1.48-4.26) and using physiotherapy as pain management (odds ratio, 3.06; 95% confidence interval, 1.02-9.14) were risk factors for burnout. Moderate to severe pain was not a risk factor for thoughts of attrition or career change after adjustment. CONCLUSIONS Physical pain is prevalent among vascular surgery trainees and represents a risk factor for trainee burnout. Programs should consider mitigating this occupational hazard by offering ergonomic education and adjuncts, such as posture awareness and microbreaks during surgery, early and throughout training.
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Affiliation(s)
- Eric Pillado
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Ruojia Debbie Li
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Matthew C Chia
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Joshua S Eng
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Kathryn DiLosa
- Division of Vascular Surgery, Department of Surgery, University of California, Davis, Sacramento, CA
| | - Leanne Grafmuller
- Division of Vascular Surgery, Department of Surgery, University of Rochester, Rochester, NY
| | - Allan Conway
- Division of Vascular Surgery Lenox Hill Hospital, Department of Surgery, Northwell Health, New York, NY
| | - Guillermo A Escobar
- Division of Vascular Surgery, Department of Surgery, Emory University, Atlanta, GA
| | - Palma Shaw
- Division of Vascular Surgery, Upstate Medical University, Syracuse, NY
| | - Malachi G Sheahan
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Dawn M Coleman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC.
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Choi SH, Yan TD, Misskey J, Chen JC. The Emotional Impact and Coping Mechanisms Following Adverse Patient Events Among Canadian Vascular Surgeons and Trainees. Vasc Endovascular Surg 2024; 58:294-301. [PMID: 37878392 DOI: 10.1177/15385744231209914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND This study's objective is to evaluate the emotional experiences, coping mechanisms, and support resources for Canadian vascular surgeons and trainees following an adverse patient event or near miss. METHODS This is a cross-sectional survey study of all Canadian Society for Vascular Surgery (CSVS) members from October to November 2021. We collected data on participant experiences with adverse events, their emotional responses, the coping mechanisms used, and their perceptions on available support resources. RESULTS The survey was sent to 233 CSVS members yielding 66 responses. The majority (77%) of respondents had experiences with adverse event causing serious patient harm. The most common negative experience following an adverse event included feelings of negativity towards oneself, general distress, and anxiety about potential for future errors. The most common coping mechanism was seeking advice from a mentor or close colleague. Peers (82%) and senior colleagues (59%) were the most preferred sources of support. Most of the respondents would reach out to a mentor if they had 1, but 30% reported no mentor or close colleague for support. CONCLUSION Adverse patient events and near misses have serious negative impact on the lives of Canadian vascular surgeons and trainees. Peers and senior colleagues are the most desired source for support, but this is not universally available. Organized efforts are needed to bring awareness in our vascular surgery community on the ubiquitous nature and detrimental effects of adverse events.
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Affiliation(s)
- Sally Hj Choi
- Division of Vascular Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Tyler D Yan
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jonathan Misskey
- Division of Vascular Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Jerry C Chen
- Division of Vascular Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
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Webber S, Semia S, Nacht CL, Garcia S, Kloster H, Vellardita L, Kieren MQ, Kelly MM. Physician Work-Personal Intersection: A Scoping Review of Terms, Definitions, and Measures. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:331-339. [PMID: 38039978 DOI: 10.1097/acm.0000000000005579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
PURPOSE A substantial body of evidence describes the multidimensional relationship between the intersection of physicians' work and personal lives and health care quality and costs, workforce sustainability, and workplace safety culture. However, there is no clear consensus on the terms, definitions, or measures used in physician work-personal intersection (WPI) research. In this scoping review, the authors aimed to describe the terms and definitions used by researchers to describe physician WPI, summarize the measurement tools used, and formulate a conceptual model of WPI that can inform future research. METHOD The authors searched PubMed, CINAHL, Scopus, and Web of Science for studies that investigated U.S. practicing physicians' WPI and measured WPI as an outcome from January 1990 to March 2022. The authors applied thematic analysis to all WPI terms, definitions, and survey questions or prompts in the included studies to create a conceptual model of physician WPI. RESULTS Ultimately, 102 studies were included in the final analysis. The most commonly used WPI terms were work-life balance, work-life integration, and work-home or work-life conflict(s). There was no consistency in the definition of any terms across studies. There was heterogeneity in the way WPI was measured, and only 8 (7.8%) studies used a validated measurement tool. The authors identified 6 key driver domains of WPI: work and personal demands; colleague and institutional support and resources; personal identity, roles, health, and values; work schedule and flexibility; partner and family support; and personal and professional strategies. CONCLUSIONS The authors found significant variability in the terms, definitions, and measures used to study physician WPI. They offer a conceptual model of the WPI construct that can be used to more consistently study physician WPI in the future. Future work should further investigate the validity of this model and generate consensus around WPI terms, definitions, and measures.
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Izumi A, Nwakoby A, Verma R, Yanagawa B. Wellness and burnout in cardiac surgery: not black and white. Curr Opin Cardiol 2024; 39:98-103. [PMID: 38116804 DOI: 10.1097/hco.0000000000001112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW Despite a growing emphasis on burnout in medicine, there remains a paucity of data in cardiac surgery. Herein, we summarize recent data on cardiac surgeon well being and identify factors for consideration in future burnout inquiries and management. RECENT FINDINGS Overall, 70-90% of cardiothoracic surgeons report job satisfaction in the United States. However, 35-60% still endorse burnout symptoms, and the specialty reports some of the highest rates of depression (35-40%) and suicidal ideation (7%). Such negative experiences are greater among early-stage and female surgeons and may be addressed through targeted, program-specific wellness policies. Canada's single-payer healthcare system might exacerbate surgeon burnout due to lower financial compensation and job autonomy. SUMMARY Cardiothoracic surgeons appear simultaneously burnt out and professionally fulfilled. They report a high incidence of depression and clock in the most hours, yet the majority would choose this specialty again. These findings reveal a more nuanced state of well being than previously appreciated and speak to ambiguities in how burnout is conceived and measured. A broader examination across surgical and social contexts highlights the hierarchical nature of burnout factors and potential ways forward. Collectively, these insights can inform assessments of burnout in Canadian cardiac surgery that remain absent to date.
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Affiliation(s)
- Aliya Izumi
- Division of Cardiovascular Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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10
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Bentin JM, Jonsdottir FR. Workload and the mysterious law of karma. BMJ 2023; 383:2686. [PMID: 38110226 DOI: 10.1136/bmj.p2686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Affiliation(s)
- Jakob Mejdahl Bentin
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital-Rigshospitalet, Denmark
| | - Frida Run Jonsdottir
- Department of Vascular Surgery, Heart Centre, Copenhagen University Hospital-Rigshospitalet, Denmark
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11
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Kang SH, Lynch L, Wolf E, Mirka GA. Quantifying the effectiveness of a passive trunk-support exosuit at reducing erector spinae muscle fatigue during a quasi-static posture maintenance task. ERGONOMICS 2023:1-10. [PMID: 38108329 DOI: 10.1080/00140139.2023.2295214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
The objective of this study was to explore the effectiveness of a passive back-support exosuit at reducing low back muscle fatigue during an 18-minute trunk posture maintenance task. On two separate days sixteen participants performed an 18-minute trunk posture profile that reflected trunk flexion postures observed during a challenging vascular surgery procedure. On one day they performed the procedure with the support of the exosuit, on the other day without. Test contractions were performed every three minutes to capture the time-dependent electromyographic activity of the bilateral erector spinae muscles. Time domain (amplitude) and frequency domain (median frequency) measures of erector spinae muscle fatigue were assessed. Results revealed that the exosuit significantly reduced the measures of erector spinae muscle fatigue in terms of both amplitude (6.1%) and median frequency (5.3%), demonstrating a fatigue reduction benefit of the exosuit in a realistic surgical posture maintenance task.
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Affiliation(s)
- Sang Hyeon Kang
- The Physical Ergonomics and Biomechanics Laboratory, Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA
| | - Laura Lynch
- The Physical Ergonomics and Biomechanics Laboratory, Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA
| | - Emma Wolf
- The Physical Ergonomics and Biomechanics Laboratory, Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA
| | - Gary A Mirka
- The Physical Ergonomics and Biomechanics Laboratory, Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA
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12
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Møller CM, Clausen T, Aust B, Budtz-Lilly JW, Eiberg JP. Burnout and Its Consequences among Vascular Surgeons and Trainees: A Danish National Survey. J Am Coll Surg 2023; 237:874-883. [PMID: 37694920 DOI: 10.1097/xcs.0000000000000853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Burnout among physicians has widespread negative consequences. Little is known about burnout among European vascular surgeons (VS). A previously published study found that 82% of VS and vascular surgical trainees (VST) in Denmark experience burnout symptoms. The present study aimed to investigate work- and health-related consequences of burnout. STUDY DESIGN An electronic survey was distributed to all VS/VST in Denmark in January 2020. Validated assessment tools were used to measure burnout, mental health, and psychosocial work environment aspects. RESULTS Of 104 invited VS/VST, 82% (n = 85) completed the survey. VS accounted for 72% (n = 61) of the respondents, and 40% (n = 33) were female. Statistically significant associations were found between higher levels of burnout and a range of work- and health-related outcomes, including a sense of meaning at work, workplace commitment, conflicts between work and private life, work stress, sick leave, and depressive symptoms. VS/VST using pain medication daily or weekly had significantly higher burnout scores than respondents who rarely or never use pain medication. A significant association between burnout and job satisfaction and retention was found, with respondents indicating an intention to stay within the specialty having significantly lower burnout scores than those who considered leaving within 5 years. Among those who indicated leaving the specialty, 35% (n = 13) attributed this to their current working conditions. CONCLUSIONS Burnout among VS/VST in Denmark is negatively associated with various work- and health-related outcomes. The work environment seems to play an essential role in these associations, and alterations in workplace organization may remedy this situation.
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Affiliation(s)
- Cecilie M Møller
- From the Department of Cardiothoracic and Vascular Surgery, University Hospital Aarhus, Aarhus, Denmark (Møller, Budtz-Lilly)
| | - Thomas Clausen
- From the Department of Cardiothoracic and Vascular Surgery, University Hospital Aarhus, Aarhus, Denmark (Møller, Budtz-Lilly)
| | - Birgit Aust
- From the Department of Cardiothoracic and Vascular Surgery, University Hospital Aarhus, Aarhus, Denmark (Møller, Budtz-Lilly)
| | - Jacob W Budtz-Lilly
- From the Department of Cardiothoracic and Vascular Surgery, University Hospital Aarhus, Aarhus, Denmark (Møller, Budtz-Lilly)
| | - Jonas P Eiberg
- From the Department of Cardiothoracic and Vascular Surgery, University Hospital Aarhus, Aarhus, Denmark (Møller, Budtz-Lilly)
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Bischoff A, Solecruz E, Mainard N, Faivre G, Canavese F. How are French pediatric orthopedic surgeons affected by burnout? Results of a nationwide survey. Orthop Traumatol Surg Res 2023; 109:103628. [PMID: 37105385 DOI: 10.1016/j.otsr.2023.103628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/12/2023] [Accepted: 01/24/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Burnout is a syndrome that adversely affects those who work in roles designed to assist and aid others, such as healthcare professionals. There is a paucity of data available on this topic among French pediatric orthopedic surgeons, registrars and interns. Therefore, we conducted a national survey to: (1) assess the prevalence of burnout syndrome among French pediatric orthopedic surgeons; (2) determine the risks and protective factors associated with this syndrome. HYPOTHESIS The prevalence of burnout among French pediatric orthopedic surgeons is at least as high as in other medical and surgical specialties. MATERIALS AND METHODS We conducted a nationwide survey during the months of June and July 2022 by distributing a digitized questionnaire by e-mail. The burnout syndrome was assessed by the MBI (Maslach Burnout Inventory) score. Demographic and professional practice data were also collected. RESULTS Thirty-eight interns and 65 pediatric orthopedic registrars took part in the survey, i.e. a participation rate estimated at 65.5% and 44.4% respectively. Twenty-six percent (n=10) of interns and 13.9% (n=9) of registrars had MBI scores suggestive of moderate or severe burnout. Respectively 20.8% (n=9) and 9.2% (n=6) of interns and registrars reported suicidal thoughts in the past year. After statistical analysis, medical errors (OR: 3.4336; 95% CI: 1.7164-6.869; p<0.001) and suicidal ideation (OR: 2.3075; 95% CI: 1.0480-5.081; p=0.038) were associated with severe burnout. Having children (OR: 0.495; 95% CI: 0.2491-0.983; p=0.044) emerged as a protective factor. DISCUSSION With a high participation rate, this study reveals a high burnout rate among French pediatric orthopedic interns and registrars, even if slightly lower than those found in other surgical specialties. Interns seem more exposed to this risk than their seniors. The consequences of burnout are diverse but can be significant. These results necessitate a vigilant approach to the occurrence of burnout among health professionals, and the appropriate management of it. LEVEL OF EVIDENCE III; descriptive cross-sectional study without a control group.
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Affiliation(s)
- Aline Bischoff
- Service de chirurgie orthopédique et traumatologique pédiatrique, département universitaire, CHR de Lille, 2, avenue Oscar Lambret, 59000 Lille, France.
| | - Eva Solecruz
- Service de neurologie, département universitaire, CHU de Marseille/Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Nicolas Mainard
- Service de chirurgie orthopédique et traumatologique pédiatrique, département universitaire, CHR de Lille, 2, avenue Oscar Lambret, 59000 Lille, France
| | - Grégoire Faivre
- Service de chirurgie orthopédique et traumatologique, CH de Dunkerque, 130, avenue Louis Herbeaux, 59240 Dunkerque, France
| | - Federico Canavese
- Service de chirurgie orthopédique et traumatologique pédiatrique, département universitaire, CHR de Lille, 2, avenue Oscar Lambret, 59000 Lille, France
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14
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Norasi H, Hallbeck MS, Elli EF, Tollefson MK, Harold KL, Pak R. Impact of preferred surgical modality on surgeon wellness: a survey of workload, physical pain/discomfort, and neuromusculoskeletal disorders. Surg Endosc 2023; 37:9244-9254. [PMID: 37872425 PMCID: PMC10709269 DOI: 10.1007/s00464-023-10485-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/17/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND We compared surgeons' workload, physical discomfort, and neuromusculoskeletal disorders (NMSDs) across four surgical modalities: endoscopic, laparoscopic, open, and robot-assisted (da Vinci Surgical Systems). METHODS An electronic survey was sent to the surgeons across an academic hospital system. The survey consisted of 47 questions including: (I) Demographics and anthropometrics; (II) The percentage of the procedural time that the surgeon spent on performing each surgical modality; (III) Physical and mental demand and physical discomfort; (IV) Neuromusculoskeletal symptoms including body part pain and NMSDs. RESULTS Seventy-nine out of 245 surgeons completed the survey (32.2%) and 65 surgeons (82.2%) had a dominant surgical modality: 10 endoscopic, 15 laparoscopic, 26 open, and 14 robotic surgeons. Physical demand was the highest for open surgery and the lowest for endoscopic and robotic surgeries, (all p < 0.05). Open and robotic surgeries required the highest levels of mental workload followed by laparoscopic and endoscopic surgeries, respectively (all p < 0.05 except for the difference between robotic and laparoscopic that was not significant). Body part discomfort or pain (immediately after surgery) were lower in the shoulder for robotic surgeons compared to laparoscopic and open surgeons and in left fingers for robotic surgeons compared to endoscopic surgeons (all p < 0.05). The prevalence of NMSD was significantly lower in robotic surgeons (7%) compared to the other surgical modalities (between 60 and 67%) (all p < 0.05). CONCLUSIONS The distribution of NMSDs, workload, and physical discomfort varied significantly based on preferred surgical approach. Although robotic surgeons had fewer overall complaints, improvement in ergonomics of surgery are still warranted.
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Affiliation(s)
- Hamid Norasi
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - M Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA.
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
- Department of Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Enrique F Elli
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Matthew K Tollefson
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | - Raymond Pak
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
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15
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Jayroe H, Weaver L, Velazquez G, Nelson P, Jennings W, Henning N, Edmonds J, Nsa W, Zamor K, Kempe K. Vascular Surgery Training Positions and Applicant 10-Year Trends with Consideration for Further Expansion. Ann Vasc Surg 2023; 95:291-296. [PMID: 37247836 DOI: 10.1016/j.avsg.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/28/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND There is a significant shortage of vascular surgeons in the United States and projections for these practicing surgical specialists continue to worsen. Annual appraisal of our workforce recruitment and growth is imperative. MATERIALS AND METHODS Retrospective data were analyzed using the National Resident Matching Program from 2012-2022 applicant appointment years (specialty code for vascular surgery 450). Simple linear trend analysis was performed for the number of positions available and the number of applicants, stratified by fellowship or residency. RESULTS Over the 10-year study period, the total vascular surgery trainee positions expanded from 161 to 202. Integrated residency positions increased (41 positions in 2012 vs. 84 in 2022) while available fellowship positions remained stagnant (120 in 2012 vs. 118 in 2022). Total applicants rose as well, from 213 to 311. In 2022, unmatched applicants have increased for both paradigms (25 fellowship and 84 residency applicants) and 100% of programs filled. On average, the number of residency positions offered increased by 4 each year (P < 0.0001) and the number of fellowship positions increased by 0.5 each year (P = 0.1617). The number of integrated residency applicants increased by approximately 9 per year (P = 0.001), while the number of fellowships applicants increased by approximately 1.5 per year (P = 0.121). CONCLUSIONS Applicants for both vascular tracks have increased since 2012 indicating successful recruitment; however, all 2022 programs filled, leaving many applicants unmatched. Residency positions have continued to expand while fellowship positions have not. With the demonstrated surge among applicants, the disproportionate lack of increasing training positions, and the existing shortage of vascular surgeons, there is an urgency to meet the increasing demand. A concerted effort should be made toward adding additional residency and fellowship positions where feasible.
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Affiliation(s)
- Hannah Jayroe
- Division of Vascular Surgery, Department of General Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Libby Weaver
- Division of Vascular and Endovascular Surgery, School of Medicine, University of Virginia, Charlottesville, VA
| | - Gabriela Velazquez
- Department of Vascular and Endovascular Surgery, Medical Center Boulevard, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Peter Nelson
- Division of Vascular Surgery, Department of General Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - William Jennings
- Division of Vascular Surgery, Department of General Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Nolan Henning
- University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Joseph Edmonds
- University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Wato Nsa
- Department of Medical Informatics Tulsa, The University of Oklahoma Health Sciences Center, School of Community Medicine, Tulsa, OK
| | - Kimberly Zamor
- Division of Vascular Surgery, Department of General Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Kelly Kempe
- Division of Vascular Surgery, Department of General Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK.
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16
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Farag N, Pham BL, Aldilli L, Bourque ML, Zigui M, Nauche B, Ades M, Drudi LM. A Systematic Review and Meta-Analysis on Sex-Based Disparities in Patients with Chronic Limb Threatening Ischemia Undergoing Revascularization. Ann Vasc Surg 2023; 95:317-329. [PMID: 37075836 DOI: 10.1016/j.avsg.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND This systematic review and meta-analysis sought to describe the prognostic implications of sex on the clinical outcomes of patients undergoing interventions for chronic limb threatening ischemia (CLTI). METHODS Studies were systematically searched across 7 databases from inception to August 25, 2021 and rerun on October 11, 2022. Studies focusing on patients with CLTI undergoing open surgery, endovascular treatment (EVT), or hybrid procedures were included if sex-based differences were associated with a clinical outcome. Two independent reviewers screened studies for inclusion, extracted data, and assessed risk of bias using the Newcastle-Ottawa scale. Primary outcomes included inpatient mortality, major adverse limb events (MALE), and amputation-free survival (AFS). Meta-analyses were performed using random effects models and reported pooled odds ratio (pOR) and 95% confidence interval (CI). RESULTS A total of 57 studies were included in the analysis. A meta-analysis of 6 studies demonstrated that female sex was associated with statistically higher inpatient mortality compared to male sex undergoing open surgery or EVT (pOR, 1.17; 95% CI: 1.11-1.23). Female sex also demonstrated a trend toward increased limb loss in those undergoing EVT (pOR, 1.15; 95% CI: 0.91-1.45) and open surgery (pOR 1.46; 95% CI: 0.84-2.55). Female sex also had a trend toward higher MALE (pOR, 1.06; 95% CI, 0.92-1.21) in 6 studies. Finally, female sex had a trend toward worse AFS (pOR, 0.85; 95% CI, 0.70-1.03) in 8 studies. CONCLUSIONS Female sex was significantly associated with higher inpatient mortality and a trend toward higher MALE following revascularization. Female sex trended toward worse AFS. The reasons for these disparities are likely multifaceted on patient, provider, and systemic levels and should be explored to identify solutions for decreasing these health inequities across this vulnerable patient population.
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Affiliation(s)
- Nardin Farag
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Bao Linh Pham
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Lyne Aldilli
- Sciences biologiques, Faculty of Arts and Sciences, Université de Montréal, Montreal, QC, Canada
| | - Marie-Lyne Bourque
- Division of Vascular Surgery, Université de Montréal, Montreal, QC, Canada
| | - Marguerite Zigui
- École de Santé publique, Université de Montréal, Montreal, QC, Canada
| | - Benedicte Nauche
- Bibliothèque du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Matthew Ades
- Department of Medicine, Division of General Internal Medicine, McGill University, Montreal, QC, Canada
| | - Laura M Drudi
- Division of Vascular Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Innovation Hub, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
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17
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Sheahan M. Ghosts in the machine. J Vasc Surg 2023; 77:1803. [PMID: 37225354 DOI: 10.1016/j.jvs.2023.01.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Malachi Sheahan
- Division of Vascular and Endovascular Surgery, Louisiana State University School of Medicine, New Orleans, LA
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18
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Norasi H, Wang T, Tetteh E, Smith T, Davila VJ, Erben Y, DeMartino RR, Hallbeck MS, Mendes BC. Intraoperative workload in elective open vascular and endovascular surgery: A study of procedural drivers. APPLIED ERGONOMICS 2023; 111:104049. [PMID: 37210778 DOI: 10.1016/j.apergo.2023.104049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/23/2023]
Abstract
This study investigated vascular surgeon workload and its association with specific procedural drivers over different procedure types. Thirteen attending vascular surgeons (two females) were emailed a survey over a 3-month period. Data from 253 surgical procedures (118 open, 85 endovascular, 18 hybrid, and 32 venous) revealed high physical and cognitive workload among vascular surgeons. Based on the statistically significant findings and similar non-significant trends in the data (significance level of 0.01), open and hybrid vascular procedures showed higher levels of physical and cognitive workload compared to venous cases, while endovascular procedures were relatively more moderate. Additionally, the workload subscales for five subcategories of open procedures (e.g., arteriovenous access) as well as three subcategories of endovascular procedures (e.g., aortic) were compared. The granularity of the intraoperative workload drivers across various vascular procedure types and adjunct equipment could be the key to create targeted ergonomic interventions to reduce workload during vascular surgeries.
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Affiliation(s)
- Hamid Norasi
- Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, 205 3rd Avenue SW, Rochester, MN, 55905, USA; Mayo Clinic, Division of Health Care Delivery Research, 200 1st St. SW, Rochester, MN, 55905, USA.
| | - Tianke Wang
- Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, 205 3rd Avenue SW, Rochester, MN, 55905, USA.
| | - Emmanuel Tetteh
- Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, 205 3rd Avenue SW, Rochester, MN, 55905, USA; Mayo Clinic, Division of Health Care Delivery Research, 200 1st St. SW, Rochester, MN, 55905, USA.
| | - Tianqi Smith
- Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, 205 3rd Avenue SW, Rochester, MN, 55905, USA.
| | - Victor J Davila
- Mayo Clinic, Division of Vascular Surgery, Department of Surgery, 5777 E. Mayo Blvd., Phoenix, AZ, 85054, USA.
| | - Young Erben
- Mayo Clinic, Division of Vascular Surgery, Department of Surgery, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Randall R DeMartino
- Mayo Clinic, Division of Vascular Surgery, Department of Surgery, 200 1st St. SW, Rochester, MN, 55905, USA.
| | - M Susan Hallbeck
- Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, 205 3rd Avenue SW, Rochester, MN, 55905, USA; Mayo Clinic, Division of Health Care Delivery Research, 200 1st St. SW, Rochester, MN, 55905, USA.
| | - Bernardo C Mendes
- Mayo Clinic, Division of Vascular Surgery, Department of Surgery, 200 1st St. SW, Rochester, MN, 55905, USA.
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19
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Conte MS. Vascular health and the health of vascular surgery-2021 Western Vascular Society Presidential Address. Semin Vasc Surg 2023; 36:1-8. [PMID: 36958890 DOI: 10.1053/j.semvascsurg.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023]
Affiliation(s)
- Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, 400 Parnassus Avenue, A-501, San Francisco, CA 94143-0957.
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20
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Drudi LM, D'Oria M, Bath J, Van Nispen J, Smeds MR. Postoperative complications and their association with post-traumatic stress disorder in academic vascular surgeons. J Vasc Surg 2023; 77:899-905.e1. [PMID: 36402248 DOI: 10.1016/j.jvs.2022.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 10/22/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Postoperative complications are an inherent component of surgical practice. This study seeks to address their association with emotional responses of academic vascular surgeons. METHODS An anonymous electronic survey was sent to all vascular surgery program directors in North America with a request to disseminate to their faculty. The survey captured data on demographics and practice type and used imbedded validated measures to determine emotional responses to postoperative complications and to assess coping mechanisms. Univariate analysis was performed to determine differences between those who reported at least partial symptoms of post-traumatic stress disorder (PTSD) following their worse major complication over the previous year and those who did not. Multivariable logistic regression analysis was performed for all covariates found significant on univariate analysis, and those deemed clinically relevant. RESULTS The survey was distributed to 267 faculty at 128 institutions in the United States and 10 institutions in Canada and completed by 65 participants (response rate, 32%). Twenty of 65 (31%) identified as female, and the total group had a mean age of 47 ± 10.2 years. Most respondents (43/65; 66%) reported a major complication within 3 months of the survey, with the majority of respondents (45/65; 69%) reporting the outcome of patient mortality. Of respondents, 20 of 65 (31%) demonstrated at least partial symptoms of PTSD in response to the worst complication from the previous year, with 12 of 65 (19%) meeting the clinical diagnosis of PTSD. Respondents in the PTSD group were more likely to criticize/blame themselves following the complication (P = .0028); less likely to identify the complication as "expected" (P = .048) or to believe causes of their complications were due to others/external factors; and more likely to identify as a female (55% vs 20%; P = .008). Regarding support following major complications, most respondents (57/65; 88%) desired the ability to discuss details of the case with a respected peer. The most common external pressure influencing their emotional responses to complications was maintaining reputation and a sense of honor (66%). Gender differences persisted on multivariate analysis (P = .016). CONCLUSIONS Emotional responses following major postoperative complications in vascular surgery are common and may pose a risk for PTSD. This may occur more commonly following complications that are unexpected or in cases in which the cause of the complication was due to a perceived or actual surgical mistake. The ubiquitous nature and severity of the emotional toll of major complications for vascular surgeons is poorly described and under-recognized. Gender-related differences may exist, and most surgeons desire a support network of respected peers with whom to discuss complications.
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Affiliation(s)
- Laura M Drudi
- Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Carrefour de l'Innovation, Centre de Rechercher du CHUM, Montreal, Quebec, Canada
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Jonathan Bath
- Division of Vascular Surgery, University of Missouri, Columbia, MO
| | - Johan Van Nispen
- Division of Vascular Surgery, St. Louis University, St. Louis, MO
| | - Matthew R Smeds
- Division of Vascular Surgery, St. Louis University, St. Louis, MO.
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21
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Characterizing the geographic distribution of vascular surgeons in the United States. J Vasc Surg 2023; 77:256-261. [PMID: 36152983 DOI: 10.1016/j.jvs.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/03/2022] [Accepted: 09/12/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The shortage of vascular surgeons can be attributed to multiple factors, including an aging population, the increasing demand for vascular surgeons, and an aging vascular surgery workforce. The distribution of vascular surgeons across the United States varies by locale; thus, the shortage affects regions of different sizes disproportionately. We collated the geographic data to characterize the current distribution of vascular surgeons with an emphasis on the practice location, population density, and population age. METHODS Vascular surgeons were identified using the Physician Compare National Downloadable file from the Centers for Medicare and Medical Services. The counties were matched with each surgeon's practice location. The locations were categorized into metropolitan, urban, or rural using the rural-urban continuum codes. Census Bureau data were used to match all counties with their population-level metrics. The distribution of vascular surgeons was analyzed by comparing the number of counties served, total patient population served, and patient population aged >50 and >65 years served. Finally, the density of vascular surgeons in the United States for the total population and for those aged >50 and >65 years was calculated. RESULTS In 2018, the U.S. population was 309.8 million, and there were 3145 counties. Of the 3145 counties, 533 (17%) had had a practicing vascular surgeon. The combined population of these counties was 213.8 million people (69% of the U.S. population). Stratified by age, the vascular surgeons in these 533 counties could treat 37.3 million people aged >50 years and 17.4 million people aged >65 years. However, 2612 counties (83%), with a total population of 96 million people (31% of the U.S. population), had had no practicing vascular surgeon. When stratified by age, 78.1 million people in the uncovered counties were aged >50 years and 35 million were aged >65 years. Of the 2612 uncovered counties, 48% were urban and 24% were rural. CONCLUSIONS We found a nationwide shortage of vascular surgeons, with urban and rural areas disproportionately affected negatively. Although encouraging vascular surgeons to practice in underserved areas would be an ideal solution, it is not pragmatic. Therefore, developing alternatives such as using primary care providers, investing in telehealth and developing transfer systems could be viable methods of providing vascular care to geographically isolated populations. These findings have significant implications for hospitals, patients, and vascular surgeons, who would all stand to benefit from efforts to address these disparities.
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Trends in Surgeon Burnout in the US and Canada: Systematic Review and Meta-Regression Analysis. J Am Coll Surg 2023; 236:253-265. [PMID: 36519921 DOI: 10.1097/xcs.0000000000000402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Burnout among surgeons is increasingly recognized as a crisis. However, little is known about changes in burnout prevalence over time. We evaluated temporal trends in burnout among surgeons and surgical trainees of all specialties in the US and Canada. STUDY DESIGN We systematically reviewed MEDLINE, Embase, and PsycINFO for studies assessing surgeon burnout from January 1981 through September 2021. Changes in dichotomized Maslach Burnout Inventory scores and mean subscale scores over time were assessed using multivariable random-effects meta-regression. RESULTS Of 3,575 studies screened, 103 studies representing 63,587 individuals met inclusion criteria. Publication dates ranged from 1996 through 2021. Overall, 41% of surgeons met criteria for burnout. Trainees were more affected than attending surgeons (46% vs 36%, p = 0.012). Prevalence remained stable over the study period (-4.8% per decade, 95% CI -13.2% to 3.5%). Mean scores for emotional exhaustion declined and depersonalization declined over time (-4.1 per decade, 95% CI -7.4 to -0.8 and -1.4 per decade, 95% CI -3.0 to -0.2). Personal accomplishment scores remained unchanged. A high degree of heterogeneity was noted in all analyses despite adjustment for training status, specialty, practice setting, and study quality. CONCLUSIONS Contrary to popular perceptions, we found no evidence of rising surgeon burnout in published literature. Rather, emotional exhaustion and depersonalization may be decreasing. Nonetheless, burnout levels remain unacceptably high, indicating a need for meaningful interventions across training levels and specialties. Future research should be deliberately designed to support longitudinal integration through prospective meta-regression to facilitate monitoring of trends in surgeon burnout.
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Karhula K, Koskinen A, Ervasti J, Hakola T, Isoviita VM, Kivimäki I, Puttonen S, Oksanen T, Härmä M. Hospital physicians´ working hour characteristics and sleep quality: a cross-sectional analysis of realized working hour and survey data. BMC Health Serv Res 2022; 22:943. [PMID: 35869512 PMCID: PMC9308190 DOI: 10.1186/s12913-022-08336-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hospital physicians’ work includes on-call duties to provide 24/7 health care. Previous studies using self-reported survey data have associated long working hours and on-call work with sleep difficulties. To reduce recall bias, we complemented survey data with payroll-based objective data to study whether hospital physicians’ realized working hours are associated with sleep.
Methods
The study was nested within the Finnish Public Sector study. We used survey data on 728 hospital physicians (mean age 43.4 years, 62% females) from 2015 linked to realized daily working hour data from 3 months preceding the survey. The associations of working hour characteristics with sleep quantity and quality were studied with multinomial logistic regression analysis adjusted for demographics, overall stressfulness of life situation, control over scheduling of shifts, and hospital district.
Results
One fourth (26%) of the participants reported short (≤6.5 h) average sleep duration. Frequent night work (> 6 shifts/91 days) was associated with short sleep (OR 1.87 95%CI 1.23–2.83) compared to no night work. Approximately one third (32%) of the physicians reported insufficient sleep. Physicians with long weekly working hours (> 48 hours) had higher odds for insufficient sleep (OR 1.78 95%CI 1.15–2.76) than physicians with short weekly working hours (< 40 hours). Insufficient sleep was also associated with frequent on-call duties (> 12 shifts/3 months OR 2.00 95%CI 1.08–3.72), frequent night work (OR 1.60 95%CI 1.09–2.37), and frequent short shift intervals (≤11 hours; > 12 times/3 months OR 1.65 95%CI 1.01–2.69) compared to not having these working hour characteristics. Nearly half of the physicians (48%) reported at least one sleep difficulty at least two times a week and frequent night work increased odds for difficulties in initiating sleep (OR 2.43 95%CI 1.04–5.69). Otherwise sleep difficulties were not associated with the studied working hour characteristics.
Conclusion
We used realized working hour data to strengthen the evidence on on-call work and sleep quality and our results advice to limit the frequency of night work, on-call shifts, short shift intervals and long weekly working hours to promote hospital physicians’ sufficient sleep.
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Smith TG, Lowndes BR, Schmida E, Lund SB, Linden AR, Rivera M, Gas BL, Hallbeck MS. Course Design and Learning Outcomes of a Practical Online Ergonomics Course for Surgical Residents. JOURNAL OF SURGICAL EDUCATION 2022; 79:1489-1499. [PMID: 35907697 DOI: 10.1016/j.jsurg.2022.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/23/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Course content was designed and the learning outcomes assessed for an online ergonomics course for surgical residents. This course could fulfill an optional Surgical Council on Resident Education (SCORE) curriculum on Surgical Ergonomics. DESIGN The online course included five 5-minute modules within the residents' learning system, each ending with an ungraded knowledge question, and a final 5-question multiple-choice retention quiz that allowed infinite attempts. The course was designed by ergonomists and surgeons at a quaternary academic hospital system. Participants were given two weeks to complete the modules. An electronic survey with questions assessing ergonomics knowledge and understanding on a 5-point Likert scale (strongly disagree - strongly agree) was distributed both before and after the course. The post-course survey included three additional questions to elicit feedback regarding learning experience and course design. Descriptive statistics and nonparametric paired comparisons were used to evaluate learning outcomes. SETTING General surgery residency program at an academic medical center in the U.S. PARTICIPANTS Twenty-two general surgery post graduate year 1 residents (PGY1s) were recruited to participate and completed the pre-course survey. Eight out of the 22 participants (36%) completed the online course and quiz; seven (32%) completed the course, quiz, and the post-course survey. RESULTS Participants had high pre-course awareness of the importance of surgical ergonomics, benefits of work-related musculoskeletal disorder (WMSD) prevention, as well as awkward intraoperative postures being an WMSD risk factor. Participants' confidence increased significantly from pre- to post-course in ability to assess risk (p = 0.021), but not in ability or willingness to mitigate risky surgical postures. Participants who completed the quiz answered a median of 4 (IQR: [4, 5]) questions correctly. All participants indicated that they would recommend this course to other residents. CONCLUSIONS These short practical ergonomics online learning modules increased surgical residents' confidence in assessing surgical WMSD risks.
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Affiliation(s)
- Tianqi G Smith
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | | | - Elizabeth Schmida
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Sarah B Lund
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anna R Linden
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Mariela Rivera
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Becca L Gas
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - M Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota; Department of Surgery, Mayo Clinic, Rochester, Minnesota.
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Deol ZK. “The United State of Venous and Lymphatic Medicine ” – Uniting the Specialties to Form a More Perfect Union. J Vasc Surg Venous Lymphat Disord 2022; 11:668-670. [PMID: 36323402 DOI: 10.1016/j.jvsv.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/05/2022] [Indexed: 11/06/2022]
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Hodkinson A, Zhou A, Johnson J, Geraghty K, Riley R, Zhou A, Panagopoulou E, Chew-Graham CA, Peters D, Esmail A, Panagioti M. Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis. BMJ 2022; 378:e070442. [PMID: 36104064 PMCID: PMC9472104 DOI: 10.1136/bmj-2022-070442] [Citation(s) in RCA: 102] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the association of physician burnout with the career engagement and the quality of patient care globally. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, PsycINFO, Embase, and CINAHL were searched from database inception until May 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Observational studies assessing the association of physician burnout (including a feeling of overwhelming emotional exhaustion, feelings of cynicism and detachment from job defined as depersonalisation, and a sense of ineffectiveness and little personal accomplishment) with career engagement (job satisfaction, career choice regret, turnover intention, career development, and productivity loss) and the quality of patient care (patient safety incidents, low professionalism, and patient satisfaction). Data were double extracted by independent reviewers and checked through contacting all authors, 84 (49%) of 170 of whom confirmed their data. Random-effect models were used to calculate the pooled odds ratio, prediction intervals expressed the amount of heterogeneity, and meta-regressions assessed for potential moderators with significance set using a conservative level of P<0.10. RESULTS 4732 articles were identified, of which 170 observational studies of 239 246 physicians were included in the meta-analysis. Overall burnout in physicians was associated with an almost four times decrease in job satisfaction compared with increased job satisfaction (odds ratio 3.79, 95% confidence interval 3.24 to 4.43, I2=97%, k=73 studies, n=146 980 physicians). Career choice regret increased by more than threefold compared with being satisfied with their career choice (3.49, 2.43 to 5.00, I2=97%, k=16, n=33 871). Turnover intention also increased by more than threefold compared with retention (3.10, 2.30 to 4.17, I2=97%, k=25, n=32 271). Productivity had a small but significant effect (1.82, 1.08 to 3.07, I2=83%, k=7, n=9581) and burnout also affected career development from a pooled association of two studies (3.77, 2.77 to 5.14, I2=0%, n=3411). Overall physician burnout doubled patient safety incidents compared with no patient safety incidents (2.04, 1.69 to 2.45, I2=87%, k=35, n=41 059). Low professionalism was twice as likely compared with maintained professionalism (2.33, 1.96 to 2.70, I2=96%, k=40, n=32 321), as was patient dissatisfaction compared with patient satisfaction (2.22, 1.38 to 3.57, I2=75%, k=8, n=1002). Burnout and poorer job satisfaction was greatest in hospital settings (1.88, 0.91 to 3.86, P=0.09), physicians aged 31-50 years (2.41, 1.02 to 5.64, P=0.04), and working in emergency medicine and intensive care (2.16, 0.98 to 4.76, P=0.06); burnout was lowest in general practitioners (0.16, 0.03 to 0.88, P=0.04). However, these associations did not remain significant in the multivariable regressions. Burnout and patient safety incidents were greatest in physicians aged 20-30 years (1.88, 1.07 to 3.29, P=0.03), and people working in emergency medicine (2.10, 1.09 to 3.56, P=0.02). The association of burnout with low professionalism was smallest in physicians older than 50 years (0.36, 0.19 to 0.69, P=0.003) and greatest in physicians still in training or residency (2.27, 1.45 to 3.60, P=0.001), in those who worked in a hospital (2.16, 1.46 to 3.19, P<0.001), specifically in emergency medicine specialty (1.48, 1.01 to 2.34, P=0.042), or situated in a low to middle income country (1.68, 0.94 to 2.97, P=0.08). CONCLUSIONS This meta-analysis provides compelling evidence that physician burnout is associated with poor function and sustainability of healthcare organisations primarily by contributing to the career disengagement and turnover of physicians and secondarily by reducing the quality of patient care. Healthcare organisations should invest more time and effort in implementing evidence-based strategies to mitigate physician burnout across specialties, and particularly in emergency medicine and for physicians in training or residency. SYSTEMATIC REVIEW REGISTRATION PROSPERO number CRD42021249492.
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Affiliation(s)
- Alexander Hodkinson
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Anli Zhou
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds, UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Keith Geraghty
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Ruth Riley
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Andrew Zhou
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Efharis Panagopoulou
- Laboratory of Hygiene, Aristotle Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - David Peters
- Westminster Centre for Resilience, Faculty of Science and Technology, University of Westminster, London, UK
| | - Aneez Esmail
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Maria Panagioti
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
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Sauder M, Zagales I, Zagales R, Das S, Sen-Crowe B, Bilski T, Kornblith L, Elkbuli A. Comprehensive Assessment of Burnout Among Surgical Trainees and Practicing Surgeons: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2022; 79:1188-1205. [PMID: 35624025 DOI: 10.1016/j.jsurg.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/14/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Surgeon burnout has received increasing attention due to evidence of high prevalence across specialties. We aimed to (1) systematically characterize existing definitions of burnout, (2) evaluate tools to measure burnout, and (3) determine risk factors of surgical burnout. DESIGN PubMed, Google Scholar, and Embase databases were searched to identify burnout rates and tools used to measure the quality of life (QoL) published from January 2000-December 2021. PARTICIPANTS Surgical Trainees and Practicing Surgeons. RESULTS We identified 39 studies that defined surgical burnout, with 9 separate tools used to measure QoL. Surgeon burnout rates were found to be highest among general surgery trainees (20%-95%). Burnout among general surgery attendings ranged from 25% to 44%. Those most likely to experience burnout were younger and female. High rates of surgeon burnout were reported among all surgical specialties; however, these rates were lower than those of general surgeons. CONCLUSION Definitions of burnout vary throughout the surgical literature, but are consistently characterized by emotional exhaustion, depersonalization, and lack of personal accomplishment. The most utilized tool to measure surgical burnout has been the Maslach Burnout Inventory. Across specialties, there are high rates of burnout in both surgical trainees and attendings, indicating that this is a systemic issue within the field of surgery. Given the wide-scale nature of the problem, it is recommended that institutions provide support to surgical trainees and attending surgeons and that individual surgeons take steps toward mitigating burnout.
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Affiliation(s)
- Matthew Sauder
- Dr. Kiran.C. Patel College of Allopathic Medicine, NSU NOVA Southeastern University, Fort Lauderdale, Florida
| | - Israel Zagales
- Universidad Iberoamericana (UNIBE) Escuela de Medicina, Santo Domingo, Dominican Republic
| | - Ruth Zagales
- Florida International University, Miami, Florida
| | - Snigdha Das
- Dr. Kiran.C. Patel College of Allopathic Medicine, NSU NOVA Southeastern University, Fort Lauderdale, Florida
| | - Brendon Sen-Crowe
- Dr. Kiran.C. Patel College of Allopathic Medicine, NSU NOVA Southeastern University, Fort Lauderdale, Florida
| | - Tracy Bilski
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida
| | - Lucy Kornblith
- Department of Surgery, Division of Trauma and Surgical Critical Care, Zuckerberg San Francisco General Hospital, San Francisco, California; University of San Francisco, San Francisco, California
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida.
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Impact of "Defensive Medicine" On the Costs of Diabetes and Associated Conditions. Ann Vasc Surg 2022; 87:231-236. [PMID: 35595208 DOI: 10.1016/j.avsg.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Geographic variation in healthcare spending is typically attributed to differences in patient health status and provider practice patterns. While medicolegal considerations (i.e., "defensive medicine") anecdotally impact healthcare spending, this phenomenon is difficult to measure. The purpose of this study was to explore the association between the medicolegal environment and Medicare costs for diabetes and associated conditions of interest to vascular surgeons. Specifically, we hypothesized that an adverse medicolegal environment is associated with higher per-capita Medicare costs for diabetic patients. METHODS Medicare data including the most recent (2018) Medicare Geographic Variation Public Use Files and Chronic Conditions Data Files were linked to National Practitioner Database (NPDB) files from the preceding 5 years (2013-2017), in addition to US Census data and AMA workforce statistics. State-level medicolegal environment was characterized by K-means clustering across a panel of metrics related to malpractice payment magnitude and prevalence. Per-capita Medicare spending for diabetes was compared across 5 distinct medicolegal environments. Costs were standardized and risk-adjusted to account for known geographic variation in healthcare costs and patient population. Analysis of variance (ANOVA) was applied to unadjusted data, followed by multivariate regression modeling. Readmissions rates, per-capita imaging studies, per-capita tests, per-capita procedures, and lower extremity amputation rates were compared between the least litigious quintile from the K-means clustering and the two most litigious quintiles. RESULTS Median (IQR) unadjusted Medicare per-capita expenditure on diabetic patients was $15,963 ($14,885 to $17,673), ranging from $13,762 (Iowa) to $21,865 (D.C.). 1.6-fold variation persisted after payment standardization. Cluster analysis based on malpractice-related variables yields 5 distinct medicolegal environments, based on litigation frequency and malpractice payment amounts. Per-capita spending on diabetes varied, ranging from $15,799 in states with low payments and infrequent litigation to $18,838 in states with the most adverse medicolegal environment (P<.05). After cost standardization and risk adjustment with multiple linear regression, malpractice claim prevalence (per 100 physicians) remained an independent predictor of states with the highest DM spending (p=0.022)[Table1]. Moreover, diabetic patients in states with adverse medicolegal environments had more procedures, imaging studies, and readmissions (p<.05 for all) but did not have significant differences in amputation rates compared to less litigious states. CONCLUSION An adverse medicolegal environment is independently associated with higher healthcare costs but does not result in improved outcome (i.e. amputation rate) for diabetic Medicare beneficiaries. Across states, a 1% increase in lawsuits/100 physicians was associated with a >10% increase in risk-adjusted standardized per-capita costs. These findings demonstrate the potential contribution of "defensive medicine" to variation in healthcare utilization and spending in a population of interest to vascular surgeons.
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Smith ME, Obi AT. The operating room may be hazardous to your health. J Vasc Surg 2022; 75:1437-1438. [DOI: 10.1016/j.jvs.2021.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022]
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Vascular Surgeon Burnout and Resilience in the United Kingdom: A report from the Vascular Society Workforce Committee. Ann Vasc Surg 2022; 84:169-178. [DOI: 10.1016/j.avsg.2022.01.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/12/2022] [Accepted: 01/23/2022] [Indexed: 11/22/2022]
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Chia MC, Hu YY, Li RD, Cheung EO, Eng JS, Zhan T, Sheahan MG, Bilimoria KY, Coleman DM. Prevalence and risk factors for burnout in U.S. vascular surgery trainees. J Vasc Surg 2022; 75:308-315.e4. [PMID: 34298120 PMCID: PMC8712370 DOI: 10.1016/j.jvs.2021.06.476] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/16/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Burnout and suicidality are known risks for vascular surgeons above other surgical subspecialties, with surgical trainees at risk for exposure to factors that increase burnout. This study aimed to inform initiatives to improve wellness by assessing the prevalence of hazards in vascular training (mistreatment, duty-hour violations) and the rates of wellness outcomes (burnout, thoughts of attrition/specialty change/suicide). We hypothesized that mistreatment and duty-hour violations would predispose trainees to increased burnout. METHODS We performed a cross-sectional study of residents and fellows enrolled in accredited United States vascular surgery training programs using a voluntary, confidential survey administered during the 2020 Vascular Surgery In-Training Examination. The primary outcome assessed was burnout symptoms reported on a weekly basis or more frequently. The rates of wellness outcomes were measured. The association of mistreatment and duty hours with the primary outcome was modeled with multivariable logistic regression. RESULTS A total of 475 residents and fellows who were enrolled in one of 120 vascular surgery training programs completed the survey (84.2% response rate). Of 408 trainees completing burnout survey items, 182 (44.6%) reported symptoms of burnout. Fewer trainees reported thoughts of attrition (n = 42 [10.0%], specialty change (n = 35 [8.4%]), or suicide (n = 22 [4.9%]). Mistreatment was reported by 191 vascular trainees (47.3%) and was more common in female trainees (n = 63 [48.5%] reporting monthly or more frequently) compared with male trainees (n = 51 [18.6%]; P < .001). Duty-hour violations were also more commonly reported by female trainees (n = 31 [21.4%] reporting 3+ months in violation) compared with male trainees (n = 50 [16.2%]; P = .002). After controlling for race/ethnicity, postgraduate year, program type, and geography, female trainees were less likely to report burnout (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.28-0.86). Trainees experiencing mistreatment monthly or more were three times more likely to report burnout (OR, 3.09; 95% CI, 1.78-5.39). Frequency of duty-hour violations also increased the odds of reporting burnout (1-2 months in violation: OR, 2.09; 95% CI, 1.17-3.73; 3+ months in violation: OR, 3.95; 95% CI, 2.24-6.97). CONCLUSIONS Nearly one-half of vascular surgery trainees reported symptoms of burnout, which was associated with frequency of mistreatment and duty-hour violations. Interventions to improve well-being in vascular surgery must be tailored to the local training environment to address trainee experiences that contribute to burnout.
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Affiliation(s)
- Matthew C Chia
- Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University, Chicago, Illinois
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University, Chicago, Illinois
| | - Ruojia Debbie Li
- Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University, Chicago, Illinois
| | - Elaine O Cheung
- Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University, Chicago, Illinois
| | - Joshua S Eng
- Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University, Chicago, Illinois
| | - Tiannan Zhan
- Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University, Chicago, Illinois
| | - Malachi G Sheahan
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana (Sheahan)
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Northwestern University, Chicago, Illinois
| | - Dawn M Coleman
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan (Coleman)
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Abstract
Rationale & Objective Burnout decreases job satisfaction and leads to poor patient outcomes but remains underinvestigated in nephrology. We explored the prevalence and determinants of burnout among a sample of nephrologists. Study Design Cross-sectional. Setting & Participants The nephrologists were approached via the American Medical Association Physicians Masterfile, National Kidney Foundation listserv, email, and social media between April and August 2019. The predictors were demographics and practice characteristics. The outcome was burnout, defined as responding “once a week” or more on either 1 of the 2 validated measures of emotional exhaustion and depersonalization or both. Analytical Approach Participant characteristics were tabulated. Responses were compared using χ2 tests. Multivariable logistic regression was used to estimate the odds ratios (ORs) of burnout for risk factors. Free text responses were thematically analyzed. Results About half of 457 respondents were 40-59 years old (n=225; 49.2%), and the respondents were more predominantly men (n=296; 64.8%), US medical graduates (n=285; 62.4%), and in academic practice (n=286; 62.6%). Overall, 106 (23.2%) reported burnout. The most commonly reported primary drivers of burnout were the number of hours worked (n=27; 25.5%) and electronic health record requirements (n=26; 24.5%). Caring for ≤25 versus 26-75 patients per week (OR, 0.34; 95% confidence interval [95% CI], 0.15-0.77), practicing in academic versus nonacademic settings (OR, 0.33; 95% CI, 0.21-0.54), and spending time on other responsibilities versus patient care (OR, 0.32; 95% CI, 0.17-0.61) were each independently associated with nearly 70% lower odds of burnout after adjusting for age, sex, race, and international medical graduate status. The free text responses emphasized disinterested health care systems and dissatisfaction with remuneration as the drivers of burnout. Limitations Inability to precisely capture response rate. Conclusions Nearly one-quarter of the nephrologists in our sample reported burnout. Future studies should qualitatively investigate how the care setting, time spent on electronic medical records, and hours of clinical care drive burnout and explore other system-level drivers of burnout in nephrology.
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Maloni KC, Calligaro KD. The inferiority of a virtual subinternship compared with in-person training. J Vasc Surg 2021; 74:2072-2073. [PMID: 34809814 DOI: 10.1016/j.jvs.2021.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Krystal C Maloni
- Department of Vascular surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC.
| | - Keith D Calligaro
- Department of Vascular surgery, Pennsylvania Hospital, Philadelphia, Pa
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Møller CM, Clausen T, Aust B, Eiberg JP. A cross-sectional national study of burnout and psychosocial work environment in vascular surgery in Denmark. J Vasc Surg 2021; 75:1750-1759.e3. [PMID: 34788647 DOI: 10.1016/j.jvs.2021.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Little is known about burnout among European vascular surgeons. In this study, the prevalence of burnout and its associated risk factors were investigated among all vascular surgeons (VS) and vascular surgeons in training (VST) in Denmark. METHODS An anonymous electronic survey was distributed to all clinical active VS and VST on the 1st of January 2020. Validated assessment tools were used to measure burnout and aspects of the psychosocial work environment. RESULTS 104 VSs and VSTs were invited to participate, and 82% (n=85) completed the survey. The majority of the respondents were male (60%, n=50) and VSs (67%, n=61). Of the respondents, 82% (n=70) reported either light (54%, n=46), moderate (22%, n=19) or severe (6%, n=5) personal burnout. More than 50% (n=47) reported work-related burnout, respectively light (39%, n=33), moderate (9%, n=8) and severe (7%, n=6), while 35% (n=30) reported patient-related burnout, respectively light (31%n=26), moderate (2%, n=2) and severe (2%, n=2). Respondents with more than four 24-hour-on-call shifts/month had significantly higher work-related burnout scores, while respondents with home-living children and those aged 45-59 years respectively showed significantly higher personal and patient-related burnout. There were strong associations between personal and work-related burnout and the psychosocial work environment, especially work organisation and interpersonal relations, but not job demands. The prevalence of burnout was unevenly distributed across departments, with the most affected department having a burnout occurrence twice the least affected department. CONCLUSIONS Based on a national survey conducted among all clinical active VSs and VSTs in Denmark, more than 80% (n=70) suffered from burnout, of which 28% (n=24) suffered from moderate to severe personal burnout. The strong association with the psychosocial work environment, and the significant differences between departments, suggest that burnout is modifiable through changes in the work environment.
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Affiliation(s)
- Cecilie Markvard Møller
- Department of Cardiothoracic and Vascular Surgery, University Hospital Aarhus, Denmark; The Danish Society of Vascular Surgery.
| | - Thomas Clausen
- The National Research Centre for the Working Environment (NRCWE), Copenhagen, Denmark
| | - Birgit Aust
- The National Research Centre for the Working Environment (NRCWE), Copenhagen, Denmark
| | - Jonas Peter Eiberg
- The Danish Society of Vascular Surgery; Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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A Gender-Based Analysis of Predictors and Sequelae of Burnout Amongst Practicing American Vascular Surgeons. J Vasc Surg 2021; 75:1422-1430. [PMID: 34634416 DOI: 10.1016/j.jvs.2021.09.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 09/13/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Surgeons report higher burnout and suicidal ideation (SI) rates than the general population. This study sought to identify the prevalence and gender-specific risk factors for burnout and SI among men and women vascular surgeons to guide future interventions. METHODS In 2018, active Society for Vascular Surgery (SVS) members were surveyed confidentially using the Maslach Burnout Index embedded in a questionnaire that captured demographic and practice-related characteristics. Results were stratified by gender. Univariate and multivariate logistic regression models were developed to identify predictors for the end points of burnout and SI. RESULTS Overall survey response rate was 34.3% (N=878) of practicing vascular surgeons. A higher percentage of women responded (19%) than compose SVS membership (13.7%). Women respondents were significantly younger, with fewer years in practice, and were less likely to be in private practice than the men who responded. Women were also less likely to be married/partnered, or to have children. The prevalence of burnout was similar for women and men (42.3% and 40.9% [NS]); however, the prevalence of SI was significantly higher in women (12.9% vs 6.6%; P < .007). Whereas there was no difference in mean hours worked or call taken, women were more likely to have had a recent conflict between work and home responsibilities and to have resolved this conflict in favor of work. Although men and women had the same incidence of reported recent medical errors, women were less likely to self-report a recent malpractice suit or to think that a fair resolution was reached. There was no gender difference in reported work-related pain. Multivariable analysis revealed that not enough family time and work-related pain were predictors for burnout in both men and women. Additional factors were associated with burnout in men, such as malpractice and EMR dissatisfaction. Multivariable analysis revealed that work-related pain was an independent predictor for SI for the entire cohort. CONCLUSION The prevalence of burnout among vascular surgeons is high. Women vascular surgeons have double the rates of SI compared to male vascular surgeons. Taken together, this study demonstrated that many of the same factors are associated with burnout in women and men, which include not enough family time, conflict between work and personal life, and work-related pain. Additional factors in men included conflict between work and family, work-related pain, and EMR dissatisfaction.
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Soh IY, Money SR, Huber TS, Coleman DM, Sheahan MG, Morrissey NJ, Hallbeck MS, Meltzer AJ. Malpractice Allegations Against Vascular Surgeons:Prevalence, Risk Factors, and Impact on Surgeon Wellness. J Vasc Surg 2021; 75:680-686. [PMID: 34478809 DOI: 10.1016/j.jvs.2021.07.233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/25/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The contemporary medicolegal environment has been linked to procedure overuse, healthcare variation, and higher costs. For physicians accused of malpractice, there is also a personal toll. The objective of this study was to evaluate the prevalence of and risk factors for involvement in medical malpractice lawsuits among US vascular surgeons, and to examine the association between these allegations with surgeon wellness. METHODS In 2018, the Society of Vascular Surgery (SVS) Wellness Task Force conducted a confidential survey of active members using a validated burnout assessment (Maslach Burnout Index) embedded into a questionnaire. This survey included questions related to medical errors and malpractice litigation. De-identified demographic, personal, and practice-related characteristics were assessed in respondents who reported malpractice allegations in the preceding two years, then compared to those without recent medicolegal litigation. Risk factors for malpractice allegations were identified (chi-square, Kruskal-Wallis tests), and the association between malpractice allegations with wellness was examined. Multivariate logistic regression models were developed to identify independent risk factors for malpractice accusations. RESULTS Of 2905 active SVS members, 871 responses from practicing vascular surgeons were analyzed. 161 (18.5%) were named in a malpractice lawsuit within two years. Malpractice allegations were significantly associated with surgeon burnout [OR 1.47 (1.01, 2.15), p=0.041], but not with self-reported depression or suicidal ideation. The nature of malpractice claims included procedural errors (23.1%), failure to treat (18.8%) and error/delay in diagnosis (16.9%). 20% of claims were settled prior to trial and 19% were dismissed. Defendant vascular surgeons reported a "fair" resolution in 26.4% of closed cases. By unadjusted analysis, factors significantly associated with recent malpractice claims included mean age (51.7+/-10.0 vs. 49.3+/-11.2; p=0.0044) and mean years in practice (18.0+/-10.7 vs. 15.2+/-11.8; p=0.0007). Multivariate analysis revealed independent variables associated with malpractice allegations, including on-call frequency (p=0.0178), recent medical errors (p=0.0189), and male surgeons (p=0.045). CONCLUSIONS Malpractice allegations are common for vascular surgeons and are significantly associated with surgeon burnout. Nearly 20% of survey respondents reported being named in a lawsuit within the preceding two years. Our findings underscore the need for SVS initiatives to provide counseling and peer support for vascular surgeons facing litigation.
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Affiliation(s)
- I Y Soh
- Division of Vascular Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ.
| | - S R Money
- Division of Vascular Surgery, Department of Surgery, Ochsner Health, New Orleans, LA
| | - T S Huber
- Division of Vascular Surgery, Department of Surgery, University of Florida, Gainesville, FL
| | - D M Coleman
- Section of Vascular Surgery, Department of Surgery, The University of Michigan, Ann Arbor, MI
| | - M G Sheahan
- Division of Vascular Surgery, Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - N J Morrissey
- Division of Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - M S Hallbeck
- Division of Vascular Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - A J Meltzer
- Division of Vascular Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ
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Drudi LM, Nishath T, Ma X, Mouawad NJ, O'Banion LA, Shalhub S. The impact of the COVID-19 pandemic on wellness among vascular surgeons. Semin Vasc Surg 2021; 34:43-50. [PMID: 34144747 PMCID: PMC9710729 DOI: 10.1053/j.semvascsurg.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 12/14/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has placed significant strain on the health and welfare of all health care professionals, including vascular surgeons. This review summarizes the implications of the pandemic on the health and wellness of surgeons and trainees, with a particular focus on those in vascular surgery (VS). A literature review was completed using common resource databases. We provide a brief history of burnout in VS and explore burnout and wellness in VS during this unprecedented pandemic. We then offer recommendations to address mental health needs by the VS workforce and highlight opportunities to address the gaps in the literature. The impact of COVID-19 on the professional and personal lives of surgeons and trainees in VS is notable. More than half of vascular surgeons reported some degree of anxiety. Factors associated with anxiety and burnout include COVID-19 exposure, moral injury, practice changes, and financial impacts. Trainees appeared to have more active coping strategies with dampened rates of anxiety compared to those in practice. Women appear to be disproportionately affected by the pandemic, with higher rates of anxiety and burnout. Groups underrepresented in medicine seemed to have more resilience when it came to burnout, but struggled with other inequities in the health care environment, such as structural racism and isolation. Strategies for addressing burnout include mindfulness practices, exercise, and peer and institutional support. The COVID-19 pandemic has had a substantial mental health impact on the VS workforce globally, as shifts were made in patient care, surgical practice, and work-home life concerns.
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Affiliation(s)
- Laura M. Drudi
- Division of Vascular Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Thamanna Nishath
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Xiya Ma
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | | | - Leigh Ann O'Banion
- Division of Vascular and Endovascular Surgery, University of California San Francisco–Fresno, Fresno, CA
| | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356410, Seattle, WA, 98195,Corresponding author
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Coleman DM. Invited commentary. J Vasc Surg 2021; 73:2164-2165. [PMID: 34024463 DOI: 10.1016/j.jvs.2021.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/26/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Dawn M Coleman
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
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Goldstone J. Maintenance of health is as important as maintenance of certification. J Vasc Surg 2021; 73:1851. [PMID: 34024459 DOI: 10.1016/j.jvs.2020.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/15/2020] [Indexed: 10/21/2022]
Affiliation(s)
- Jerry Goldstone
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, Calif
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Zhang JQ, Dong J, Pardo J, Emhoff I, Serres S, Shanafelt T, James T. Burnout and Professional Fulfillment in Early and Early-Mid-Career Breast Surgeons. Ann Surg Oncol 2021; 28:6051-6057. [PMID: 33876361 DOI: 10.1245/s10434-021-09940-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/08/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Prior work has shown that burnout among breast surgeons is prevalent and highest in those earlier in their clinical practice career. Therefore, we sought to better understand and identify specific contributors to early-career breast surgeon burnout. METHODS We analyzed data from our 2017 survey of members of the American Society of Breast Surgeons. The 16-items of the Professional Fulfillment Index were used in determining overall burnout and professional fulfillment scores. Multivariable regressions were performed to evaluate factors related to overall burnout and professional fulfillment. RESULTS The mean overall burnout score was 1.23 (0-4 scale; higher score unfavorable) for surgeons in practice < 5 years, compared with 1.39 for surgeons in practice 5-9 years and 1.22 for those in practice ≥ 10 years. The mean professional fulfillment score was 2.71 (0-4 scale; higher score favorable) for surgeons in practice < 5 years, 2.66 for surgeons in practice 5-9 years, and 2.67 for surgeons in practice ≥ 10 years. Multivariable analysis showed that burnout was positively correlated with ≥ 60 work hours per week in the group practicing for < 5 years, and dedicating less than full time to breast surgery in the group in practice 5-9 years. Professional fulfillment was negatively associated with single relationship status in surgeons practicing < 5 years, and dedicating less than full time to breast surgery for those in practice 5-9 years. CONCLUSION Our study suggests that breast surgeons who have been in practice for 5-9 years have particularly high overall burnout rates and additional support focused on this group of breast surgeons may be needed.
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Affiliation(s)
- Jennifer Q Zhang
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joe Dong
- OpenNotes, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jaime Pardo
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Isha Emhoff
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Stephanie Serres
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tait Shanafelt
- Stanford University School of Medicine, Stanford, CA, USA
| | - Ted James
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,BreastCare Center, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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