Job Satisfaction Among Young Board-Certified Surgeons at Academic Centers in Europe and North America

Surgeon-Scientists Going Extinct: Last Call for Action or Too Late?

OBJECTIVE

To define the concept of surgeon-scientists and identify the root causes of their decline in number and impact. The secondary aim was to provide actionable remedies.

BACKGROUND

Surgeons who conduct research in addition to patient care are referred to as "surgeon-scientists." While their value to society remains undisputed, their numbers and associated impact have been plunging. While reasons have been well identified along with proposals for countermeasures, their application has largely failed.

METHODS

We conducted a systematic review covering all aspects of surgeon-scientists together with a global online survey among 141 young academic surgeons. Using gap analysis, we determined implementation gaps for proposed measures. Then, we developed a comprehensive rescue package.

RESULTS

A surgeon-scientist must actively and continuously engage in both patient care and research. Competence in either field must be established through protected training and criteria of excellence, particularly reflecting contribution to innovation. The decline of surgeon-scientists has reached an unprecedented magnitude. Leadership turning hospitals into "profit factories" is one reason, a flawed selection process not exclusively based on excellence is another. Most importantly, the appreciation for the academic mission has vanished. Along with fundamentally addressing these root causes, surgeon-scientists' path to excellence must be streamlined, and their continuous devotion to innovation cherished.

CONCLUSIONS

The journey of the surgeon-scientist is at a crossroads. As a society, we either adapt and shift our priorities again towards innovation or capitulate to greed for profit, permanently losing these invaluable professionals. Successful rescue packages must not only involve hospitals and universities but also the political sphere.

[Working conditions in surgery and their impact : Results of a national survey]

BACKGROUND

In surgical disciplines poor working conditions and a high level of dissatisfaction among surgeons in the various disciplines have been reported. The psychological consequences of these conditions on the surgeons themselves and the effects on their families have so far been inadequately considered.

OBJECTIVE

The objective of this national survey of the Professional Association of German Surgery (Berufsverband der Deutschen Chirurgie e. V.) was to determine the current status of working conditions in surgical departments of German hospitals and to demonstrate their psychological and familial effects.

MATERIAL AND METHODS

In the period January-February 2024 a questionnaire with 26 questions focusing on psychological stress, work-related partnership and family problems as well as addictive behavior was sent to all members of the Berufsverband der Deutschen Chirurgie e. V. and to all German surgical societies.

RESULTS

A total of 2221 questionnaires could be analyzed. Among the survey participants, bureaucracy (84.4%) and inadequate compensation for overtime (68.1%) were seen as the main stress factors. Alcohol (20.3%), nicotine (8.9%) and medication (8.3%) were cited as ways of managing the workload. Of the surgeons 60% reported a negative impact on their relationship with their partner and 40% on their relationship with their children.

DISCUSSION

The surgeons reported poor working conditions. These have a massive impact on the mental health of surgeons and on their family relationships. Consequently, many surgeons consider leaving the surgical profession. To improve this situation and to make the surgical profession attractive again, a drastic rethinking is needed.

Towards a Virtual "Global Academia of Surgeons"

OBJECTIVE

To explore the prospects of academic e-learning by evaluating our long-standing internet-based surgical learning program and to assess the impact of training on the presentation skills of our residents. The eventual goal is to search whether such models could be further developed by the European Surgical Association (ESA).

BACKGROUND

E-learning has become a major educational trend particularly during the COVID-19 pandemic. For more than a decade, our academic tertiary center has released weekly video-lectures covering the entire abdominal-surgical curriculum for residents. All lessons were prepared under the supervision of specialized experts and recorded and edited by a professional film team before being released on a dedicated YouTube channel ( https://www.usz.ch/surgical-resident-lectures ).

METHODS

To date, our channel includes 120 presentations with more than 619,000 views. We conducted a survey among online users with a medical background and tested the benefits and potential for improvements of local stakeholders to collect individual reviews.

RESULTS

A total of 708 users from 106 countries participated in the survey. Continuing medical education (49%), specific questions (38%), and exam preparation (33%) were the main motivations for video viewing. The preferred topics were current guidelines (69%), latest research topics (59%), and complex surgical conditions (52%). Ninety-four percent of our local audience reported a positive learning experience.

CONCLUSION

E-learning can improve local academic training and promote the global visibility of strong academic centers. Providing free and unrestricted expertise via social media is a novel and groundbreaking opportunity that fills a global education gap by dissemination of surgical education on an unprecedented scale. Expert associations such as the ESA may adopt similar formats and foster their perception as true beacons of knowledge.

Burnout in Canadian urology: Cohort analysis from the 2018 Canadian Urological Association census

INTRODUCTION

Physician burnout is associated with medical error, patient dissatisfaction, and poorer physician health. Urologists have reported high levels of burnout and poor work-life integration compared with other physicians. Burnout rates among Canadian urologists has not been previously investigated. We aimed to establish the prevalence of Canadian urologist burnout and associated factors.

METHODS

In the 2018 Canadian Urological Association census, the Maslach Burnout Inventory questions were assigned to all respondents. Responses from 105 practicing urologists were weighted by region and age group to represent 609 urologists in Canada. Burnout was defined as scoring high on the scales of emotional exhaustion or depersonalization. Demographic and practice variables were assessed to establish factors associated with burnout. Comparisons were made to the results of the 2016 American Urological Association census.

RESULTS

Overall, 31.8% of respondents met the criteria for burnout. There was no effect of subspecialty practice or practice setting on burnout. On univariate analysis, rates of burnout were highest among urologists under financial strain (50.8%), female urologists (45.3%), and early-to-mid-career urologists (37.7-41.8%). Factors associated with demanding practices and poor work-life integration were predictive of burnout. A total of 12.2% of urologists reported seeking burnout resources and 54.0% wished there were better resources available.

CONCLUSIONS

Urologist burnout in Canada is lower than reported in other countries, but contributing factors are similar. Urologists who report demanding clinical practices (particularly in early-to-mid career), poor work-life integration, financial strain, and female gender may benefit from directed intervention for prevention and management of burnout. Burnout resources for Canadian urologists require further development.

Job satisfaction and workplace stressors among surgical providers at a single institution

OBJECTIVE

Job satisfaction and work stress are associated with provider health and patient outcomes. This study aimed to evaluate job satisfaction and workplace stressors in surgical providers (surgeons, physician assistants [PAs], and NPs).

METHODS

A survey was distributed to providers within a single surgical department. Job satisfaction and workplace stressors were evaluated by sex, age, profession, career length, and work hours.

RESULTS

Providers practicing for 11 to 15 years had greater job satisfaction than those practicing for more than 20 years, with no other differences by demographic group. Females cited supervisory support as a top workplace stressor more than did males (P = .01) and PAs and NPs cited supervisory support (P < .01) and compensation/finances more than surgeons (P = .05). Workplace stressors varied by practice years and work hours.

CONCLUSIONS

Healthcare organizations should be aware of diversity in perceived workplace stressors. A "one size fits all" approach to provider well-being is likely to be ineffective.

[Qualitative study on young hospital physicians: They remain satisfied…]

INTRODUCTION

Prevalence of depression, suicidal ideation and burnout are higher among physicians than in general population. Young physicians seem more concerned and the beginning of career seems to be a period of greater risks for hospital practitioners. While this may be the case, in France, few studies have specifically evaluated the quality of the working conditions of this population. The objective of this study is to identify stress factors related to the organization of work and to social relationships at work, as they are perceived by the young hospital physicians.

METHODS

A qualitative study through semi-structured interviews was conducted with hospital practitioners with less than 10 years of practice. Manual analysis of the interviews was carried out by three interviewers and supplemented by a computerized lexical analysis.

RESULTS

Eighteen physicians were interviewed. Five categories of psychosocial and organizational factors have been identified. Teamwork and communication are generally associated with positive feelings. The pace of work, professional status, organizational factors and material conditions are considered unsatisfactory. Young physicians, however, are satisfied with the content of their work, particularly because of scientific emulation and skills development.

CONCLUSION

The results of this study should help to better target prevention actions in order to improve the working conditions of young doctors. It seems a priority to reduce their workload or to regulate their working time, to offer greater stability to their work and to provide them with better material work conditions.

Burnout and psychological distress between surgical and non-surgical residents

Surgical training is considered to be very stressful among residents and medical students choose less often surgery for their career. Our aim was to assess the prevalence of burnout and psychological distress in residents attending surgical specialties (SS) compared to non-surgical specialties (NSS). Residents from the University of Bologna were asked to participate in an anonymous online survey. The residents completed a set of questions regarding their training schedule and three standardized questionnaires: (1) the Maslach Burnout Inventory, assessing the three dimensions of burnout: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA); (2) the Zung Self-Rating Depression Scale; (3) the Psychosomatic Problems Scale. One-hundred and ninety residents completed the survey. Overall, the prevalence of burnout was 73% in the SS group and 56.3% in the NSS group (P = 0.026). More specifically, SS reported higher levels of EE and DP compared to NSS. No significant differences between SS and NSS emerged for PA, depression, or somatic problems. The present findings indicate that burnout is more prevalent in surgical residents than in residents attending non-surgical specialties. ClinicalTrials.gov identifier: NCT03668080.

The Economics of Academic Advancement Within Surgery

BACKGROUND

The success of an academic surgeon's career is often viewed as directly related to academic appointment; therefore, the sequence of promotion is a demanding, rigorous process. This paper seeks to define the financial implication of academic advancement across different surgical subspecialties.

STUDY DESIGN

Data was collected from the Association of American Medical College's 2015 report of average annual salaries. Assumptions included 30 years of practice, 5 years as assistant professor, and 10 years as associate professor before advancement. The base formula used was: (average annual salary) × (years of practice [30 years - fellowship/research years]) + ($50,000 × years of fellowship/research) = total adjusted lifetime salary income.

RESULTS

There was a significant increase in lifetime salary income with advancement from assistant to associate professor in all subspecialties when compared to an increase from associate to full professor. The greatest increase in income from assistant to associate professor was seen in transplant and cardiothoracic surgery (35% and 27%, respectively). Trauma surgery and surgical oncology had the smallest increases of 8% and 9%, respectively. With advancement to full professor, the increase in lifetime salary income was significantly less across all subspecialties, ranging from 1% in plastic surgery to 8% in pediatric surgery.

CONCLUSION

When analyzing the economics of career advancement in academic surgery, there is a substantial financial benefit in lifetime income to becoming an associate professor in all fields; whereas, advancement to full professor is associated with a drastically reduced economic benefit.

Academic versus Clinical Productivity of Cardiac Surgeons in the State of New York: Who Publishes More and Who Operates More

We investigated whether/how cardiac surgeons can be productive both academically and clinically. Using online resources (New York State Adult Cardiac Surgery database, SCOPUS), we collected individual clinical volumes (operations performed/year), academic metrics (ongoing publications, role as author), practice setting, and seniority for all cardiac surgeons in the State of New York from 1994 to 2011. Over time, individual clinical volumes decreased (median operations/year: 193 in 1995 vs 126 in 2010; P < 0.001), whereas academic productivity remained unchanged (median publications/year: 0.7 vs 0.3; P = 0.55). There was no correlation (Spearman's correlation coefficient: -0.061; P = 0.08) between the number of new publications and operations/year for the whole population. More operations/year (median: 155 vs 144; P = 0.03) were performed by surgeons without versus with publications during that same year. Who published more worked at hospitals with higher clinical volumes (Spearman's correlation coefficient: 0.16; P < 0.001) and was more likely affiliated with thoracic surgery fellowship programs (median publications/year: 1.7 for affiliated vs 0 for nonaffiliated surgeons; P < 0.001). Cardiac surgeons could be classified into four categories: ∼40 per cent clinically busy, but not publishing at all; ∼45 per cent operating less, but publishing a little; ∼15 per cent clinically very productive (operating as much as the non-publishers) and publishing a lot; and ∼1 per cent operating the least, but publishing the most.

Analysis of gender-based differences among surgeons in Japan: results of a survey conducted by the Japan Surgical Society. Part 1: Working style

PURPOSE

To assess the working styles of men and women working as surgeons in Japan.

METHODS

In July, 2014, the Japan Surgical Society invited all their members (n = 29,861), through an internet campaign, to participate in a nationwide survey of surgeons. The items investigated in this descriptive study included demographic information and working styles, based on a questionnaire.

RESULTS

In total, 6211 surgeons participated (response rate 20.8%, 5586 men and 625 women). The largest age stratum was 40-49 years for men and 30-39 years for women. Overall, respondents identified their labor contract, including salary and work hours, as the highest priority for improvement. Women with children were more likely to be part-time employees, work fewer hours, and take fewer house calls/on-calls than their male counterparts. Moreover, women of all ages earned a lower annual income than men, irrespective of whether they had children. Perception scores for discrimination related to work and promotion were significantly higher among women than men (p < 0.01 and p = 0.011, respectively).

CONCLUSIONS

A significant difference in working style was observed between men and women working as surgeons in Japan.

Among Musculoskeletal Surgeons, Job Dissatisfaction Is Associated With Burnout

BACKGROUND

Burnout is common in professions such as medicine in which employees have frequent and often stressful interpersonal interactions where empathy and emotional control are important. Burnout can lead to decreased effectiveness at work, negative health outcomes, and less job satisfaction. A relationship between burnout and job satisfaction is established for several types of physicians but is less studied among surgeons who treat musculoskeletal conditions.

QUESTIONS/PURPOSES

We asked: (1) For surgeons treating musculoskeletal conditions, what risk factors are associated with worse job dissatisfaction? (2) What risk factors are associated with burnout symptoms?

METHODS

Two hundred ten (52% of all active members of the Science of Variation Group [SOVG]) surgeons who treat musculoskeletal conditions (94% orthopaedic surgeons and 6% trauma surgeons; in Europe, general trauma surgeons do most of the fracture surgery) completed the Global Job Satisfaction instrument, Shirom-Malamed Burnout Measure, and provided practice and surgeon characteristics. Most surgeons were male (193 surgeons, 92%) and most were academically employed (186 surgeons, 89%). Factors independently associated with job satisfaction and burnout were identified with multivariable analysis.

RESULTS

Greater symptoms of burnout (β, -7.13; standard error [SE], 0.75; 95% CI, -8.60 to -5.66; p < 0.001; adjusted R(2), 0.33) was the only factor independently associated with lower job satisfaction. Having children (β, -0.45; SE, 0.0.21; 95% CI, -0.85 to -0.043; p = 0.030; adjusted R(2), 0.046) was the only factor independently associated with fewer symptoms of burnout.

CONCLUSIONS

Among an active research group of largely academic surgeons treating musculoskeletal conditions, most are satisfied with their job. Efforts to limit burnout and job satisfaction by optimizing engagement in and deriving meaning from the work are effective in other settings and merit attention among surgeons.

LEVEL OF EVIDENCE

Level II, prognostic study.

Factors affecting scientific productivity of German oral-maxillofacial surgery training centers: a retrospective cohort study

PURPOSE

To identify factors associated with scientific productivity (SP) of German oral-maxillofacial surgery (OMFS) training centers.

MATERIALS AND METHODS

This retrospective cohort study was composed of a set of data from German OMFS training centers. A total of eight predictor variables were grouped into demographic, structural, and personal categories. The outcome variables were average publications in 2013 per senior staff, and percentage of OMFS trainees with >1 publications. Descriptive and univariate statistics were computed using P < 0.05.

RESULTS

The sample included outputs from 62 OMFS departments (34 [54.8 %] university-based; 46 [74.2 %] in large cities). Average publications were 2.4 ± 3 per senior staff (range, 0-27), and 160 trainees (31.7 %) published >1 papers. The number of publications and productive trainees was not linked to department name and number of female senior staffs, but publication count was significantly increased when the hospital was in a metropolis (P = 0.018) or university-based (P < 0.0001), the OMFS' chairperson and >3 staffs within the department had a postdoctoral degree (German "Habilitation") (P = 0.013 and <0.0001), and the chairperson had h-index >10 or the first/last authorship in 2013 (P < 0.0001). Female senior surgeons were less scientifically productive than the male ones (P = 0.01).

CONCLUSION

SP of German OMFS training centers is greatly different across the country and influenced by city size, university base, educational backgrounds, and research activities of chairpersons and senior staffs. This helps students, trainees, and young surgeons to reach the career choice that is personally appropriate. The involved organizations may need to encourage research output of less productive surgeons/centers. Increasing postdoctoral-qualified staffs will increase SP of the department.

"It takes a village" to raise research productivity: Impact of a Trauma Interdisciplinary Group for Research (TIGR) at an urban, Level 1 trauma center

BACKGROUND

Few interdisciplinary research groups include basic scientists, pharmacists, therapists, nutritionists, lab technicians, as well as trauma patients and families, in addition to clinicians. Increasing interprofessional diversity within scientific teams working to improve trauma care is a goal of national organizations and federal funding agencies like the National Institutes of Health (NIH). This paper describes the design, implementation, and outcomes of a Trauma Interdisciplinary Group for Research (TIGR) at a Level 1 trauma center as it relates to increasing research productivity, with specific examples excerpted from an on-going NIH-funded study.

METHODS

We utilized a pre-test/post-test design with objectives aimed at measuring increases in research productivity following a targeted intervention. A SWOT (strengths, weaknesses, opportunities, threats) analysis was used to develop the intervention which included research skill-building activities, accomplished by adding multidisciplinary investigators to an existing NIH-funded project. The NIH project aimed to test the hypothesis that accelerated biologic aging from chronic stress increases baseline inflammation and reduces inflammatory response to trauma (projected N=150). Pre/Post-TIGR data related to participant screening, recruitment, consent, and research processes were compared. Research productivity was measured through abstracts, publications, and investigator-initiated projects.

RESULTS

Research products increased from N =12 to N=42; (~ 400%). Research proposals for federal funding increased from N=0 to N=3, with success rate of 66%. Participant screenings for the NIH-funded study increased from N=40 to N=313. Consents increased from N=14 to N=70. Lab service fees were reduced from $300/participant to $5/participant.

CONCLUSIONS

Adding diversity to our scientific team via TIGR was exponentially successful in 1) improving research productivity, 2) reducing research costs, and 3) increasing research products and mentoring activities that the team prior to TIGR had not entertained. The team is now well-positioned to apply for more federally funded projects and more trauma clinicians are considering research careers than before.