Practice Patterns and Outcomes Among Surgical Oncology Fellowship Graduates Performing Complex Cancer Surgery in the United States Across Different Career Stages

BACKGROUND

Practice patterns and potential quality differences among surgical oncology fellowship graduates relative to years of independent practice have not been defined.

METHODS

Medicare claims were used to identify patients who underwent esophagectomy, pancreatectomy, hepatectomy, or rectal resection for cancer between 2016 and 2021. Surgical oncology fellowship graduates were identified, and the association between years of independent practice, serious complications, and 90-day mortality was examined.

RESULTS

Overall, 11,746 cancer operations (pancreatectomy [61.2%], hepatectomy [19.5%], rectal resection [13.7%], esophagectomy [5.6%]) were performed by 676 surgical oncology fellowship graduates (females: 17.7%). The operations were performed for 4147 patients (35.3%) by early-career surgeons (1-7 years), for 4104 patients (34.9%) by mid-career surgeons (8-14 years), and for 3495 patients (29.8%) by late-career surgeons (>15 years). The patients who had surgery by early-career surgeons were treated more frequently at a Midwestern (24.9% vs. 14.2%) than at a Northeastern institution (20.6% vs. 26.9%) compared with individuals treated by late-career surgeons (p < 0.05). Surgical oncologists had comparable risk-adjusted serious complications and 90-day mortality rates irrespective of career stage (early career [13.0% and 7.2%], mid-career [12.6% and 6.3%], late career [12.8% and 6.5%], respectively; all p > 0.05). Surgeon case-specific volume independently predicted serious complications across all career stages (high vs. low volume: early career [odds ratio {OR}, 0.80; 95% confidence interval {CI}, 0.65-0.98]; mid-career [OR, 0.81; 95% CI, 0.66-0.99]; late career [OR, 0.78; 95% CI, 0.62-0.97]).

CONCLUSION

Among surgical oncology fellowship graduates performing complex cancer surgery, rates of serious complications and 90-day mortality were comparable between the early-career and mid/late-career stages. Individual surgeon case-specific volume was strongly associated with postoperative outcomes irrespective of years of independent practice or career stage.

Malpractice Claims Following Major Liver and Pancreatic Surgeries: What Can we Learn?

INTRODUCTION

General surgery is a highly litigious specialty. Lawsuits can be a source of emotional distress and burnout for surgeons. Major hepatic and pancreatic surgeries are technically challenging general surgical oncology procedures associated with an increased risk of complications and mortality. It is unclear whether these operations are associated with an increased risk of lawsuits. The objective of the present study was to summarize the medical malpractice claims surrounding pancreatic and hepatic surgeries from publicly available court records.

METHODS

The Westlaw legal database was searched and analyzed for relevant malpractice claims from the last two decades.

RESULTS

Of 165 search results, 30 (18.2%) cases were eligible for inclusion. Appellant cases comprised 53.3% of them. Half involved a patient death. Including co-defendants, a majority (n = 21, 70%) named surgeons as defendants, whereas several claims (n = 13, 43%) also named non-surgeons. The most common cause of alleged malpractice was a delay in diagnosis (n = 12, 40%). In eight of these, surgery could not be performed. The second most common were claims alleging the follow-up surgery was due to negligence (n = 6). Collectively, 20 claims were found in favor of the defendant. Seven verdicts (23.3%) returned in favor of the plaintiff, two of which resulted in monetary awards (totaling $1,608,325 and $424,933.85). Three cases went to trial or delayed motion for summary judgment. There were no settlements.

CONCLUSIONS

A defendant verdict was reached in two-thirds of malpractice cases involving major hepatic or pancreatic surgery. A delay in diagnosis was the most cited claim in hepatopancreaticobiliary lawsuits, and defendants may often practice in nonsurgical specialties. While rulings favoring plaintiffs are less frequent, the payouts may be substantial.

Interactive multidisciplinary pilot workshop to improve medical student perception of and interest in breast surgical oncology

BACKGROUND

Exposure to breast surgical oncology (BSO) and the multidisciplinary management of patients with breast cancer is limited in medical school. The purpose of this study was to assess changes in student perceptions of BSO as a career following an interactive multidisciplinary workshop.

METHODS

Pre-clinical medical students participated in a multidisciplinary, hands-on workshop, composed of breast radiology (BR), breast surgical oncology (BSO) and breast plastic reconstructive surgery (B-PRS). BR presented students screening and diagnostic breast imaging followed by hands-on ultrasound-guided biopsy on phantom simulators. BSO demonstrated lumpectomy, mastectomy, sentinel lymph node biopsy, and axillary lymph node dissections while B-PRS demonstrated oncoplastic techniques and autologous flap reconstruction with cadavers. Pre-and post-workshop surveys assessed student opinions on surgery and BSO. Results were compared using Wilcoxon Signed Rank, Wilcoxon Rank Sum, and Fisher's Exact.

RESULTS

The workshop was attended by twenty-four students. There was a statistically significant increase in interest in BSO from 52% to 86% after the workshop (p = 0.003). The event improved understanding of the work and lifestyle in BSO for 79% (19/24). All students (100%) expressed interest to further explore BSO. The most common attractors to a career in BSO were impacts on patients' lives (N = 23), intellectual stimulation (N = 22), and earnings (N = 20). The most reported deterrents were lack of personal time (N = 18) and stress (N = 15).

CONCLUSION

An interactive, anatomically based exposure to multidisciplinary breast cancer surgery improves medical student perception and interest in BSO. Medical schools should consider incorporating similar events to foster interest in BSO and other surgical subspecialties.

The prevalence of burnout in oncology professionals: an overview of systematic reviews with meta-analyses including more than 90 distinct studies

PURPOSE

This overview of reviews aimed to summarize the prevalence of burnout and the dimensions of burnout (emotional exhaustion, depersonalization, and personal accomplishment) in oncology professionals around the world.

METHODS

The CINAHL, Embase, PsycINFO, and PubMed databases were searched from inception to September 13, 2023. AMSTAR 2 was used to assess the quality of reviews. The overlap between reviews was calculated.

RESULTS

Twelve reviews were included. Overall, reviews showed that burnout was prevalent in oncologists and oncology nurses. On the other hand, no reviews meta-analyzed the prevalence of burnout in oncology radiation therapists. In addition, the dimensions of burnout, high emotional exhaustion, high depersonalization, and low personal accomplishment were highly prevalent across reviews in oncologists, oncology nurses, and oncology radiation therapists. In oncologists, the Americas (specifically Canada) showed the highest prevalence rates for high emotional exhaustion, whereas high depersonalization and low personal accomplishment were mainly prevalent in Europe and Asia, respectively. In oncology nurses, high emotional exhaustion and high depersonalization were mainly prevalent in Asia, whereas low personal accomplishment was more prevalent in the Americas (specifically Canada). The prevalence of overall levels of burnout was not meta-analyzed by continents.

CONCLUSION

Some methodological improvements may help to make more robust the findings of this overview (e.g., specific subgroup meta-analyses by oncology specialties), which may help readers reach more precise, direct, and consistent findings.

PROTOCOL REGISTRATION

https://doi.org/10.17605/OSF.IO/QPWG5 .

Well-Being and Professional Fulfillment in Mohs Surgeons: An Explanatory Sequential Mixed-Method Design Study

BACKGROUND

There are limited data evaluating specific themes of well-being and professional fulfillment in Mohs surgeons.

OBJECTIVE

To identify factors that drive occupational distress and those that promote well-being and professional fulfillment among Mohs surgeons.

METHODS

This is an explanatory sequential mixed-method study, using semistructured individual interviews. Common drivers of physician well-being and fulfillment were identified based on the independent assessment of the coding in the interview transcripts.

RESULTS

This study reports the following qualitative themes: (1) gratitude for the chosen profession and relationships, (2) unrealistic standards of perfection that may have contributed to past career success but are unattainable and create emotional burden, and (3) ability to practice in a manner aligned with personal values promotes professional fulfillment.

CONCLUSION

This study suggests that gratitude, self-compassion, and ability to practice in a manner aligned with personal values promote well-being and professional fulfillment in Mohs surgeons. Notably, we found that unrealistic standards of perfection and personal-organization practice incongruences contribute to burnout.

Social support moderates the relationship between burnout and job satisfaction in aerodigestive team members

OBJECTIVES

Burnout among healthcare workers is a public health crisis. Burnout is associated with elevated cynicism, emotional exhaustion, and low job satisfaction. Methods to combat burnout have been challenging to identify. Based on positive experiences of pediatric aerodigestive team members, we hypothesized that social support in multidisciplinary aerodigestive teams moderates the effects of burnout on job satisfaction.

METHODS

Using a survey of the Aerodigestive Society, members of Aerodigestive teams (N = 119) completed demographics, the Maslach Burnout Inventory, and measures of job satisfaction, emotional, and instrumental social support. In addition to assessing relationships between components of burnout and job satisfaction, six tests were conducted using PROCESS to ascertain the degree to which social support moderated these relationships.

RESULTS

Similar to US healthcare base rates, burnout scores in this sample suggest that a third-to-half felt Emotionally Exhausted and Burned Out from work "A few times a month"-to-"Every Day." Simultaneously, however, the majority in sample (60.6%) noted feeling that they "positively impact others' lives" with 33.3% endorsing "Every Day." Job satisfaction was strikingly high at 89%, with most reporting Aerodigestive team affiliation related to higher job satisfaction. Both Emotional and Instrumental social support moderated the effect of Cynicism and Emotional Exhaustion on Job Satisfaction, with higher Job Satisfaction scores in conditions of high support.

CONCLUSIONS

These results support the hypothesis that social support from a multidisciplinary aerodigestive team moderates the effect of burnout in its team members. Further work is needed to understand if membership in other interprofessional healthcare teams can help combat the negative effects of burnout.

Investigating Surgeons' Reactions to Patients' Death: A Phenomenological Study

The main purpose of this study was to scrutinize the reaction of surgeons towards patients' death. This study enjoyed a qualitative approach using a phenomenological lived experience. 12 surgeons who had witnessed patients' death were selected through purposive sampling until data saturation was achieved. The data were collected using semi-structured interviews and were analyzed through the Colaizzi's method. The main concepts extracted from the analysis of the participants' experience comprised three main themes, six sub-categories and 19 initial sub-categories. The main themes were (a) emotional-mental reactions including the sub-themes of emotional distress, mood disorder and mental distress, (b) death encounter including the sub-themes of rational encounter and pre-emptive measure and (c) post-traumatic growth covering the concepts of optimism and performance improvement. The obtained findings imply that the patients' death can sometimes make surgeons aware of the post-incident growth although such deaths affect their personal, family, social and professional lives.

Trends in Surgeon Burnout in the US and Canada: Systematic Review and Meta-Regression Analysis

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.

Trends in leadership at breast surgical oncology fellowships

Introduction

Breast surgical oncology is a defined sub-specialty of general surgery that focuses on the surgical management of breast disease and malignancy within a multidisciplinary context. The fellowship directors (FD) that lead these programs have been selected for their abilities. As programs do research to ensure proper training for the next generation of breast surgical oncologists, we wanted to look into the FDs responsible for their training.

Methods

The Breast Surgical Oncology care program list was compiled via the Society of Surgical Oncology and American Society of Breast Surgeons Accredited programs (n = 60). The demographic information that was of interest included, but was not limited to, gender, age, ethnicity/background, past residency training, past fellowship training, year graduated from residency and fellowship, year since graduation to FD appointment, time at institution till FD appointment, and Hirsch index (h-index).

Results

Data were collected on all 60 FDs. The average age of FDs was 52 years old, 27% of FDs are men and 73% of FDs are women. The average H-index, number of publications, and number of citations were 19, 67, and 2648, respectively. The mean graduation year from residency was 2003, and from fellowship was 2006; with a mean of 9 years post fellowship graduation until becoming an FD. The most frequently attended residency was Rush (n = 4), and the most common fellowships were Memorial Sloan Kettering (n = 8), MD Anderson Cancer Center (n = 7), and John Wayne Cancer Institute (n = 4). Nine of the FDs stayed at the same institution after doing both residency and fellowship there (15%).

Conclusion

This is the first study to examine the demographics of those in FD positions in Surgical Breast Oncology, which is a relatively young fellowship. We found that FDs in Breast Surgical Oncology are defined by their high output of research. This qualification may be why the average age, and the number of years to FD are higher compared to other specialties where this research has been undertaken. Initial evaluation of FDs suggest more diversity in this field is needed. Further insight into the leaders training our next generation of surgeons is warranted.

Burnout prevalence and degree among undergraduate medical students in Indonesia during 1 month of the COVID-19 pandemic: A cross-sectional descriptive survey

BACKGROUND

Medical students are under high pressure to perform academically and also face the impact of the COVID-19 pandemic, putting them at risk of developing burnout.

AIMS

This study aims to evaluate the prevalence and degree of burnout among medical students in Indonesia during 1 month of the COVID-19 pandemic.

METHODS

From April to May 2021, we conducted an online survey of Indonesian medical students to assess burnout (using Maslach Burnout Inventory-Student Survey, MBI-SS).

RESULTS

A total of 1,947 students from 27 universities participated in the study. About 35.5% had burnout, 41.7% with a moderate to high level of emotional exhaustion, 45% had moderate to high level of depersonalization and 66.7% had a low level of personal accomplishment.

CONCLUSION

A total of 35.5% of medical students in our sample experienced burnout. We suggest further research to explore and identify factors related to these findings and the need for potential interventions at global and national level to enhance the well-being of medical students.

The global level of harm among surgical professionals during the COVID-19 pandemic: A multinational cross-sectional cohort study

BACKGROUND

Health care workers, including surgical professionals, experienced psychological burnout and physical harm during the coronavirus 2019 pandemic. This global survey investigated the coronavirus 2019 pandemic impact on psychological and physical health.

METHODS

We conducted a global cross-sectional survey between February 18, 2021 and March 13, 2021. The primary outcome was to assess the psychological burnout, fulfillment, and self-reported physical level of harm. A validated Stanford Professional Fulfilment Index score with a self-reported physical level of harm was employed. We used a practical overall composite level of harm score to calculate the level of harm gradient 1-4, combining psychological burnout with self-reported physical level of harm score.

RESULTS

A total of 545 participants from 66 countries participated. The final analysis included 520 (95.4%) surgical professionals barring medical students. Most of the participants (81.3%) were professionally unfulfilled. The psychological burnout was evident in 57.7% and was significantly common in those <50 years (P = .002) and those working in the public sector (P = .005). Approximately 41.7% of respondents showed changes in the physical health with self-remedy and no impact on work, whereas 14.9% reported changes to their physical health with <2 weeks off work, and 10.1% reported changes in physical health requiring >2 weeks off work. Severe harm (level of harm 4) was detected in 10.6%, whereas moderate harm (level of harm 3) affected 40.2% of the participants. Low and no harm (level of harm 2 and level of harm 1) represented 27.5% and 21.7%, respectively.

CONCLUSION

Our study showed that high levels of psychological burnout, professional unfulfillment, work exhaustion, and severe level of harm was more frequent in younger professionals working in the public sector. The findings correlated with a high level of harm in surgical professionals impacting surgical services.

Burnout syndrome among residents of different surgical specialties in a tertiary referral teaching hospital in Indonesia during COVID-19 pandemic

Introduction

Burnout is experienced frequently by residents, especially during COVID-19 pandemic. Impacts of the pandemic on clinical workload and training program of the residents has also resulted in burnout, which may impact their clinical performance and safety. Therefore, this paper aims to assess burnout syndrome among surgical residents in Indonesia during COVID-19 pandemic.

Methods

A cross-sectional survey was conducted on 120 surgical residents (from orthopedics, general surgery, and urology department) of a tertiary referral teaching hospital in Malang using web-based questionnaire. Personal data form and Maslach Burnout Inventory (MBI) for medical personnel were used. There are 3 subscales of MBI: emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). Comparative and correlative analysis were performed to analyze the socio-demographic, academic, and work-related factors in relation to the subscales scores of MBI-HSS and the presence of burnout.

Results

Burnout were experienced by 56.67% of residents in this study. There were statistically significant association regarding burnout and marital status, residency specialty, year of residency, and working hours upon analysis of mean and classification of subscale scores of MBI with the examined factors.

Conclusion

This study showed that burnout is a major issue in surgical residents during COVID-19 pandemic and may be associated with certain socio-demographic, academic, and work-related factors. Further studies to identify factors contributing to burnout in residents during COVID-19 pandemic are needed. It is imperative to formulate resident-centered strategies to prevent and address burnout among residents to ensure their overall well-being during this pandemic.

Impact of the early COVID-19 pandemic on Breast Surgical Oncology fellow education

INTRODUCTION

The early COVID-19 pandemic rapidly transformed healthcare and medical education. We sought to evaluate the professional and personal impact of the pandemic on 2019-2020 Breast Surgical Oncology (BSO) fellows in Society of Surgical Oncology approved programs to capture the experience and direct future changes.

METHODS

From July 15, 2020 to August 4, 2020 a survey was administered to the American Society of Breast Surgeons' fellow members. The survey assessed the impact of the pandemic on clinical experience, education/research opportunities, personal health/well-being, and future career. Responses were collected and aggregated to quantify the collective experience of respondents.

RESULTS

Twenty-eight of fifty-seven (54%) eligible fellows responded. Twenty-one (75%) indicated the clinical experience changed. Twenty-seven (96%) reported less time spent caring for ambulatory breast patients and sixteen (57%) reported the same/more time spent in the operating room. Fourteen (50%) stated their future job was impacted and eight (29%) delayed general surgery board examinations. Stress was increased in 26 (93%). Personal health was unaffected in 20 (71%), and 3 (10%) quarantined for COVID-19 exposure/infection.

CONCLUSION

The COVID-19 pandemic altered the clinical experience of BSO fellows; however, the operative experience was generally unaffected. The creation of frameworks and support mechanisms to mitigate potential challenges for fellows and fellowship programs in the ongoing pandemic and other times of national crisis should be considered.

Burnout and Professional Fulfillment in Early and Early-Mid-Career Breast Surgeons

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.

Differences in Family Planning and Fertility Among Female and Male Gynecologic Oncologists

Background: The objective of the study was to compare family planning and infertility among female and male gynecologic oncologists in the United States

Methods: This cross-sectional multiple choice survey was administered to the Society of Gynecologic Oncology gynecologic oncologists. The survey collected information on demographics and practice, family planning, and fertility and infertility experiences. Chi-square and Fisher's exact tests were used to compare experiences by gender.

Results: Two hundred eighteen of 1243 (18%) members responded to the survey. The majority were women (71%), Caucasian (78%), and had been practicing fewer than 10 years (56%). One-third (32%) were 35+ years of age at the birth of their first child, and 67% delayed childbearing due to their career. Women were more likely than men to report career choice-influenced family planning. Just under half (44%) expressed current or past concerns about fertility, and this was more prevalent among women; 81% had sought infertility counseling. Among respondents who had fertility struggles, almost half (45%) reported their colleagues were unaware. Forty percent felt their fertility concerns affected work life, and 13% felt stigmatized for their fertility struggles.

Conclusions: These findings suggest that a career in gynecologic oncology have an impact on family planning, often resulting in childbearing delays and infertility concerns, especially among women. Support for our colleagues struggling with infertility should be included in wellness initiatives.

Optimizing Surgeon Well-Being: A Review and Synthesis of Best Practices

Through a systematic review and mixed-methods meta-synthesis of the existing literature on surgeon well-being, we sought to identify the specific elements of surgeon well-being, examine factors associated with suboptimal well-being, and highlight opportunities to promote well-being.

Background

Suboptimal surgeon well-being has lasting and substantial impacts to the individual surgeon, patients, and to society as a whole. However, most of the existing literature focuses on only 1 aspect of well-being-burnout. While undoubtedly a crucial component of overall well-being, the mere absence of burnout does not fully consider the complexities of being a surgeon.

Methods

We performed a literature search within Ovid Medline, Elsevier Excerpta Medica dataBASE, EBSCOhost Cumulative Index to Nursing and Allied Health Literature, and Clarivate Web of Science from inception to May 7, 2020, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies with primary data examining surgeon well-being were included. Using a predetermined instrument, data were abstracted from each study and compared using thematic analysis.

Results

A total of 5369 abstracts were identified and screened, with 184 full articles (172 quantitative, 3 qualitative, 9 mixed methods) selected for analysis. Among these, 91 articles measured burnout, 82 examined career satisfaction, 95 examined work-related stressors, 44 explored relationships and families, and 85 assessed emotional and physical health. Thematic analysis revealed 4 themes: professional components, personal components, work-life balance, and impacts to well-being.

Conclusions

Surgeon well-being is complex and multifaceted. This nuanced examination of surgeon well-being highlights the critical need to develop and provide more long-term support to surgeons-with interventions being tailored based on individual, institutional, and systemic factors.

Prevalence of burnout among healthcare professionals at the Serbian National Cancer Center

OBJECTIVE

The aim of this study was to investigate the level of burnout and identify who is at highest risk among healthcare professionals (HCPs) working at the largest referent national institution.

METHODS

A cross-sectional survey was conducted at the Institute of Oncology and Radiology of Serbia from May 2019 to July 2019, evaluating the level of burnout, depression, fatigue, socio-demographic, behavioral and professional characteristics, and quality of life among healthcare professionals. Of the 576 distributed questionnaires among physicians, nurses/technicians and healthcare coworkers, 432 participants returned their questionnaires (75%). All instruments used in our study had been validated and cross-culturally adapted to Serbian language.

RESULTS

The overall prevalence of burnout was 42.4%, with the greatest proportion of burned out in emotional exhaustion domain (66.9%). The multivariable-adjusted model analysis showed that nurses/technicians had a 1.41 times greater chance of experiencing burnout, compared to physicians (OR = 1.41, 95% CI 1.16-7.10), and that with each year of work experience, the chance of burnout increased by about 2% (OR = 1.02, 95% CI 1.00-1.92). Furthermore, it was shown that, with each point in the PHQ-9 score for depression, probability of burnout increased by 14% (OR = 1.14, 95% CI 1.07-1.94). Finally, after controlling all these potential confounders, the Mental Composite Score of SF-36 score showed an independent prognostic value in exploring the burnout presence among HCPs (OR = 1.17, 95% CI 1.03-2.47).

CONCLUSION

Our research showed a significant level of burnout among healthcare professionals working in oncology, especially among nurses/technicians. The development of effective interventions at both individual and organizational level toward specific risk groups is needed.

Burnout Among United States Orthopaedic Surgery Residents

OBJECTIVE

There is growing interest in the problem of burnout among physicians. Here, we examine the factors associated with burnout in orthopedic surgical training.

DESIGN

An Internet-based anonymous survey assessing workload, work-life balance, education, and resident-specific factors such as marital status and postgraduate year was developed. The survey was distributed to United States orthopedic surgery residency directors in September 2018, and program directors were asked to forward the survey to their trainees. Multivariable analysis assessed correlations with burnout.

SETTING

All 161 Accreditation Council for Graduate Medical Education (ACGME)-accredited United States orthopedic surgery residency programs.

PARTICIPANTS

Two hundred and three United States orthopedic surgery residents.

RESULTS

Thirty-eight percent of respondents reported symptoms of burnout. Even so, the vast majority did not regret choosing a medical career (95%) or their choice of residency program (90%). Greater than half of trainees who responded reported educational debt over $200,000. Thirteen percent reported receiving verbal abuse from faculty more than rarely. On multivariable analysis, 3 factors emerged that were associated with higher burnout: working more than 80 hours per week (odds ratio [OR] 2.8; range, 1.1-7.8), use of electronic medical record more than 20 hours per week (OR 2.1; range 1.0-4.5), and receiving verbal abuse from faculty more than rarely (OR 3.7; range, 1.3-11.5). The perception of adequate nursing support was associated with lower burnout (OR 0.2; range, 0.04-0.5).

CONCLUSIONS

More than one-third of orthopedic trainees are experiencing burnout, but most still maintain high levels of career satisfaction. The key factors strongly associated with resident burnout are modifiable. Targeted interventions related to these factors should be evaluated for their potential to reduce burnout in orthopedic surgery residents.

CLINICAL RELEVANCE

Strategies to reduce the development of burnout have the potential to improve quality of care and decrease medical errors.

Frequency of Burnout Among Palliative Care Physicians Participating in a Continuing Medical Education Course

CONTEXT

Palliative care (PC) physicians are vulnerable for burnout given the nature of practice. The burnout frequency may be variable and reported between 24% and 38% across different countries.

OBJECTIVE

The main objective of our study was to determine the frequency of burnout among PC physicians participating in PC continuing medical education course.

METHODS

A survey including the Maslach Burnout Inventory-General along with 41 custom questions were administered to determine the frequency of burnout among physicians attending the 2018 Hospice and Palliative Medicine Board review course.

RESULTS

Of 110 physicians, 91 (83%) completed the survey. The median age was 48 years with 65% being females, 81% married, 46% in community practice, 38% in practice for 6-15 years. PC was practiced ≥50% of the time by 62%, and 76% were doing clinical work. About 73 (80%) reported that PC is appreciated at their work, 58 (64%) reported insurance to be a burden, and 58 (64%) reported that the electronic medical record was a burden. About 82 (90%) felt optimistic about continuing PC in future. Maslach Burnout Inventory results suggest that 35 (38%) participants reported at least one symptom of burnout. Only being single/separated showed trend toward significance with burnout (P = 0.056).

CONCLUSION

Burnout among PC physicians who attended a board review course was 38%. Being single/separated showed trend toward association with burnout. Physicians who choose to attend continuing medical education may have unique motivating characteristics allowing them to better cope with stress and avoid burnout.

Professional quality of life and burnout amongst radiation oncologists: The impact of alexithymia and empathy

BACKGROUND AND PURPOSE

Different factors may influence the professional quality of life of oncology professionals. Among them, personality traits, as alexithymia and empathy, are underinvestigated. Alexithymia is about deficits in emotion processing and awareness. Empathy is the ability to understand another's 'state of mind'/emotion. The PROject on BurnOut in RadiatioN Oncology (PRO BONO) assesses professional quality of life, including burnout, in the field of radiation oncology and investigates alexithymia and empathy as contributing factors.

MATERIAL AND METHODS

An online survey was conducted amongst ESTRO members. Participants completed 3 validated questionnaires for alexithymia, empathy and professional quality of life: (a) Toronto Alexithymia Scale; (b) Interpersonal Reactivity Index; (c) Professional Quality of Life Scale. The present analysis, focusing on radiation/clinical oncologists, evaluates Compassion Satisfaction (CS), Secondary Traumatic Stress (STS) and Burnout and correlates them with alexithymia and empathy (empathic concern, perspective taking and personal distress) with generalized linear modeling. Significant covariates on univariate linear regression analysis were included in the multivariate linear regression model.

RESULTS

A total of 825 radiation oncologists completed all questionnaires. A higher level of alexithymia was associated to decreased CS (β: -0.101; SE: 0.018; p < 0.001), increased STS (β: 0.228; SE: 0.018; p < 0.001) and burnout (β: 0.177; SE: 0.016; p < 0.001). A higher empathic concern was significantly associated to increased CS (β: 0.1.287; SE: 0.305; p = 0.001), STS (β: 0.114; SE: 0.296; p < 0.001), with no effect on burnout. Personal distress was associated to decreased CS (β: -1.423; SE: 0.275; p < 0.001), increased STS (β: 1.871; SE: 0.283; p < 0.001) and burnout (β: 1.504; SE: 0.245; p < 0.001).

CONCLUSIONS

Alexithymic personality trait increased burnout risk, with less professional satisfaction. Empathic concern was associated to increased stress, without leading to burnout, resulting in higher professional fulfillment. These results may be used to benchmark preventing strategies, such as work-hour restrictions, peer support, debriefing sessions, and leadership initiatives for professionals at risk.

Socioeconomic Factors Associated With Burnout Among Oncology Trainees

PURPOSE:

Burnout in the medical workforce leads to early retirement, absenteeism, career changes, financial losses for medical institutions, and adverse outcomes for patients. Recent literature has explored burnout in different specialties of medicine. This article examines burnout among medical oncology trainees and identifies factors associated with burnout and professional dissatisfaction, including socioeconomic factors.

METHODS:

US medical oncology programs were sent a survey that included the Maslach Burnout Index–Human Services Survey as well as demographic, socioeconomic, and program-specific questions tailored to medical oncology fellowship. Primary binary end points included burnout, satisfaction with being a physician, and satisfaction with being a medical oncologist. Binomial logistic models determined associations between various characteristics and end points.

RESULTS:

Overall, 261 US fellows completed the survey. Seventy percent of international medical graduates reported no educational debt, whereas only 36% of US graduates reported no educational debt. Eighty-two percent of survey respondents reported their mother had at least a bachelor’s degree, and 87% of respondents reported their father had at least a bachelor’s degree. At least 27% of respondents had symptoms of burnout. Factors inversely associated with burnout on multivariable analysis included having a mother who graduated college (odds ratio [OR], 0.27), reporting an adequate perceived balance between work and personal life (OR, 0.22), feeling that faculty care about educational success (OR, 0.16), and being in the final year of training (OR, 0.45). Having debt ≥ $150,000 (OR, 2.14) was directly associated with burnout.

CONCLUSION:

Symptoms of burnout are common among medical oncology fellows and are associated with educational debt and socioeconomic factors.

Systematic review of the impact of patient death on surgeons

BACKGROUND

The death of a patient is experienced at some time by most surgeons. The aim of this review was to use existing literature to establish how surgeons have dealt with the death of patients.

METHODS

A systematic review of the medical literature was performed. MEDLINE/PubMed, Ovid, Web of Science, Embase, and Google Scholar were searched for qualitative and quantitative studies on surgeon reactions when facing death or a dying patient. This systematic review was performed following the recommendations of the Cochrane collaboration and reported following the PRISMA guidelines. Individual and interview-based opinions were summarized and synthesized.

RESULTS

An initial search found 652 articles. After exclusion of articles that did not satisfy the inclusion criteria, 20 articles remained and seven were included. Two of these articles were personal opinion of the author and five were interviews or surveys. The main findings were that facing death routinely induces a strong psychological burden and that surgeons are more at risk than the general population to develop psychological morbidity.

CONCLUSION

Although it is a frequent and emotional subject in the surgical world, the impact of patient death on surgeons is not abundantly studied in the literature. Dealing with patient death or taking care of a dying patient might have long-lasting psychological impact on surgeons.

Assessing Burnout and Professional Fulfillment in Breast Surgery: Results From a National Survey of the American Society of Breast Surgeons

BACKGROUND

Physician burnout is a well-recognized problem in health care that has a negative impact on professional well-being and quality of patient care. Rates of burnout in breast surgery are not well-defined. This study sought to understand the degree of burnout among breast surgeons and to identify factors that influence professional fulfillment.

METHODS

All U.S. members of the American Society of Breast Surgeons with a valid email address were surveyed in October 2017. The results were anonymous, and the participants were blinded to the study hypothesis. The survey included 30 questions (16-item Professional Fulfillment Index [PFI] and 14-item demographics/practice patterns). Multivariable linear regressions were performed to assess overall burnout and high professional fulfillment.

RESULTS

Of the 2568 surveys delivered, 708 surveys were initiated, and 660 were completed. Among breast surgeons, 270 (41.3%) expressed burnout, whereas 281 (42.5%) reported high professional fulfillment. In the multivariable analysis, years in practice was inversely associated with burnout and positively correlated with professional fulfillment. Working more than 60 h per week was positively associated with burnout, and having more than 50% of practice dedicated to breast surgery correlated positively with fulfillment.

CONCLUSION

Approximately 4 of 10 breast surgeons have symptoms of burnout, whereas 4 of 10 surgeons report high professional fulfillment. Specific clinical practice conditions largely influence rates of burnout and professional fulfillment. The contributing factors identified in the study analysis may be useful in identifying breast surgeons at higher risk for burnout. The study findings also help to inform the design of interventions focused on the clinical practice environment to promote professional fulfillment and sustainability.

A Cross-sectional Analysis of Compassion Fatigue, Burnout, and Compassion Satisfaction in Pediatric Emergency Medicine Physicians in the United States

OBJECTIVES

The objective was to determine the prevalence of compassion fatigue (CF), burnout (BO), and compassion satisfaction (CS) and identify potential personal and professional predictors of these phenomena in pediatric emergency medicine (PEM) physicians.

METHODS

A modified Compassion Fatigue and Satisfaction Self-Test for Helpers and a questionnaire of personal and professional characteristics were distributed electronically to PEM physicians nationally. The prevalence of these phenomena was calculated. Hierarchical linear regression models for CF, BO, and CS as a function of potential risk factors were constructed.

RESULTS

The final analyzable survey rate represented 22.7% of the physicians invited to participate. The prevalences of CF, BO, and CS were 16.4, 21.5, and 18.5%, respectively. BO score, distress about a "clinical situation," "physical work environment," and engaging in prayer/meditation were each significant determinants of higher CF scores, whereas "socializing with family/friends" was significantly associated with lower CF scores. CF score, emotional depletion, and distress due to "coworkers" were each significant determinants of higher BO scores, whereas CS score and "talking with a family member" as a means of self-care were significantly associated with lower BO scores. Socializing with family/friends and >20 years as PEM provider were each significant determinants of higher CS scores, whereas BO score, emotional depletion, distress about the physical work environment and "administrative issues," 10% to 24% of time spent caring for pediatric patients, and "talking with life partner" about work-related distress were each significant determinants of lower CS scores. We acknowledge that the generalizability of our findings is limited by the sample size and by the fact that participants were largely female, Caucasian, and junior faculty and worked in academic medical centers.

CONCLUSIONS

PEM physicians are at risk for developing CF, BO, and low CS. Proactive awareness of these phenomena and their predictors may allow providers to better manage the unique challenges and emotional stressors of the pediatric ED to enhance personal well-being and professional performance.

Survey of Surgical Oncology Fellowship Graduates 2005-2016: Insight into Initial Practice

BACKGROUND

Despite burgeoning interest in Complex General Surgical Oncology (CGSO) fellowship training, little is reported about postgraduate employment. The goal of this study was to characterize CGSO graduates' first employment and to identify factors that influenced this decision.

METHODS

The National Cancer Institute (NCI) and Society of Surgical Oncology developed and distributed an electronic survey to CGSO fellows who graduated from 2005 to 2016.

RESULTS

The survey response rate was 47% (237/509). Fifty-seven percent of respondents were first employed as faculty surgeons at a university-based/affiliated hospital, with 15% returning to their residency institution. The distribution of respondents' current employment across the United States mirrored the locations of their hometowns. Eighty-five percent of respondents care for patients across at least three disease types, most commonly hepatopancreatobiliary (81%), esophagus/gastric (75%), and sarcoma (74%). Twenty-seven percent of respondents spend the majority of their time in one area of surgical oncology; melanoma, breast, and head/neck were the most common. Two-thirds of respondents (67%) reported that they performed either clinical or basic science research as part of their current position. Multiple factors influenced the decision of first faculty position.

CONCLUSIONS

Most CGSO graduates are employed at academic medical centers across the country in proximity to NCI-designated centers, treat a variety of disease types, and spend a percentage of their time dedicated to clinical research.

Medical oncology job satisfaction: Results of a global survey

BACKGROUND

While physician burnout is increasingly recognized, little is known about medical oncologist job satisfaction, and the factors associated with low satisfaction. Here, we report the results of an international survey of medical oncologists.

METHODS

An online survey was distributed using a modified snowball methodology via national oncology societies to chemotherapy-prescribing physicians in 65 countries. Oncologist job satisfaction was assessed by asking, "On a scale of 1-10, how would you rate your satisfaction as an oncologist? 1 = unsatisfying, 10 = satisfying." Low, moderate and high job satisfaction was defined as scores of 1-6, 7-8, and 9-10, respectively.

RESULTS

1,115 physicians from 42 countries completed the survey. Overall job satisfaction rates were 20% (222/1,115), 51% (573/1,115), and 29% (320/1,115) for low-, moderate-, and high-satisfaction, respectively. Respondents with low job satisfaction were younger (P = 0.001) and had fewer years in clinical practice (P = 0.013) compared to those with high satisfaction. Increasing hours worked by per week (p = 0.042), decreasing annual weeks of paid vacation (P = 0.007), being on-call every night (P = 0.016), higher clinic volumes (P = 0.004) and lack of access to on-site radiotherapy (P = 0.049), palliative care (P = 0.005), and chemotherapy pharmacists (P = 0.033) were associated with low-job satisfaction. Respondents with low-job satisfaction were less likely to discuss prognosis with their patients compared to those with moderate or high job satisfaction (median 45% of patients v 65% v 75%, P < 0.001).

CONCLUSIONS

Globally, 1 in 5 medical oncologists report low job satisfaction. The main correlates of job satisfaction are related to system-level pressures resulting in less time for quality patient care and personal resilience. Improving oncologist job satisfaction will require new approaches to models of care delivery.

Prevalence of Burnout and Career Satisfaction Among Oncologists in China: A National Survey

BACKGROUND

Burnout and career satisfaction has been extensively studied among U.S. and European oncologists, although little is known about the situation among Chinese oncologists. Therefore, we conducted this national survey to investigate the prevalence of burnout and career satisfaction among Chinese oncologists.

PATIENTS AND METHODS

Between September 2015 and December 2016, a cross-sectional field survey was conducted through the Chinese Society of Clinical Oncology and the Chinese Committee of Rehabilitation and Palliative Care. The full-length survey consisted of 59 questions investigating personal and professional characteristics and standardized instruments to measure burnout (Maslach Burnout Inventory-Human Service Survey) and career satisfaction. An additional six questions, derived from the National Survey on the Practice of Medicine by Chinese Physicians related to burnout or career satisfaction, were also included.

RESULTS

In total, 3,500 oncologists received the questionnaire, and 2,700 (77.1%) responded, of whom 1,620 (46.3%) were eligible for analysis (median age, 36 years; 56.1% male). Overall, 827 oncologists (51.0%) were burned out. Five factors (lower curative rate of patients, more hours devoted to patient care, more nights on call per week, fewer minutes allocated for return outpatient visits, and more weekends rounding per year) were associated with burnout. Meanwhile, burnout was also strongly associated with a negative view of the physician-patient relationship (p < .001; odds ratio [OR], 2.07). Notably, the career satisfaction (34.4% for career and 52.1% for specialty) of Chinese oncologists was far less than U.S. colleagues, which may result from low compensation (p < .001; OR, 1.660).

CONCLUSION

The overall prevalence of burnout among oncologists in China was similar to oncologists in the U.S., whereas personal accomplishment and career satisfaction were lower. Interestingly, the reasons were different. Beside high workload, the low curative rate of patients was found to be another factor associated with Chinese physicians' burnout. The ongoing Chinese health care system reform may improve the current situation.

IMPLICATIONS FOR PRACTICE

Burnout and career satisfaction has been extensively studied among physicians and oncologists in the U.S. and Europe, but little is known about the situation among Chinese oncologists. This study is the first large-scale national study of Chinese oncologists using standardized instruments to evaluate burnout and career satisfaction. The experience of burnout has been linked to a long list of negative implications. However, this issue has not aroused enough concern in China until now. This study may have a vital significance for the ongoing Chinese health care reform aiming to improve the Chinese health care system.

National Study of Burnout and Career Satisfaction Among Physician Assistants in Oncology: Implications for Team-Based Care

PURPOSE

A high rate of burnout has been reported in oncology physicians. Physician assistants (PAs) may also face similar risks of burnout. We sought to measure the personal and professional characteristics associated with burnout and career satisfaction and the potential impact on the oncology PA workforce.

PARTICIPANTS AND METHODS

A national survey of PAs in oncology was completed by using the Maslach Burnout Inventory from September 2015 to January 2016.

RESULTS

In all, 855 PAs were contacted and 250 submitted complete surveys (response rate, 29.2%). Respondents were representative of PAs in oncology with a mean age of 41.8 years, females (88.8%), academic practice (55.2%), urban location (61.2%), outpatient (74.4%), medical oncology (75.2%), worked 41 to 50 hours per week (52.8%), and had a mean of 9.6 years as a PA in oncology. Burnout was reported in 34.8% of PAs, 30.4% reported high emotional exhaustion, 17.6% reported high depersonalization, and 19.6% reported a low sense of personal accomplishment. In multivariable analysis, age, time spent on indirect patient care, oncology subspecialty, and relationship with collaborating physician were factors associated with burnout. Career and specialty satisfaction was high (86.4% and 88.8%, respectively). In the next 2 years, only 3.6% of PAs plan to pursue a different career or specialty and only 2.0% plan to retire.

CONCLUSION

Despite high career and specialty satisfaction, burnout is reported in one third of PAs in oncology. Further exploration of the relationship between PAs and collaborating physicians may provide insight on methods to decrease burnout. Negligible short-term attrition of the current oncology PA workforce is anticipated.

Burnout Evaluation of Radiation Residents Nationwide: Results of a Survey of United States Residents

PURPOSE

To assess rates of burnout among US radiation oncology residents and evaluate program/resident factors associated with burnout.

METHODS AND MATERIALS

A nationwide survey was distributed to residents in all US radiation oncology programs. The survey included the Maslach Burnout Index-Human Services Survey (MBI-HSS) as well as demographic and program-specific questions tailored to radiation oncology residents. Primary endpoints included rates of emotional exhaustion, depersonalization, and personal accomplishment from MBI-HSS subscale scores. Binomial logistic models determined associations between various residency/resident characteristics and high burnout levels.

RESULTS

Overall, 232 of 733 residents (31.2%) responded, with 205 of 733 (27.9%) completing the MBI-HSS. High levels of emotional exhaustion and depersonalization were reported in 28.3% and 17.1%, respectively; 33.1% experienced a high burnout level on at least 1 of these 2 MBI-HSS subscales. Low rates of personal accomplishment occurred in 12% of residents. Twelve residents (5.9%) reported feeling "at the end of my rope" on a weekly basis or more. On multivariable analysis there was a statistically significant inverse association between perceived adequacy of work-life balance (odds ratio 0.37; 95% confidence interval 0.17-0.83) and burnout.

CONCLUSIONS

Approximately one-third of radiation oncology residents have high levels of burnout symptoms, consistent with previous oncology literature, but lower levels than those among physicians and residents of other specialties. Particularly concerning was that more than 1 in 20 felt "at the end of my rope" on a weekly basis or more. Targeted interventions to identify symptoms of burnout among radiation oncology residents may help to prevent the negative downstream consequences of this syndrome.

Compassion fatigue, burnout and compassion satisfaction in neonatologists in the US

OBJECTIVE

Compassion fatigue (CF) is distress experienced by caregivers from ongoing contact with patients who are suffering. Burnout (BO) is occupational stress directly related to dissonance between job demands and available resources. Compassion satisfaction (CS) is professional fulfillment experienced through helping others. CF in physicians is not well studied. Neonatologists may be at particular risk for CF by virtue of recurrent exposure to distress in patients and their families. The objectives of this study were to determine the prevalence of CF, BO and CS, and to identify potential predictors for these phenomena in neonatologists.

STUDY DESIGN

A modified Compassion Fatigue and Satisfaction Self-Test and a questionnaire of professional details and personal characteristics were distributed electronically to neonatologists nationally. Multivariable logistic and linear regression models for CF, BO and CS as a function of potential predictors were constructed.

RESULTS

The survey response rate was 47%. The prevalence of CF, BO and CS was 15.7, 20.8 and 21.9%, respectively. Female gender, emotional depletion, distress from 'a clinical situation', 'co-workers', 'personal health issues' and 'not talking about distressing issues' were each significant determinants of CF. Emotional depletion, distress from the 'physical work environment' and 'co-workers', and 'not talking about distressing issues' were significant determinants of BO. Self-identification as Hispanic; 'not currently feeling distressed'; talking about distressing issues; and utilization of pediatric palliative care services were significant determinants of higher CS.

CONCLUSIONS

CF and BO may impact emotional well-being and professional performance of neonatologists. Enhancement of CS is a potential target for intervention.

A saúde física e mental do profissional médico: uma revisão sistemática

RESUMO O objetivo desta revisão sistemática da literatura foi de identificar as principais doenças que acometem os médicos em todo o mundo, mediante uma pesquisa eletrônica na base de dados Biblioteca Virtual em Saúde (BVS) baseada na metodologia Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma). Foram analisados 57 dos 374 artigos científicos encontrados sobre o tema em inglês, português e espanhol, publicados entre 2005 e 2015. Os resultados encontrados apontaram que os acometimentos mentais prevaleceram, destacando-se o esgotamento profissional (síndrome de burnout). Entre as doenças físicas, predominaram os acometimentos musculoesqueléticos.

Burnout and associated factors among members of the Society of Gynecologic Oncology

OBJECTIVE

Burnout is specific to the work domain and in physicians is indicative of emotional exhaustion, depersonalization in relationships with coworkers and detachment from patients, and a sense of inadequacy or low personal accomplishment. The purpose of this study was to determine the burnout rate among gynecologic oncologists and evaluate other personal, professional, and psychosocial factors associated with this condition.

STUDY DESIGN

This study used a cross-sectional design. Current members of the Society of Gynecologic Oncology were sent an anonymous email survey including 76 items measuring burnout, psychosocial distress, career satisfaction, and quality of life.

RESULTS

A total of 1086 members were invited, 436 (40.1%) responded, and 369 (84.6%) of those completed the survey. Of physicians, 30% scored high for emotional exhaustion, 10% high for depersonalization, and 11% low for personal accomplishment. Overall, 32% of physicians scored above clinical cutoffs indicating burnout. In all, 33% screened positive for depression, 13% endorsed a history of suicidal ideation, 15% screened positive for alcohol abuse, and 34% reported impaired quality of life. Nonetheless, 70% reported high levels of personal accomplishment, and results suggested most were satisfied with their careers, as 89% would enter medicine again and 61% would encourage their child to enter medicine. Respondents with high burnout scores were less likely to report they would become a physician again (P = .002) or encourage a child to enter medicine (P < .001), and more likely to screen positive for depression (P < .001), alcohol abuse (P = .006), history of suicidal ideation (P < .001), and impaired quality of life (P < .001).

CONCLUSION

Burnout is a significant problem associated with psychosocial distress and lower levels of career satisfaction in gynecologic oncologists. Burnout in obstetrics-gynecology and gynecologic oncology is of particular concern as young age and female gender are often identified as risk factors for this significant problem. Interventions targeted at improving quality of life, treatment of depression, or alcohol abuse may have an impact on burnout. However, significant barriers may exist as 44.5% of respondents in this study reported that they would be reluctant to seek medical care for depression, substance use, or other mental health issues due to concerns about their medical license.

Attitudes and Perceptions of Surgical Oncology Fellows on ACGME Accreditation and the Complex General Surgical Oncology Certification

BACKGROUND

With the first qualifying examination administered September 15, 2014, complex general surgical oncology (CGSO) is now a board-certified specialty. We aimed to assess the attitudes and perceptions of current and future surgical oncology fellows regarding the recently instituted Accreditation Council for Graduate Medical Education (ACGME) accreditation.

METHODS

A 29-question anonymous survey was distributed to fellows in surgical oncology fellowship programs and applicants interviewing at our fellowship program.

RESULTS

There were 110 responses (79 fellows and 31 candidates). The response rate for the first- and second-year fellows was 66 %. Ninety-percent of the respondents were aware that completing an ACGME-accredited fellowship leads to board eligibility in CGSO. However, the majority (80 %) of the respondents stated that their decision to specialize in surgical oncology was not influenced by the ACGME accreditation. The fellows in training were concerned about the cost of the exam (90 %) and expressed anxiety in preparing for another board exam (83 %). However, the majority of the respondents believed that CGSO board certification will be helpful (79 %) in obtaining their future career goals. Interestingly, candidate fellows appeared more focused on a career in general complex surgical oncology (p = 0.004), highlighting the impact that fellowship training may have on organ-specific subspecialization.

CONCLUSIONS

The majority of the surveyed surgical oncology fellows and candidates believe that obtaining board certification in CGSO is important and will help them pursue their career goals. However, the decision to specialize in surgical oncology does not appear to be motivated by ACGME accreditation or the new board certification.

Factors associated with career satisfaction and burnout among US neurosurgeons: results of a nationwide survey

OBJECT :The object of this study was to identify and quantify predictors of burnout and career satisfaction among US neurosurgeons.

METHODS

All US members (3247) of the American Association of Neurological Surgeons (AANS) were invited to participate in a survey between September and December 2012. Responses were evaluated through univariate analysis. Factors independently associated with burnout and career satisfaction were determined using multivariable logistic regression. Subgroup analysis of academic and nonacademic neurosurgeons was performed as well.

RESULTS

The survey response rate was 24% (783 members). The majority of respondents were male, 40-60 years old, in a stable relationship, with children, working in a group or university practice, and trained in a subspecialty. More than 80% of respondents reported being at least somewhat satisfied with their career, and 70% would choose a career in neurosurgery again; however, only 26% of neurosurgeons believed their professional lives would improve in the future, and 52% believed it would worsen. The overall burnout rate was 56.7%. Factors independently associated with both burnout and career satisfaction included achieving a balance between work and life outside the hospital (burnout OR 0.45, satisfaction OR 10.0) and anxiety over future earnings and/or health care reform (burnout OR 1.96, satisfaction OR 0.32). While the burnout rate for nonacademic neurosurgeons (62.9%) was higher than that for academic neurosurgeons (47.7%), academicians who had practiced for over 20 years were less likely to be satisfied with their careers.

CONCLUSIONS

The rates of burnout and career satisfaction were both high in this survey study of US neurosurgeons. The negative effects of burnout on the lives of surgeons, patients, and their families require further study and probably necessitate the development of interventional programs at local, regional, and even national levels.

An interactive individualized intervention to promote behavioral change to increase personal well-being in US surgeons

OBJECTIVE

Evaluate the utility of a computer-based, interactive, and individualized intervention for promoting well-being in US surgeons.

BACKGROUND

Distress and burnout are common among US surgeons. Surgeons experiencing distress are unlikely to seek help on their own initiative. A belief that distress and burnout are a normal part of being a physician and lack of awareness of distress level relative to colleagues may contribute to this problem.

METHODS

Surgeons who were members of the American College of Surgeons were invited to participate in an intervention study. Participating surgeons completed a 3-step, interactive, electronic intervention. First, surgeons subjectively assessed their well-being relative to colleagues. Second, surgeons completed the 7-item Mayo Clinic Physician Well-Being Index and received objective, individualized feedback about their well-being relative to national physician norms. Third, surgeons evaluated the usefulness of the feedback and whether they intended to make specific changes as a result.

RESULTS

A total of 1150 US surgeons volunteered to participate in the study. Surgeons' subjective assessment of their well-being relative to colleagues was poor. A majority of surgeons (89.2%) believed that their well-being was at or above average, including 70.5% with scores in the bottom 30% relative to national norms. After receiving objective, individualized feedback based on the Mayo Clinic Physician Well-Being Index score, 46.6% of surgeons indicated that they intended to make specific changes as a result. Surgeons with lower well-being scores were more likely to make changes in each dimension assessed (all Ps<0.001).

CONCLUSIONS

US surgeons do not reliably calibrate their level of distress. After self-assessment and individualized feedback using the Mayo Clinic Physician Well-Being Index, half of participating surgeons reported that they were contemplating behavioral changes to improve personal well-being.