Burnout in Orthopaedic Surgeons: A Challenge for Leaders, Learners, and Colleagues: AOA Critical Issues

Worsening Burnout in Orthopedic Surgeons Since 2019 and Key Areas of Work life Drivers

Background

In 2019, we assessed rates of burnout in orthopedic surgeons (attendings and trainees) at our institution and found distinct levels and drivers of burnout. Excessive workload had the strongest association with burnout across career stages.

Purposes

We sought to re-examine the rates of burnout in orthopedic trainees and faculty in the same institution several years later and to identify the areas of worklife that correlated with burnout at distinct career stages, comparing 2019 and 2023 responses.

Methods

From November 2022 to February 2023, we invited 190 orthopedic attending surgeons and trainees to participate in a survey by email. The Maslach Burnout Inventory and Areas of Worklife Scale were used to evaluate burnout and areas of worklife, respectively. Respondents were invited to elaborate on their experiences in free-text boxes. Results were compared to those of our 2019 survey.

Results

In 2023, 76 recipients completed the survey, for a 40% response rate, compared with a 79% response rate in 2019. The response rate among residents fell from 93% in 2019 to 28% in 2023. High levels of depersonalization were found in 38% of residents and 21% of attending surgeons. High levels of emotional exhaustion were found in 31% of residents and 33% of attending surgeons. The proportion of attending surgeons reporting symptoms of burnout doubled between 2019 and 2023, whereas rates remained similar in residents. In 2023, 38% of residents reported low personal accomplishment compared with 5% in 2019. Excessive workload and limited job control were the work life areas most strongly correlated with burnout.

Conclusions

The results of our 2023 survey suggest that burnout rates increased in academic orthopedic attending surgeons at our institution since 2019. The COVID-19 pandemic has highlighted the importance of institutions continuing to prioritize physician well-being.

Benchmarking psychology provision in major trauma centres (MTCs) across England and Wales against ACP-UK standards and NICE guidelines for psychological rehabilitation following major trauma

OBJECTIVES

Whilst the availability of clinical psychology is one of the key requirements for Major Trauma Centres (MTCs) outlined by NHS England, a previous study identified significant gaps in psychology provision across MTCs [1,2]. The present study aimed to understand whether MTC psychology services in England and Wales are fulfilling the section of the NHS standard contract for MTCs relating to psychology provision. It also sought to benchmark services against the relevant guidelines and standards published by the National Institute of Health and Care Excellence (NICE) and the Association of Clinical Psychologists UK (ACP-UK).

METHODS

All MTCs in England and Wales were contacted. Four told us that they have no specialist MTC psychology service. The remaining centres completed a questionnaire about their psychology service and rated whether it met, partially met, or did not meet the NHS standard contract and each of the NICE guidelines and ACP-UK standards. 25 MTC psychology services completed the questionnaire.

RESULTS

Variation was found across MTCs in the dedicated whole time equivalent (WTE) of psychology staffing, the banding of the most senior psychologist in each service, and the total percentage of MTC patients that are seen by psychology. Over half of services did not meet or only partially met the NHS standard contract. Many of the ACP-UK standards were either not met or only partially met by a majority of services.

CONCLUSIONS

The study indicates that significant variation in resource exists across MTC psychology services in England and Wales, leading to differences in the ability of services to meet standards and guidelines. Further work is indicated to address this variation and develop a minimum workforce model for MTC psychology services, to ensure equity of access to psychological support in MTCs across England and Wales.

Journey of International Medical Graduates Toward Orthopaedic Surgery Residency in the United States

International medical graduates (IMGs) are integral to the US healthcare system but are scarce in orthopaedic residency classes. Positive contributions of IMGs to the field of orthopaedic surgery in the United States are well documented, but successfully matching into an orthopaedic residency position as an IMG remains very challenging. The purpose of this study was to review current processes, strategies, and potential barriers of IMGs applying for orthopaedic surgery residency in the United States as an IMG.

Sustaining surgeon longevity in spine surgery: A narrative review

Spine surgery is a physically and mentally demanding surgical specialty. This paper focuses on raising awareness about ergonomic challenges that threaten spine surgeon longevity. Sustaining a fulfilling career in spine surgery requires a multifaceted approach that prioritizes physical well-being and mental health. By proactively addressing them through education, technology, and support systems, we can foster a future where spine surgeons enjoy long, healthy careers and continue to provide top-quality care.

Burnout in Military Orthopedic Surgeons: A Multicenter, Cross-Sectional Study

BACKGROUND

High rates of burnout are prevalent in U.S. physicians with evidence that the rates are increasing. Military orthopedic surgeons experience unique circumstances including deployments, relocations, and collateral duties that may place them at an even higher risk for burnout. The purpose of this study was to identify the prevalence and risk factors for burnout in active duty U.S. military orthopedic surgeons.

MATERIALS AND METHODS

We distributed a voluntary, anonymous, 64-question survey (SurveyMonkey) to the Society of Military Orthopaedic Surgeons listserv, an orthopedic specialty society that includes a large proportion of active duty, reserve, and retired military surgeons. The survey included questions about basic demographics, education and training, work environment, and military-specific variables, including number of deployments, relocations (Permanent Changes of Station), and perceived support from leadership. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used to measure burnout. The primary outcome was burnout, defined as high emotional exhaustion or high depersonalization scores as measured on the MBI-HSS. Low personal accomplishment was included as a secondary outcome. A multivariate analysis was performed for each primary domain of the MBS-HSS to determine risk factors for burnout.

RESULTS

A total of 191 active duty orthopedic surgeons (138 attendings and 53 residents) completed a survey. Males comprised 82% of respondents while 18% were female. Of all the respondents, 33% (63/191) met criteria for burnout. Military residents reported higher rates of burnout than attending physicians (49% vs. 26%, respectively, P = .002). Age, gender, race, relationship status, military branch, and level of training were not independently associated with burnout. Analysis of the diagnostic domains of burnout showed that a longer remaining active duty service obligation (P = .007) and a rank O5 or higher (P = .04) were associated with high emotional exhaustion. Support of colleagues and leadership (P = .01), a manageable workload (P < .001), and attending a service academy (P = .03) were protective. Residents had higher depersonalization scores than attendings (P < .001). A manageable workload (P < .001), a general practice (no fellowship training) (P = .01), and the rank of O4 (P = .006) were protective against depersonalization. However, being a generalist was associated with low personal achievement scores (P = .04) while fellowship training was protective (P = .05). Only 50% of attendings and 70% of residents indicated that they would join the military again, while 93% of attendings and 86% of residents would choose to enter orthopedics again.

CONCLUSIONS

Despite several specific additional stressors, the prevalence of burnout in military orthpaedic surgeons is similar to previously reported rates in all orthopedic surgeons. Military-specific challenges such as deployments and relocations unique to military orthopedic surgeons were not associated with increased burnout.

The relationship between self-determination and burnout: Mental health outcomes in medical residents

BACKGROUND

Burnout is a pervasively increasing threat to personal and professional wellbeing and performance. It is yet understudied in relation to basic psychological needs (BPN), especially in at-risk population such as medical residents. This study intends to explore the differential relationship between various aspects of burnout including depersonalization (DP), emotional exhaustion (EE) and lack of personal achievement (PA) and subsets of BPN satisfaction or frustration namely autonomy, relatedness, and competence, with the framework of the Self-Determination Theory (SDT) in healthcare.

MATERIALS

A total of 110 medical residents in various Lebanese hospitals were included. Demographics and standardized scales were used to measure basic psychological need satisfaction and frustration (BPNSFS), burnout (MBI), depression and anxiety (PHQ-4). Residents were also asked about subjective evaluation of academic training and level of impact by ongoing crises (COVID-19 pandemic, Beirut port explosion and financial breakdown).

RESULTS

Result point to alarming prevalence of burnout and mental distress in our sample. It also indicates a differential correlation between gender, financial security and various subsets of burnout. It lastly points to association of DP with overall satisfaction scale (Beta = 0.342, p = 0.001) and PHQ-4 scores (Beta = -0.234, p = 0.017), while feeling burdened to attend lectures and having been physically affected by the Beirut blast correlated with a sense of PA (Beta = 0.332, p = 0.010, Beta = 0.187, p = 0.041 respectively) and PHQ-4 (Beta = 0.341, p = 0.000), interacting with COVID-19 patients (Beta = 0.168, p = 0.020) and feeling protected in the working environment (Beta = -.231, p = 0.002) showed a significant association with EE.

DISCUSSION

Within the SDT framework, this study highlights the complex interplay between collective crises, subjective evaluations or work conditions and other demographics with aspects of burnout in medical residents. It mostly points to the need address this at an individual but also an institutional level to buffer distress in future healthcare providers.

Why Do Early-Career Adult Reconstruction Surgeons Change Jobs? An American Association of Hip and Knee Surgeons Young Arthroplasty Group Survey Study

Background

There are high reported rates of burnout and job turnover among orthopedic surgeons. The purpose of this study was to investigate the prevalence of job change among early-career adult reconstruction surgeons and to examine which demographic or practice factors influenced job change.

Methods

An electronic survey was distributed to all practicing surgeon members of the American Association of Hip and Knee Surgeons Young Arthroplasty Group. The survey included questions about practice type, demographics, job change, and a validated burnout questionnaire. Survey responses were collected using a secure database. Statistical analysis was performed to examine relationships between respondent characteristics and job change.

Results

There were 201/389 responses (51.7%). The most common motivators for job change were better workplace culture (64%), opportunities for career growth (52%), and better alignment with values of the department/institution (45%). There were few female respondents; however, they trended toward reporting higher rates of job change (35.6% female vs 21.3% male, P = .3). Respondents who were considering changing jobs but had not done so were significantly more likely to report symptoms of burnout in all studied subscales: emotional exhaustion (P < .0001), depersonalization (P = .0002), and sense of personal accomplishment (P = .007).

Conclusions

Surgeons changing jobs cited social factors such as workplace culture as reasons for leaving. Burnout symptoms were higher in surgeons considering changing jobs but improved in those who had already changed jobs. It is important to identify factors that lead to job change to guide young surgeons in job selection and improve retention.

Psychological Health and Wellness and the Impact of a Supportive Text Messaging Program (Wellness4MDs) Among Physicians and Medical Learners in Canada: Protocol for a Longitudinal Study

BACKGROUND

Burnout, anxiety, and depression continue to affect physicians, postgraduate medical trainees, and medical students globally and in Canada particularly after the COVID-19 pandemic.

OBJECTIVE

The primary goal of this project is to design, implement, monitor, and evaluate a daily supportive SMS text messaging program (Wellness4MDs, Global Psychological e-Health Foundation). The program aims to reduce the prevalence and severity of burnout, anxiety, and depression symptoms among physicians, postgraduate medical trainees, and medical students in Canada.

METHODS

This longitudinal study represents a multistakeholder, mixed methods, multiyear implementation science project. Project evaluation will be conducted through a quantitative prospective longitudinal approach using a paired sample comparison, a naturalistic cross-sectional controlled design, and satisfaction surveys. Prevalence estimates for psychological problems would be based on baseline data from self-completed validated rating scales. Additional data will be collected at designated time points for paired comparison. Outcome measures will be assessed using standardized rating scales, including the Maslach Burnout Inventory for burnout symptoms, the 9-item Patient Health Questionnaire for depression symptoms, the 7-item Generalized Anxiety Disorder scale for anxiety symptoms, and the World Health Organization-Five Well-Being Index.

RESULTS

The project launched in the last quarter of 2023, and program evaluation results will become available within 36 months. The Wellness4MDs program is expected to reduce the prevalence and severity of psychological problems among physicians in Canada and achieve high subscriber satisfaction.

CONCLUSIONS

The results from the Wellness4MDs project evaluation will provide key information regarding the effectiveness of daily supportive SMS text messages and links to mental health resources on these mental health parameters in Canadian physicians, postgraduate trainees, and medical students. Information will be useful for informing policy and decision-making concerning psychological interventions for physicians in Canada.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/44368.

Accessibility and Characterization of Parental Leave Policies for Orthopaedic Surgery Residency Training in the United States

INTRODUCTION

This study assesses the accessibility and nature of parental leave policies during orthopaedic surgery residency training after implementation of the Accreditation Council for Graduate Medical Education (GME) mandate for 6 weeks of paid parental leave effective July of 2022.

MATERIALS AND METHODS

An audit of orthopaedic surgery residency and affiliated GME websites was conducted to assess the accessibility of parental leave policies during the 2023-2024 academic year. Details on length of leave and nature of renumeration during the leave were recorded. Bivariate analyses were conducted to determine residency program characteristics associated with the accessibility of a parental leave policy. Results were compared with a previous analysis during the 2017-2018 academic year.

RESULTS

A total of 200 residency programs were evaluated, and 152 had parental leave policies (76.0%). Compared with 2017 to 2018, a similar percentage of parental leave policies were accessible on residency program websites (3.0% vs. 2.0%, P = 0.777) but fewer were accessible on GME websites (55.5% vs. 80.7%, P < 0.001). More contemporary policies were obtained from program coordinators (18.5% vs. 7.2%, P = 0.003), and more were not available (24.0% vs. 9.0%, P < 0.001). Most policies offered renumeration (86.7%) and leave for 6 weeks in length (75.0%). A higher prevalence of parental leave policy accessibility was found among orthopaedic residency programs with university affiliation (P < 0.001), more faculty members (P = 0.008) and residents (P = 0.017), a higher percentage of female faculty (P = 0.008), affiliation with a top 50 ranked National Institutes of Health-funded orthopaedic surgery department, and accreditation achieved before 2017 to 2018 (P = 0.004).

DISCUSSION

Most orthopaedic surgery residency programs do not have accessible parental leave policies on their websites. The new Accreditation Council for GME mandate will require orthopaedic residency programs to provide residents with 6 weeks of paid parental leave during residency training. Accessible policies may be useful to applicants interested in child rearing during orthopaedic residency training.

Do Women and Minority Orthopaedic Residents Report Experiencing Worse Well-being and More Mistreatment Than Their Peers?

BACKGROUND

Despite the increased risk of attrition for women and minority residents during orthopaedic residency, there is currently a paucity of research examining the training environment of these residents. To address this, we examined how well-being constructs may differ for women or minority residents compared with their peers, and whether these residents report experiencing more mistreatment during residency.

QUESTIONS/PURPOSES

(1) How does the psychologic wellbeing of women and minority residents compare with that of their peers regarding the constructs of burnout, lifestyle satisfaction, social belonging, and stereotype threat? (2) Do reported mistreatment experiences during residency differ among women and minority residents compared with their peers? (3) Is there a difference in the proportion of women and minority orthopaedic residents with thoughts of leaving residency compared with their peers?

METHODS

Seventeen orthopaedic residency programs in the 91 programs comprising the Collaborative Orthopaedic Educational Research Group agreed to participate in the study. Program directors sent an anonymous one-time survey with two reminders to all orthopaedic residents at their respective institutions. The survey instrument comprised validated and previously used instruments with face validity designed to measure burnout, satisfaction, duty-hour violations, belonging, stereotype threat, mistreatment, and thoughts of leaving residency, in addition to demographic information. Forty-three percent (211 of 491) of residents responded to the survey. Race or ethnicity data were combined into "White" and "underrepresented in orthopaedics" (URiO), which included residents who self-identified as Asian, African American, Hispanic or Latino, Native American, or other, given that these groups are all underrepresented racial and ethnic groups in orthopaedics. The demographic makeup of our study, 81% men and 75% White, is roughly comparable to the current demographic makeup of orthopaedic residency programs, which is 82% men and 74% White. Data were analyzed using chi-square tests, Fisher exact tests, and t-tests as appropriate. For comparisons of Likert scale measures, we used an anchor-based approach to determining the minimum detectable change (MDC) and set the MDC as a 1-point difference on a 5-point scale and a 1.5-point difference on a 7-point scale. Stereotype threat is reported as the mean ▵ from the neutral response, and ▵ of 1.5 or greater was considered significant.

RESULTS

Women residents were more likely than men to report experiencing emotional exhaustion (odds ratio 2.18 [95% confidence interval 1.1 to 4.5]; p = 0.03). Women reported experiencing stereotype threat regarding their identity as women surgeons (mean ▵ 1.5 ± 1.0). We did not identify a difference in men's and women's overall burnout (OR 1.4 [95% CI 0.7 to 3.0]; p = 0.3), lifestyle satisfaction across multiple domains, or sense of social belonging (men: 4.3, women 3.6; mean difference 0.7 [95% CI 0.4 to 0.9]; p < 0.001). We did not identify differences in overall burnout (OR 1.5 [95% CI 0.8 to 3.0]; p = 0.2), lifestyle satisfaction across multiple domains, sense of social belonging (White: 4.2, URiO: 3.9; mean difference 0.3 [95% CI 0.17 to 0.61]; p < 0.001), or stereotype threat (mean ▵ 0.8 ± 0.9) between White and URiO surgeons. Women were more likely than men to report experiencing mistreatment, with 84% (32 of 38) of women and 43% (70 of 164) of men reporting mistreatment at least a few times per year (OR 7.2 [95% CI 2.8 to 18.1]; p < 0.001). URiO residents were more likely than White residents to report experiencing mistreatment overall, with 65% (32 of 49) of URiO residents and 45% (66 of 148) of White residents reporting occurrences at least a few times per year (OR 2.3 [95% CI 1.2 to 4.6]; p = 0.01). Women were more likely than men to report experiencing gender discrimination (OR 52.6 [95% CI 18.9 to 146.1]; p < 0.001), discrimination based on pregnancy or childcare status (OR 4.3 [95% CI 1.4 to 12.8]; p = 0.005), and sexual harassment (OR 11.8 [95% CI 4.1 to 34.3]; p < 0.001). URiO residents were more likely than White residents to report experiencing racial discrimination (OR 7.8 [95% CI 3.4 to 18.2]; p < 0.001). More women than men had thoughts of leaving residency (OR 4.5 [95% CI 1.5 to 13.5]; p = 0.003), whereas URiO residents were not more likely to have thoughts of leaving than White residents (OR 2.2 [95% CI 0.7 to 6.6]; p = 0.1).

CONCLUSION

Although we did not detect meaningful differences in some measures of well-being, we identified that women report experiencing more emotional exhaustion and report stereotype threat regarding their identity as women surgeons. Women and URiO residents report more mistreatment than their peers, and women have more thoughts of leaving residency than men. These findings raise concern about some aspects of the training environment for women and URiO residents that could contribute to attrition during training.

CLINICAL RELEVANCE

Understanding how well-being and mistreatment affect underrepresented residents helps in developing strategies to better support women and URiO residents during training. We recommend that orthopaedic governing bodies consider gathering national data on resident well-being and mistreatment to identify specific issues and track data over time. Additionally, departments should examine their internal practices and organizational culture to address specific gaps in inclusivity, well-being, and mechanisms for resident support.

Finding Your Job in Orthopaedic Trauma: A Survey Revealing the Cold Hard Facts

OBJECTIVES

Finding a first job after fellowship can be stressful due to the uncertainty about which resources to use, including fellowship program directors, residency faculty, and other sources. There are more than 90 orthopaedic trauma fellows seeking jobs annually. We surveyed orthopaedic trauma fellows to determine the job search process.

METHODS

DESIGN

An anonymous 37-question survey.

SETTING

Online Survey.

PATIENT SELECTION CRITERIA

Orthopaedic trauma fellows from the 5 fellowship-cycle years of 2016-2021.

OUTCOME MEASURES AND COMPARISONS

The primary questions were related to the job search process, current job, and work details. The secondary questions addressed job satisfaction. Data analysis was performed using STATA 17.

RESULTS

There were 159 responses (40%). Most of the respondents completed a fellowship at an academic program (84%). Many (50%) took an academic job and 24% were hospital employed. Sixteen percent had a job secured before fellowship and 49% went on 2-3 interviews. Word of mouth was the top resource for finding a job (53%) compared with fellowship program director (46%) and residency faculty (33%). While 82% reported ending up in their first-choice job, 34% of respondents felt they "settled." The number of trauma cases was important (62%), ranked above compensation (52%) as a factor affecting job choice. Surgeons who needed to supplement their practice (46%) did so with primary and revision total joints (37%).

CONCLUSIONS

Jobs were most often found by word of mouth. Most fellows landed their first job choice, but still a third of respondents reporting settling on a job. Case volume played a significant role in factors affecting job choice.

An overview of occupational injuries among female orthopaedic surgeons

Introduction

The aim of this study was to assess occupational injuries among female orthopaedic surgeons and compare these rates to their male counterparts.

Methods

An electronic survey was developed to assess occupational injuries among female orthopaedic surgeons. Descriptive statistics were analyzed for all survey items, and chi-squared tests and paired t-tests were used when appropriate.

Results

169 female orthopaedic surgeons completed this survey, the average age was 50 years old. MSK Injuries: Among the 169 responding surgeons, there were a total of 320 work-related musculoskeletal injuries. Non-MSK Occupational Injuries: Female orthopaedic surgeons experience social isolation at much higher rates than their male counterparts (53.8 % and 32.9 % respectively, p < 0.0001) as well as psychological distress since beginning practice (61.5 % and 55.3 % respectively). Additionally, female orthopaedic surgeons report higher rates of burnout (72.2 %, p = 0.01) compared to male orthopaedic surgeons (63.4 %). Female orthopaedic surgeons also sought out counseling from mental health professionals at higher rates than their male counterparts since beginning training (37.3 % and 28.6 % respectively, p = 0.02). 13.1 % of female respondents reported having been diagnosed with cancer since starting practice. Additionally, 94.6 % of female orthopaedic surgeons have experienced a finger stick and 16.1 % of female orthopaedic surgeons have experienced hearing loss since beginning practice.

Discussion

This study assesses the occupational injuries that affect female orthopaedic surgeons' physical and mental well-being. We found that in comparison to male orthopaedic surgeons, the major differences were found in the psychological and emotional domains. Women reported experiencing burnout and social isolation as well as seeking professional counseling at significantly higher rates than males; however, both genders reported concerningly high numbers. This could suggest that more resources need to be made available to help orthopaedic surgeons cope with the stresses of their demanding profession, with a specific emphasis on reducing work-related stress among female orthopaedic surgeons.

Overcoming the Barriers to Diversity in Orthopaedic Surgery: A Global Perspective

BACKGROUND

Diversity in orthopaedics continues to lag behind that in other surgical specialties. This pattern exists globally and is not unique to gender or race. This review offers a global perspective on overcoming the barriers to diversity in orthopaedics.

METHODS

A literature search of MEDLINE and Embase was conducted and a narrative review was undertaken. Publications that discussed any aspect of diversity or solutions to diversity within orthopaedics or academic orthopaedics were identified.

RESULTS

A total of 62 studies were included. Studies showed that diversity in orthopaedic training is limited by structural barriers such as long hours, requirements to relocate during training, training inflexibility, and a lack of exposure to orthopaedics. Implicit bias during the selection process for training, discrimination, and a lack of role models are additional barriers that are experienced by both minority and female surgeons. The global lack of diversity suggests that there are also inherent "cultural barriers" that are unique to orthopaedics; however, these barriers are not uniformly experienced. Perceptions of orthopaedics as promoting an unhealthy work-life balance and the existence of a "boys' club" must be addressed. Strong, committed leaders can embed cultural norms, support trainees, and act as visible role models. Targeted efforts to increase diverse recruitment and to reduce bias in selection processes for medical school and specialty training will increase diversity in the "training pipeline."

CONCLUSIONS

Diversity in orthopaedics continues to lag behind that in other specialties. Increasing diversity is important for providing a more inclusive training environment, improving patient care, and reducing health disparities. Structural and cultural barriers need to be addressed to improve diversity in orthopaedics. Promoting a culture supportive of all surgeons is essential to reframing perceptions that may prevent individuals from even considering a career as an orthopaedic surgeon. Changing attitudes require focused efforts from committed leadership in a "top-down" approach that prioritizes diversity. The efforts from national bodies seeking to tackle the lack of diversity, as well as the establishment of organizations committed to diversity, such as the International Orthopaedic Diversity Alliance, provide reasons to be optimistic for the future.

What Factors Are Associated With Early Career Attrition Among Orthopaedic Surgeons in the United States?

BACKGROUND

The attrition of medical personnel in the United States healthcare system has been an ongoing concern among physicians and policymakers alike. Prior studies have shown that reasons for leaving clinical practice vary widely and may range from professional dissatisfaction or disability to the pursuit of alternative career opportunities. Whereas attrition among older personnel has often been understood as a natural phenomenon, attrition among early-career surgeons may pose a host of additional challenges from an individual and societal perspective.

QUESTIONS/PURPOSES

(1) What percentage of orthopaedic surgeons experience early-career attrition, defined as leaving active clinical practice within the first 10 years after completion of training? (2) What are the surgeon and practice characteristics associated with early-career attrition?

METHODS

In this retrospective analysis drawn from a large database, we used the 2014 Physician Compare National Downloadable File (PC-NDF), a registry of all healthcare professionals in the United States participating in Medicare. A total of 18,107 orthopaedic surgeons were identified, 4853 of whom were within the first 10 years of training completion. The PC-NDF registry was chosen because it has a high degree of granularity, national representativeness, independent validation through the Medicare claims adjudication and enrollment process, and the ability to longitudinally monitor the entry and exit of surgeons from active clinical practice. The primary outcome of early-career attrition was defined by three conditions, all of which had to be simultaneously satisfied ("condition one" AND "condition two" AND "condition three"). The first condition was presence in the Q1 2014 PC-NDF dataset and absence from the same dataset the following year (Q1 2015 PC-NDF). The second condition was consistent absence from the PC-NDF dataset for the following 6 years (Q1 2016, Q1 2017, Q1 2018, Q1 2019, Q1 2020, and Q1 2021), and the third condition was absence from the Centers for Medicare and Medicaid Services Opt-Out registry, which tracks clinicians who have formally discontinued enrollment in the Medicare program. Of the 18,107 orthopaedic surgeons identified in the dataset, 5% (938) were women, 33% (6045) were subspecialty-trained, 77% (13,949) practiced in groups of 10 or more, 24% (4405) practiced in the Midwest, 87% (15,816) practiced in urban areas, and 22% (3887) practiced at academic centers. Surgeons not enrolled in the Medicare program are not represented in this study cohort. A multivariable logistic regression model with adjusted odds ratios and 95% confidence intervals was constructed to investigate characteristics associated with early-career attrition.

RESULTS

Among the 4853 early-career orthopaedic surgeons identified in the dataset, 2% (78) were determined to experience attrition between the first quarter 2014 and the same point in 2015. After controlling for potential confounding variables such as years since training completion, practice size, and geographic region, we found that women were more likely than men to experience early-career attrition (adjusted OR 2.8 [95% CI 1.5 to 5.0]; p = 0.006]), as were academic orthopaedic surgeons compared with private practitioners (adjusted OR 1.7 [95% CI 1.02 to 3.0]; p = 0.04), while general orthopaedic surgeons were less likely to experience attrition than subspecialists (adjusted OR 0.5 [95% CI 0.3 to 0.8]; p = 0.01).

CONCLUSION

A small but important proportion of orthopaedic surgeons leave the specialty during the first 10 years of practice. Factors most-strongly associated with this attrition were academic affiliation, being a woman, and clinical subspecialization.

CLINICAL RELEVANCE

Based on these findings, academic orthopaedic practices might consider expanding the role of routine exit interviews to identify instances in which early-career surgeons face illness, disability, burnout, or any other forms of severe personal hardships. If attrition occurs because of such factors, these individuals could benefit from connection to well-vetted coaching or counseling services. Professional societies might be well positioned to conduct detailed surveys to assess the precise reasons for early attrition and characterize any inequities in workforce retention across a diverse range of demographic subgroups. Future studies should also determine whether orthopaedics is an outlier, or whether 2% attrition is similar to the proportion in the overall medical profession.

Burnout, grit and resilience among Jordanian orthopedic surgeons: a cross-sectional study

BACKGROUND

Burnout is a serious issue that affects physicians more than the general population; however, those with higher levels of grit and resilience have been shown to experience lower levels of burnout. The primary aim was to determine the prevalence of burnout among Jordanian orthopedic surgeons, explore its risk factors, and investigate the relationship between burnout and grit and resilience.

METHODS

We conducted a questionnaire-based cross-sectional study targeting a total of 180 orthopedic surgeons attending the yearly Jordanian National Orthopedic Conference (JNOC). Non-random sampling (i.e., convenience) was utilized to recruit participants. The abbreviated Maslach Burnout Inventory, short grit scale, and Connor-Davidson Resilience Scale were used. Scores were examined using the Mann-Whitney U, Kruskal-Wallis H, and Spearman's rho tests, of which results were corrected using the Bonferroni method.

RESULTS

Among 135 respondents, 62.2% were specialists and 37.8% were residents. About 52.0% practiced in public hospitals. Approximately 69.0% worked for more than 50 h weekly. The prevalence of burnout among all participants was 45.2% with more frequency among residents (66.7%). Burnout and the participants' grit and resilience showed an inverse relationship (ρ = -0.441 and ρ = -0.312, respectively). Age (ρ = 0.337), number of children (ρ = 0.245), and years of experience (ρ = 0.331) were positively correlated with grit. The median score for grit was higher in physicians who had or are having their residency outside Jordan (p < 0.001). Age (ρ = 0.233) and years of experience (ρ = 0.269) were positively correlated with resilience.

CONCLUSION

Jordanian orthopedic surgeons face significant rates of burnout. Institutional efforts should be taken to detect and prevent burnout in addition to enhancing the grit and resilience among orthopedic professionals.

Well-being and Burnout Amongst Interventional Radiologists in the United Kingdom

PURPOSE

To assess the prevalence of burnout amongst Interventional Radiologists (IRs) in the United Kingdom and identify demographic and practice-related stressors that may adversely affect well-being.

MATERIALS AND METHODS

A survey of 36 questions was divided into two sections. Section A consisted of 14 questions that assessed demographics and work characteristics; Section B assessed burnout, utilizing the 22-item Maslach burnout inventory. Four additional open-ended questions were included to allow participants to voice opinions on the biggest contributors to workplace burnout and plans that could be implemented to alleviate this. The questionnaire was distributed to the British Society of interventional (BSIR) members. The study was conducted between August and September 2022.

RESULTS

Moderate to severe scores in emotional exhaustion (EE) were recorded in 65% of participants (moderate 26%; severe 39%) of participants r. Moderate to severe depersonalization (DP) scores were recorded in 46% of participants (moderate 23%; severe 23%). Low-moderate levels of personal accomplishment (PA) scores were recorded in 77% of respondents (low 50%; moderate 27%). Weekly hours and out-of-hour IR cover were statistically significant in predicting emotional exhaustion. Age, sex (male), time available for teaching, and weekly hours were statistically significant in predicting the depersonalisation score. Age was a predictive factor for personal accomplishment. The most recurring themes in open response to major contributors of burnout were shortage of IR clinicians and supporting staff as well as the increasing IR workload.

CONCLUSIONS

This survey has demonstrated high prevalence of burnout amongst Interventional Radiologists in UK. Urgent measures are required to tackle the workforce shortage, recognition of IR workload and control IR resources.

Rates of Burnout in Female Orthopaedic Surgeons Correlate with Barriers to Gender Equity

BACKGROUND

The primary purpose of this study was to investigate the relationships between career burnout and the barriers to gender equity identified by Canadian female orthopaedic surgeons. A secondary purpose was to assess relationships between the demographic characteristics of the female surgeons and career burnout and job satisfaction.

METHODS

An electronic survey was distributed to 330 Canadian female orthopaedic surgeons. Demographic variables including age, stage and years in practice, practice setting, and marital status were collated. The survey included the Gender Bias Scale (GBS) questionnaire and 2 questions each about career burnout and job satisfaction. The Pearson r correlation coefficient evaluated the relationships among the higher- and lower-order factors of the GBS, burnout, and job satisfaction. Spearman rank correlation coefficient assessed relationships among burnout, job satisfaction, and demographic variables.

RESULTS

Survey responses were received from 218 (66.1%) of the 330 surgeons. A total of 110 surgeons (50.5%) agreed or strongly agreed that they felt career burnout (median score = 4). Burnout was positively correlated with the GBS higher-order factors of Male Privilege (r = 0.215, p < 0.01), Devaluation (r = 0.166, p < 0.05), and Disproportionate Constraints (r = 0.152, p < 0.05). Job satisfaction (median = 4) was reported by 168 surgeons (77.1%), and 66.1% were also satisfied or very satisfied with their role in the workplace (median = 4). Burnout was significantly negatively correlated with surgeon age and job satisfaction.

CONCLUSIONS

Half of the female orthopaedic surgeons reported symptoms of career burnout. Significant relationships were evident between burnout and barriers to gender equity. Identification of the relationships between gender-equity barriers and burnout presents an opportunity to modify organizational systems to dismantle barriers and reduce this occupational syndrome.

CLINICAL RELEVANCE

Given the relationships between gender inequity and career burnout in this study of female orthopaedic surgeons, actions to dismantle gender barriers and address systemic biases are necessary at all career stages to reduce burnout.

Education Research in Orthopaedic Surgery

With the ever-changing dynamics of surgical training, it is essential for the content of educational research to evolve simultaneously. This study aimed to assess the current state of scholarly work in orthopaedic training education and to identify particular educational topics that are trending in the literature.

The Arthroplasty Surgeon Growth Indicator: A Tool for Monitoring Supply and Demand Trends in the Orthopaedic Surgeon Workforce from 2020 to 2050

BACKGROUND

Orthopaedic practices in the U.S. face a growing demand for total joint arthroplasties (TJAs), while the orthopaedic workforce size has been stagnant for decades. This study aimed to estimate annual TJA demand and orthopaedic surgeon workforce supply from 2020 to 2050, and to develop an arthroplasty surgeon growth indicator (ASGI), based on the arthroplasty-to-surgeon ratio (ASR), to gauge nationwide supply and demand trends.

METHODS

National Inpatient Sample and Association of American Medical Colleges data were reviewed for individuals who underwent primary TJA and for active orthopaedic surgeons (2010 to 2020), respectively. The projected annual TJA volume and number of orthopaedic surgeons were modeled using negative binominal and linear regression, respectively. The ASR is the number of actual (or projected) annual total hip (THA) and/or knee (TKA) arthroplasties divided by the number of actual (or projected) orthopaedic surgeons. ASGI values were calculated using the 2017 ASR values as the reference, with the resulting 2017 ASGI defined as 100.

RESULTS

The ASR calculation for 2017 showed an annual caseload per orthopaedic surgeon (n = 19,001) of 24.1 THAs, 41.1 TKAs, and 65.2 TJAs. By 2050, the TJA volume was projected to be 1,219,852 THAs (95% confidence interval [CI]: 464,808 to 3,201,804) and 1,037,474 TKAs (95% CI: 575,589 to 1,870,037). The number of orthopaedic surgeons was projected to decrease by 14% from 2020 to 2050 (18,834 [95% CI: 18,573 to 19,095] to 16,189 [95% CI: 14,724 to 17,655]). This would yield ASRs of 75.4 THAs (95% CI: 31.6 to 181.4), 64.1 TKAs (95% CI: 39.1 to 105.9), and 139.4 TJAs (95% CI: 70.7 to 287.3) by 2050. The TJA ASGI would double from 100 in 2017 to 213.9 (95% CI: 108.4 to 440.7) in 2050.

CONCLUSIONS

Based on historical trends in TJA volumes and active orthopaedic surgeons, the average TJA caseload per orthopaedic surgeon may need to double by 2050 to meet projected U.S. demand. Further studies are needed to determine how the workforce can best meet this demand without compromising the quality of care in a value-driven health-care model. However, increasing the number of trained orthopaedic surgeons by 10% every 5 years may be a potential solution.

Burnout among Residents: Prevalence and Predictors of Depersonalization, Emotional Exhaustion and Professional Unfulfillment among Resident Doctors in Canada

BACKGROUND

Burnout in the medical profession has garnered a lot of attention over recent years. It has been reported across all specialties and all stages of medical education; however, resident doctors in particular are at risk for burnout throughout their years of training. This study was aimed at evaluating the prevalence and correlates of burnout among resident doctors in Alberta.

METHODS

Through a descriptive cross-sectional study design, a self-administered questionnaire was used to gather data from resident doctors at two medical schools in Alberta, Canada. The Maslach Burnout Inventory was used as the assessment tool. Chi-squared and multivariate binary logistic regression analyses were used.

RESULTS

Overall burnout prevalence among residents was 58.2%, and for professional fulfilment index, it was 56.7% for work exhaustion and interpersonal disengagement and 83.5% for lack of professional fulfillment. Working more than 80 h/week (OR = 16.437; 95% CI: 2.059-131.225), being dissatisfied (OR = 22.28; 95% CI: 1.75-283.278) or being neither satisfied nor dissatisfied with a career in medicine (OR = 23.81; 95% CI: 4.89-115.86) were significantly associated with high depersonalization. Dissatisfaction with efficiency and resources (OR = 10.83; CI: 1.66-70.32) or being neither satisfied nor dissatisfied with a career in medicine (OR = 5.14; CI: 1.33-19.94) were significantly associated with high emotional exhaustion. Working more than 80 h/week (OR = 5.36; CI: 1.08-26.42) and somewhat agreeing that the residency program has enough strategies aimed at resident well-being in place (OR = 3.70; CI: 1.10-12.46) were significantly associated factors with high work exhaustion and interpersonal disengagement. A young age of residents (≤30 years) (OR = 0.044; CI: 0.004-0.445) was significantly associated with low professional fulfillment.

CONCLUSION

Burnout is a serious occupational phenomenon that can degenerate into other conditions or disrupt one's professional performance. Significant correlates were associated with high rates of burnout. Leaders of medical schools and policymakers need to acknowledge, design, and implement various strategies capable of providing continuous effective mental health support to improve the psychological health of medical residents across Canada.

A Comprehensive Umbrella Review for Understanding Burnout in Orthopaedic Surgery

Background: Burnout is characterized by depersonalization, emotional exhaustion, and low personal achievement. Occupational demands can lead to burnout in orthopaedic surgeons, negatively impacting patients and surgeons alike. A high-level overview of burnout is lacking; we therefore aimed to conduct an umbrella review (i.e., review of reviews) summarizing evidence on burnout in orthopaedic surgery, focusing on its rates, associations, prevention, and management. Methods: We searched Ovid Medline, Ovid PsycINFO, EBSCO CINAHL, and CENTRAL from database inception to 16 July 2022, using the terms "orthopaedic surgery," "burnout," and "review." Quality assessments were conducted using the PASS checklist. An article was considered for inclusion if it was a review, summarized evidence on burnout in orthopaedic surgery, and had a full text available to allow for data extraction. We present the results of our review using narrative syntheses. Results: We included eight systematic reviews and eight narrative reviews. We found burnout to be common among orthopaedic surgeons, although reviews reported variable rates, thereby precluding definitive conclusions. Residents were found to be particularly at risk of experiencing burnout, with estimates of one in two being affected. Burnout was found to be positively associated with several personal-related factors, including identifying as a female or as a racial minority, experiencing work-life imbalances, and not having spousal support. It was also associated with work-related factors, including working long hours, having stressful work relationships, and experiencing anxiety about one's clinical competence. Literature on interventions for preventing and managing burnout was limited, although there was some evidence supporting work-hour restrictions for residents. Conclusions: Although burnout is detrimental for orthopaedic surgeons and their patients, high-quality literature in this field is scarce. Future efforts should be dedicated to conducting large-scale, prospective studies to examine burnout rates and associations as well as interventional studies to prevent and manage burnout. Level of Evidence: Level IV Key Concepts•Burnout is a work-related syndrome that negatively impacts orthopaedic surgeons and their patients.•Burnout is common in orthopaedic surgeons, though rates vary considerably between studies, making definitive conclusions difficult to draw.•Orthopaedic surgery residents are particularly at risk of experiencing burnout, with estimates of one in two being affected.•Burnout is positively associated with several personal- and work-related factors.•Research on interventions for preventing and managing burnout is limited and requires additional inquiry.

System-Level Interventions for Addressing Burnout and Improving Professional Wellness for Orthopaedic Surgeons

Burnout is characterized by feelings of depersonalization, emotional exhaustion, and low personal achievement, which adversely affects orthopaedic surgeons and their patients. Burnout is increasingly being recognized as a systemic problem, resulting from excessive workloads, administrative burdens, inadequate job resources, and lack of work-life balance. There is a growing movement to develop system-level strategies to address it. Here, we summarize evidence-based organizational strategies and approaches to assist institutions in addressing burnout in orthopaedic surgery, and we summarize key recommendations outlined in landmark burnout guidelines. Among the recommendations made by the World Health Organization (WHO) and the National Academy of Medicine (NAM), we identified seven key themes in order to address burnout, which include: (1) recognizing the presence of burnout and investing in strategies to measure and address it; (2) harnessing leadership support and commitment; (3) establishing and sustaining a culture of wellness and support; (4) promoting diversity and inclusion in the workplace; (5) securing access to mental healthcare and promoting individual resilience; (6) reducing workplace inefficiencies; and (7) enhancing orthopaedic surgeons' autonomy and control. Key Concepts•Burnout is a work-related syndrome characterized by depersonalization, emotional exhaustion, and low personal achievement that negatively impacts orthopaedic surgeons and their patients.•Burnout is increasingly being recognized as a systemic problem, resulting from excessive workloads, administrative burdens, inadequate job resources, and lack of work-life balance, requiring system-level interventions.•System-level recommendations to address burnout have been made by researchers, national medical associations, community organizations, and landmark guidelines from the World Health Organization and the National Academy of Medicine.•It is imperative that institutions invest in system-level interventions to address burnout in order to improve the work environment of orthopaedic surgeons, offer greater professional satisfaction, and facilitate better patient outcomes.

Recruiting, Supporting and Retaining Diversity in Hand Surgery

All surgical fields that lead to a career in Hand Surgery have a stark lack of diversity of sex/gender and race, at every level of the workforce, from trainees to practicing physicians. Despite consistent statistics in publications on lack of diversity in surgical fields, a guide to effective recruitment and retention is lacking. Although we recognize that a strategy cannot be applied in all practices, this article provides actionable items to consider in the commitment and work toward a more just and equitable practice of Hand Surgery.

Prevalence and Spectrum of Occupational Injury Among Orthopaedic Surgeons: A Cross-Sectional Study

Orthopaedic surgeons are at increased risk for many occupational hazards, both physical and mental. The aim of this study was to evaluate a wide range of work-related injuries among orthopaedic surgeons in the United States.

Methods

An electronic survey was developed to assess both physical and mental occupational hazards among orthopaedic surgeons. Descriptive statistics were analyzed for all survey items and compared using chi-square and paired t tests, as appropriate.

Results

The 1,645 responding orthopaedic surgeons (7% response rate) reported a total of 2,702 work-related musculoskeletal injuries, 17.9% of which required surgical treatment. Of the 61 who filed a disability claim, only 66% returned to work and 34% retired early. Additionally, 17.4% of respondents reported having been diagnosed with cancer since starting practice, and 93.8% reported experiencing a finger stick at some point in their career. Over one-half (55.8%) had experienced feelings of psychological distress since beginning practice, and nearly two-thirds (64.4%) reported burnout from work.

Conclusions

This study captured a spectrum of occupational injuries that pose longitudinal risks to an orthopaedic surgeon's physical and mental well-being. Our hope is that this analysis of occupational hazards will help to raise awareness among the orthopaedic and medical communities and lead to efforts to reduce these risks.

Level of Evidence

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Podiatric Medical Resident Wellness: A Group Survey Study

BACKGROUND

Burnout and medical resident well-being has become an increasingly studied topic in medical degree (MD) and doctor of osteopathic medicine (DO) fields and specialties, which has led to systemic changes in postgraduate education and training. Although an important topic to address for physicians of all experience levels and fields of practice, there is little research on this topic as it pertains specifically to the podiatric medical community.

METHODS

A wellness needs assessment was developed and distributed to podiatric medical residents via electronic survey to assess overall wellness levels of residents and to highlight several subdomains of well-being in the training programs of the podiatric medical profession.

RESULTS

A total of 121 residents completed the wellness needs assessment. Survey respondents indicated that they experienced high levels of professional burnout, with large numbers of them experiencing depression and anxiety. When analyzing the different subdomains of wellness, levels of intellectual and environmental wellness were high, and levels of financial and physical wellness were reported as low. In addition, free response answers were recorded in the survey regarding well-being initiatives that have been implemented in residency programs, and in many cases no such programs are reported to exist.

CONCLUSIONS

Podiatric medical residents experience compromised well-being similar to their MD/DO counterparts. These exploratory survey group results are concerning and warrant further investigation as well as organizational introspection. Analyzing well-being and implementing changes that can support podiatric physicians at all levels of training could decrease the deleterious effects of burnout in all its forms.

Hand Call Practices and Satisfaction: Survey Results From Hand Surgeons in the United States

PURPOSE

To describe current hand call practices in the United States (US) and identify aspects of call practices that lead to surgeon satisfaction.

METHODS

An anonymous survey was administered to practicing members of the American Society for Surgery of the Hand, and responses were filtered to US surgeons taking hand call. Hand call was considered: (A) hand-specific call including replantation or microvascular services or (B) hand-specific call without replantation or microvascular responsibilities. Data were collected pertaining to practices, compensation, assistance, frequency, and satisfaction. Descriptive analyses were performed and regionally subdivided. Pearson correlations were used to determine aspects of a call that influenced surgeon satisfaction.

RESULTS

A total of 662 US hand surgeons from 49 states responded. Among the respondents, 38% (251) participate in replantation or microvascular call, 34% (225) participate in hand-specific call excluding replantation, and 28% (186) do not participate in hand-specific call. Of those practicing hand call (476), 60% take 6 or fewer days of call per month, 62% have assistance with staffing consultations, 65% have assistance with surgical procedures, and 49% are financially incentivized to take call. More than half (51%) reported that they have a protected time for call aside from their elective practice, and 10% of the surgeons reported that they have a dedicated operating room (OR) time after a call to care for cases. Two percent reported that the day following call is free from clinical duties. Only 46% of the surgeons were satisfied with their call schedule, with the top concerns among unsatisfied respondents relating to pay, OR availability, and burnout. The factors correlating to surgeon satisfaction included less frequent call, assistance with performing consultations and surgery, pay for call, and OR availability.

CONCLUSIONS

The majority of US hand surgeons are not satisfied with their current call practices, with frequent concerns relating to pay, OR availability, and burnout.

CLINICAL RELEVANCE

These findings may promote awareness regarding aspects of hand call that correlate with surgeon satisfaction and highlight practice patterns that may reduce burnout.

Ergonomics in Spine Surgery

As physician burnout and wellness become increasingly recognized as vital themes for the medical community to address, the topic of chronic work-related conditions in surgeons must be further evaluated. While improving ergonomics and occupational health have been long emphasized in the executive and business worlds, particularly in relation to company morale and productivity, information within the surgical community remains relatively scarce. Chronic peripheral nerve compression syndromes, hand osteoarthritis, cervicalgia and back pain, as well as other repetitive musculoskeletal ailments affect many spinal surgeons. The use of ergonomic training programs, an operating microscope or exoscope, powered instruments for pedicle screw placement, pneumatic Kerrison punches and ultrasonic osteotomes, as well as utilizing multiple surgeons or microbreaks for larger cases comprise several methods by which spinal surgeons can potentially improve workspace health. As such, it is worthwhile exploring these areas to potentially improve operating room ergonomics and overall surgeon longevity.

Objects in Mirror Are Closer Than They Appear: Symptoms of Depression and Suicidality in Orthopaedic Surgeons

BACKGROUND

Suicide and depression among orthopaedic surgeons have recently emerged as rising concerns. Prior research has suggested that orthopaedic surgeons have the highest prevalence of suicide among surgical specialties. We sought to determine the factors associated with depression and suicidal ideation (SI) in orthopaedics, including subspecialty.

METHODS

A survey including demographic questions, the Beck Depression Inventory, and the Columbia-Suicide Severity Rating Scale was administered electronically via a listserv to the orthopaedic subspecialties of trauma, adult reconstruction, hand and upper extremity, shoulder and elbow, foot and ankle, spine, pediatrics, sports medicine, and oncology. The responses were quantified according to previously published criteria. The associations of demographic factors, training, and current practice environment with depression and suicidality were assessed using Fisher exact tests. Reverse stepwise multivariable logistic regression models were developed to identify factors associated with depression and SI.

RESULTS

The responses were obtained from 661 board-certified, practicing orthopaedic surgeons. In this study, 156 surgeons (23.6%) endorsed some level of active SI in their lifetime, 200 surgeons (30.3%) reported either active or passive SI in their lifetime, and 33 surgeons (5%) reported that, on at least 1 occasion in their lifetime, they had experienced active SI with a specific plan and intention to harm themselves. Gender, relationship status, having children, and residency and/or current practice region were significantly associated with depression and/or SI. Younger age, divorce, adult reconstruction and foot and ankle subspecialties, and attending residency in the Western U.S. were found on multivariable testing to be associated with symptoms of depression and SI (odds ratios, 1.03 [per 1-year decrease in age] to 8.28).

CONCLUSIONS

Symptoms of depression and suicidality are not uncommon among orthopaedic surgeons, and variation by gender, relationship status, and geographic location are supported by prior research. Based on our results, depression and/or SI likely affect someone close to you or someone with whom you work. The normalization of discussions surrounding emotional well-being, depression, and SI is imperative.

Discrepancies in Work-Family Integration Between Female and Male Orthopaedic Surgeons

BACKGROUND

Female surgeons, representing 6.5% of the American Academy of Orthopaedic Surgeons, are particularly vulnerable to work-family conflict. This conflict may deter women from considering orthopaedic surgery as a specialty. The study objective was to identify differences in work-family integration between female and male orthopaedic surgeons in the United States.

METHODS

An anonymous survey collecting data within the domains of work, family, and satisfaction was completed by 347 orthopaedic surgeons (153 female, 194 male). Differences in responses between males and females were identified.

RESULTS

Female surgeons were younger than males (mean, 41.1 versus 50.1 years; p < 0.001) and earlier in their careers, with 60.3% of males in practice >10 years compared with 26.1% of females (p < 0.001). Consulting (7.8% versus 31.4%; p < 0.001), course faculty positions (19.0% versus 39.2%; p < 0.001), and academic and leadership titles (30.7% versus 47.4%; p = 0.002) were significantly less common among females. There was a significant income disparity between females (mean yearly income, $300,000 to $400,000) and males (mean, $400,000 to $500,000; p < 0.001). Females were more likely to have never married (12.4% versus 2.6%; p < 0.001), or they married at a later mean age (30.2 ± 4.7 versus 28.3 ± 3.9 years; p < 0.001). Females were more likely to have no children (29.4% versus 7.8%; p < 0.001), require fertility treatment (32.0% versus 11.9%; p < 0.001), and not have children until after completing their medical training (63.0% versus 31.1%; p < 0.001). Female surgeons reported more responsibility in parenting (p < 0.001) and household duties (p < 0.001) than males. Work-family balance satisfaction was 72.3% in females and 82.1% in males (p = 0.081).

CONCLUSIONS

This study highlights deficiencies in work-family integration that appear to uniquely impact female orthopaedic surgeons. Female surgeons delay starting a family, more frequently require fertility treatments, carry more responsibility at home, have fewer academic and leadership roles, earn lower incomes, and are less satisfied with work-family balance relative to males. The discrepancy in work-family integration must be addressed to attract, support, and retain women as successful orthopaedic surgeons.

Time and Clerical Burden Posed by the Current Electronic Health Record for Orthopaedic Surgeons

INTRODUCTION

The electronic health record (EHR) has become an integral part of modern medical practice. The balance of benefit versus burden of a required EHR remains inconclusive, with many studies identifying increasing physician burnout and less face-to-face patient contact because of increasing documentation demands. Few studies have investigated EHR burden in orthopaedic surgery practice. This study aimed to characterize and compare EHR usage patterns and time allocation within EHR between orthopaedic surgeons, other surgeons, and medicine physicians at an academic medical center.

METHODS

EHR usage was digitally tracked within a large academic medical center. EHR usage data were compiled for all physicians seeing outpatients from April 2018 to June 2019. The tracking metrics included time spent answering messages, typing notes, reviewing laboratories and imaging, reading notes, and placing orders. Physicians were subdivided between orthopaedic surgeons, other surgeons, and nonsurgeon/medical specialties. Statistical comparisons using a two-sample t-test were done between orthopaedic surgeon EHR usage patterns and other surgeons, in addition to orthopaedic surgeons versus nonsurgeons.

RESULTS

One thousand sixty physicians including 28 full-time orthopaedic surgeons, 134 other surgeons, and 898 nonsurgical medicine physicians met inclusion criteria. Orthopaedic surgeons saw on average 31 patients per office day compared with other surgeons at 18 patients per office day (P < 0.01) and nonsurgeons at 12 patients per office day (P < 0.01). Orthopaedic surgeons received more EHR messages while also being more efficient at answering EHR messages compared with other surgeons and nonsurgeons (P < 0.01). EHR tasks, including answering messages, placing orders, chart review, writing notes, and reviewing imaging, consumed 58% of an orthopaedic surgeon's scheduled office day with the largest contribution from required note writing.

DISCUSSION

In academic orthopaedic practice, EHR use has surpassed face-to-face patient time, consuming 58% of orthopaedic surgeons' clinical days. With the previously shown correlation between EHR burden and physician burnout, targeted interventions to increase efficiency and off-load EHR burden are necessary to sustain a successful orthopaedic practice.

Physician wellness in orthopaedic surgery : a multinational survey study

AIMS

Physician burnout and its consequences have been recognized as increasingly prevalent and important issues for both organizations and individuals involved in healthcare delivery. The purpose of this study was to describe and compare the patterns of self-reported wellness in orthopaedic surgeons and trainees from multiple nations with varying health systems.

METHODS

A cross-sectional survey of 774 orthopaedic surgeons and trainees in five countries (Australia, Canada, New Zealand, UK, and USA) was conducted in 2019. Respondents were asked to complete the Mayo Clinic Well-Being Index and the Stanford Professional Fulfillment Index in addition to 31 personal/demographic questions and 27 employment-related questions via an anonymous online survey.

RESULTS

A total of 684 participants from five countries (Australia (n = 74), Canada (n = 90), New Zealand (n = 69), UK (n = 105), and USA (n = 346)) completed both of the risk assessment questionnaires (Mayo and Stanford). Of these, 42.8% (n = 293) were trainees and 57.2% (n = 391) were attending surgeons. On the Mayo Clinic Well-Being Index, 58.6% of the overall sample reported feeling burned out (n = 401). Significant differences were found between nations with regards to the proportion categorized as being at risk for poor outcomes (27.5% for New Zealand (19/69) vs 54.4% for Canada (49/90) ; p = 0.001). On the Stanford Professional Fulfillment Index, 38.9% of the respondents were classified as being burned out (266/684). Prevalence of burnout ranged from 27% for Australia (20/74 up to 47.8% for Canadian respondents (43/90; p = 0.010). Younger age groups (20 to 29: RR 2.52 (95% confidence interval (CI) 1.39 to 4.58; p = 0.002); 30 to 39: RR 2.40 (95% CI 1.36 to 4.24; p = 0.003); 40 to 49: RR 2.30 (95% CI 1.35 to 3.9; p = 0.002)) and trainee status (RR 1.53 (95% CI 1.15 to 2.03 p = 0.004)) were independently associated with increased relative risk of having a 'at-risk' or 'burnout' score.

CONCLUSIONS

The rate of self-reported burnout and risk for poor outcomes among orthopaedic surgeons and trainees varies between countries but remains unacceptably high throughout. Both individual and health system characteristics contribute to physician wellness and should be considered in the development of strategies to improve surgeon wellbeing. Level of Evidence: III Cite this article: Bone Jt Open 2021;2(11):932-939.

The dual degree orthopedic surgeon: A survey of the trends, motivations, and perceived value of the master of business administration degree

Orthopedic surgeons are obtaining Master of Business Administration (MBA) degrees at an increasing rate. This study aimed to identify the motivations, trends, and perceived value of the MBA degree for these dual degree surgeons. A total of 157 orthopedic surgeons with both MD and MBA degrees were surveyed with a 19-item questionnaire to identify surgeons' motivations for obtaining an MBA degree and the perceived value of the degree. A total of 66 responses (42%) were received. Most respondents (89.4%) viewed the MBA degree as either extremely valuable or valuable. Prior to obtaining an MBA, 71.9% of dual degree surgeons dedicated time to administrative duties outside of the clinic. This number increased to 98.4% after receiving an MBA (p < 0.001). With the growing number of surgeons pursuing MBA degrees, there is a decrease in the time spent in the clinical role suggesting that either the non-clinical burden is increasing, or surgeons choose to re-allocate their time. Despite the high direct costs of an MBA, a majority of orthopedic surgeons perceived the MBA degree as a valuable investment they would pursue again.

Spine Surgeons Burnout and Quality of Life: Results of a Worldwide Survey

STUDY DESIGN

Cross-sectional survey study.

OBJECTIVE

To evaluate the prevalence of burnout, assess the personal and professional characteristics associated with burnout in spine surgeons and determine their quality of life.

SUMMARY OF BACKGROUND DATA

Burnout is a syndrome characterized by emotional exhaustion, depersonalization, and decreased sense of accomplishment that leads to decreased effectiveness at work. To date, there has been a lack of information on the prevalence of burnout among spine surgeons worldwide and the risk factors associated with this condition.

METHODS

An electronic survey with members of AO Spine was performed in May 2018. The survey evaluated demographic variables, practice characteristics, burnout, and quality of life. Maslach Burnout Inventory (MBI) and EuroQol 5-dimensions (EQ5D) were used to evaluate burnout and quality of life, respectively.

RESULTS

A total of 818 surgeons from 86 countries completed the survey. The prevalence of burnout was 30.6%. In the multiple linear model, emotional fatigue was independently associated with younger age (B = -0.17, CI95% = -0.26 to -0.07, P < 0.0001), and longer working hours per week (B = -2.71, CI95% = -4.34 to -1.07, P = 0.001); depersonalization was independently associated with younger age (B = -0.13, CI95% = -0.19 to -0.07, P < 0.0001), practicing outside Latin America (LA) (B = 0.71, CI95% = 0.41-1.01, P < 0.0001) and currently being a fellow (B = 0.54, CI95% = 0.06-1.02, P = 0.02); and higher scores of personal fulfilment was associated with practicing in LA (B = -1.27, CI95% = -1.69 to -0.85, P < 0.0001).

CONCLUSION

Burnout is a common condition among spine surgeons worldwide. There is a significant association between burnout scores and decreased general quality of life. These results highlight the need to develop interventional programs to better identify, prevent, and manage this condition among practicing spine surgeons.Level of Evidence: 4.

Emotional intelligence, burnout, and professional fulfillment in clinical year medical students

BACKGROUND

Emotional intelligence (EI) has been associated with decreased burnout in surgical residents but has not been extensively studied in medical students. We hypothesized that higher EI would lead to decreased levels of burnout among medical students at a US medical school.

METHODS

The authors administered three separate EI measures and compiled an EI score by adding the normalized score on each test. These measures were the DRS-15, the Grit Scale, and the Reading the Mind Between the Eyes Quiz. The Professional Fulfillment Index (PFI) was used to determine levels of burnout experienced two weeks before survey completion.

RESULTS

The population included 68 medical students. PFI and EI scores were positively correlated (R = 0.55, p < .001). The separate EI measures indicated that both Grit (R = 0.43, p < .001) and DRS-15 (R = 0.56, p < .001) were correlated with PFI. The Eyes Quiz did not show a significant correlation with PFI (p = .2).

CONCLUSIONS

The results confirmed our hypothesis that EI would be correlated with decreased levels of burnout among this group of students. Some areas of potential future study include whether these same results hold true at other medical schools and if improving EI has a benefit of decreasing burnout.

Orthopaedic Surgeon Mental Health During the COVID-19 Pandemic

Introduction: This study compares rates of depression, suicidal ideation, and burnout among resident/fellow and attending physicians in orthopaedic surgery to other specialties during height/end of the first wave of the coronavirus disease 2019 (COVID-19) pandemic at our institution. Main outcomes and measures included suicidal ideation, Patient Health Questionnaire for Depression (PHQ-9) scores for depression, and 2 single-item measures for emotional exhaustion and depersonalization. This study provides valuable information regarding orthopaedic surgeon mental health during world crises. Methods: This is a cross-sectional survey-based study of resident, fellow, and attending physicians from 26 specialties during and after the first wave of the COVID-19 pandemic at our institution from April 24, 2020 to May 15, 2020. The survey contained 22 items. This includes consent, demographics and general data, 2 single-item questions of emotional exhaustion and depersonalization, and the PHQ-9. Subjects were eligible if they were a resident/fellow or attending physician at our institution. Results: The response rate for the study was 16.31%. Across all specialties rates were 6.2% depression, 19.6% burnout, and 6.6% suicidal ideation. The results for orthopaedic surgeons are as follows: 0% tentative diagnosis of depression, 3.8% suicidal ideation, and 4% burnout. Anesthesiology had the highest rate of depression (14.3%). Internal medicine and other non-surgical specialties had the highest rate of suicidal ideation (10.2%). Orthopaedic surgeons were significantly more likely to achieve work–life balance and experience less burnout than anesthesiologists and pediatricians. Discussion: Depression, suicidal ideation, and burnout continue to affect physicians across all specialties. These issues are amplified in light of crisis. Job satisfaction and rigorous training may be protective factors that allow orthopaedic surgeons to adapt to novel clinical settings under stress when compared to anesthesiologists and pediatricians. Resilience training and stress management strategies should continue to be investigated to better prepare physicians for world crises.

Parenthood Among Orthopedic Surgery Residents: Assessment of Resident and Program Director Perceptions on Training

Orthopedic residency training overlaps with common childbearing ages. The purpose of this study was to describe factors affecting male and female residents' family-planning decisions and attitudes of program directors (PDs) toward parenthood during residency. In 2018, using an anonymous survey model, residents and PDs in Accreditation Council for Graduate Medical Education-accredited orthopedic surgery programs were asked about their perceptions of parenthood on training, the availability of family-oriented services at their programs, and the effect of residency culture and policies on their decision to have children. This survey occurred in 2018. Three hundred forty-nine (76.2%) of 458 resident respondents were male and 109 (23.8%) were female. Two hundred four (49.9%) of 409 residents were unsure of their program's parental leave policy. Male residents reported taking an average of 0.8 weeks (95% CI, 0.0-4.0 weeks) of parental leave and females an average of 4.6 weeks (95% CI, 2.0-6.5 weeks) (P<.001). Female residents were more likely to report delaying having children during residency (56.73% vs 38.71%, P=.001) and were more likely to cite reputational concerns (57.63% vs 0.76%, P<.001) and effects on career opportunities (42.37% vs 7.57%, P<.001) as reasons for delaying parenthood. The most commonly cited negative effect of parenthood on residency training by PDs was reduction in off-duty educational time (15 of 29, 51.72%). Twenty-four (80%) of 30 PDs believe that training may need to be extended based on amount of maternity/paternity leave time taken off. Although parenthood during orthopedic training is common, both male and female residents reported delaying parenthood because of residency-related factors. Improved clarification of leave policies and establishment of clear guidelines for parenthood in residency may improve resident wellness. [Orthopedics. 2021;44(2):98-104.].

How Do Areas of Work Life Drive Burnout in Orthopaedic Attending Surgeons, Fellows, and Residents?

BACKGROUND

Concerning levels of burnout have been reported among orthopaedic surgeons and residents. Defined as emotional exhaustion and depersonalization, physician burnout is associated with decreased productivity, increased medical errors, and increased risk of suicidal ideation. At the center of burnout research, person-centered approaches focusing on individual characteristics and coping strategies have largely been ineffective in solving this critical issue. They have failed to capture and address important institutional and organizational factors contributing to physician burnout. Similarly, little is known about the relationship between burnout and the working environments in which orthopaedic physicians practice, and on how orthopaedic surgeons at different career stages experience and perceive factors relevant to burnout.

QUESTIONS/PURPOSES

(1) How does burnout differ among orthopaedic attending surgeons, fellows, and residents? (2) What specific areas of work life are problematic at each of these career stages? (3) What specific areas of work life correlate most strongly with burnout at each of these career stages?

METHODS

Two hundred orthopaedic surgeons (residents, fellows, and attending physicians) at a single institution were invited to complete an electronic survey. Seventy-four percent (148 of 200) of them responded; specifically, 43 of 46 residents evenly distributed among training years, 18 of 36 fellows, and 87 of 118 attending physicians. Eighty-three percent (123 of 148) were men and 17% (25 of 148) were women. Two validated questionnaires were used. The Maslach Burnout Inventory was used to assess burnout, measuring emotional exhaustion and depersonalization. The Areas of Worklife Survey was used to measure congruency between participants and their work environment in six domains: workload, control, reward, community, fairness, and values. Participants were invited to openly share their experiences and suggest ways to improve burnout and specific work life domains. The main outcome measures were Maslach Burnout Inventory subdomains of emotional exhaustion and depersonalization, and Areas of Worklife Survey subdomains of workload, control, reward, community, fairness and values. We compared outcome measures of burnout and work life between groups. Simple linear regression models were used to report correlations between subscales. Stratified analyses were used to identify which group demonstrated higher correlations. All open comments were analyzed and coded to fully understand which areas of work life were problematic and how they were perceived in our population.

RESULTS

Nine percent (7 of 80) of attending surgeons, 6% (1 of 16) of fellows, and 34% (14 of 41) of residents reported high levels of depersonalization on the Maslach Burnout Inventory (p < 0.001). Mean depersonalization scores were higher (worse) in residents followed by attending surgeons, then fellows (10 ± 6, 5 ± 5, 4 ± 4 respectively; p < 0.001). Sixteen percent (13 of 80) of attending surgeons, 31% (5 of 16) of fellows, and 34% (14 of 41) of residents reported high levels of emotional exhaustion (p = 0.07). Mean emotional exhaustion scores were highest (worse) in residents followed by attending surgeons then fellows (21 ± 12, 17 ± 10, 16 ± 14 respectively; p = 0.11). Workload was the most problematic work life area across all stages of orthopaedic career. Scores in the Areas of Worklife Survey were the lowest (worse) in the workload domain for all subgroups: residents (2.6 ± 0.4), fellows (3.0 ± 0.6), and attending surgeons (2.8 ± 0.7); p = 0.08. Five problematic work life categories were found through open comment analysis: workload, resources, interactions, environment, and self-care. Workload was similarly the most concerning to participants. Specific workload issues identified included administrative load (limited job control, excessive tasks and expectations), technology (electronic medical platform, email overload), workflow (operating room time, patient load distribution), and conflicts between personal, clinical, and academic roles. Overall, worsening emotional exhaustion and depersonalization were most strongly associated with increasing workload (r = - 0.50; p < 0.001; and r = - 0.32; p < 0.001, respectively) and decreasing job control (r = - 0.50; p < 0.001, and r = - 0.41; p < 0.001, respectively). Specifically, in residents, worsening emotional exhaustion and depersonalization most strongly correlated with increasing workload (r = - 0.65; p < 0.001; and r = - 0.53; p < 0.001, respectively) and decreasing job control (r = - 0.49; p = 0.001; and r = - 0.51; p = 0.001, respectively). In attending surgeons, worsening emotional exhaustion was most strongly correlated with increasing workload (r = - 0.50; p < 0.001), and decreasing job control (r = - 0.44; p < 0.001). Among attending surgeons, worsening depersonalization was only correlated with increasing workload (r = - 0.23; p = 0.04). Among orthopaedic fellows, worsening emotional exhaustion and depersonalization were most strongly correlated with decreasing sense of fairness (r = - 0.76; p = 0.001; and r = - 0.87; p < 0.001, respectively), and poorer sense of community (r = - 0.72; p = 0.002; and r = - 0.65; p = 0.01, respectively).

CONCLUSIONS

We found higher levels of burnout among orthopaedic residents compared to attending surgeons and fellows. We detected strong distinct correlations between emotional exhaustion, depersonalization, and areas of work life across stages of orthopaedic career. Burnout was most strongly associated with workload and job control in orthopaedic residents and attending surgeons and with fairness and community in orthopaedic fellows.

CLINICAL RELEVANCE

Institutions wishing to better understand burnout may use this approach to identify specific work life drivers of burnout, and determine possible interventions targeted to orthopaedic surgeons at each stage of career. Based on our institutional experience, leadership should investigate strategies to decrease workload by increasing administrative support and improving workflow; improve sense of autonomy by consulting physicians in decision-making; and seek to improve the sense of control in residents and sense of community in fellows.

What Is the Prevalence of Burnout, Depression, and Substance Use Among Orthopaedic Surgery Residents and What Are the Risk Factors? A Collaborative Orthopaedic Educational Research Group Survey Study

BACKGROUND

Burnout and depression among healthcare professionals and trainees remain alarmingly common. In 2009, 56% of orthopaedic surgery residents reported burnout. Alcohol and illicit drug use are potential exacerbating factors of burnout and depression; however, these have been scarcely studied in residency populations.

QUESTIONS/PURPOSES

(1) What proportion of orthopaedic residents report symptoms of burnout and depression? (2) What factors are independently associated with an orthopaedic resident reporting emotional exhaustion, depersonalization, low personal accomplishment, and depression? (3) What proportion of orthopaedic residents report hazardous alcohol or drug use? (4) What factors are independently associated with an orthopaedic resident reporting hazardous alcohol or drug use?

METHODS

We asked 164 orthopaedic surgery programs to have their residents participate in a 34-question internet-based, anonymous survey, 28% of which (46 of 164) agreed. The survey was distributed to all 1147 residents from these programs, and 58% (661 of 1147) of these completed the survey. The respondents were evenly distributed among training years. Eighty-three percent (551 of 661) were men, 15% (101 of 661) were women, and 1% (nine of 661) preferred not to provide their gender. The survey asked about demographics, educational debt, sleep and work habits, perceived peer or program support, and substance use, and validated instruments were used to assess burnout (abbreviated Maslach Burnout Inventory), depression (Patient Health Questionnaire-2), and hazardous alcohol use (Alcohol Use Disorder Identification Test-Consumption). The main outcome measures included overall burnout, emotional exhaustion, depersonalization, low personal accomplishment, depression, and hazardous alcohol and drug use. Using the variables gathered in the survey, we performed an exploratory analysis to identify significant associations for each of the outcomes, followed by a multivariable analysis.

RESULTS

Burnout was reported by 52% (342 of 661) of residents. Thirteen percent of residents (83 of 656) had positive screening results for depression. Factors independently associated with high emotional exhaustion scores included early training year (odds ratio 1.15; 95% confidence interval, 1.01-1.32; p = 0.03) unmanageable work volume (OR 3.13; 95% CI, 1.45-6.67; p < 0.01), inability to attend health maintenance appointments (OR 3.23; 95% CI, 1.69-6.25; p < 0.01), lack of exercise (OR 1.69; 95% CI, 1.08-2.70; p = 0.02), and lack of program support (OR 3.33; 95% CI, 2.00-5.56; p < 0.01). Factors independently associated with depersonalization included early training year (OR 1.27; 95% CI, 1.12-1.41; p < 0.01), inability to attend health maintenance appointments (OR 2.70; 95% CI, 1.67-4.35; p < 0.01), and lack of co-resident support (OR 2.52; 95% CI, 1.52-4.18; p < 0.01). Low personal accomplishment was associated with a lack of co-resident support (OR 2.85; 95% CI, 1.54-5.28; p < 0.01) and lack of program support (OR 2.33; 95% CI, 1.32-4.00; p < 0.01). Factors associated with depression included exceeding duty hour restrictions (OR 2.50; 95% CI, 1.43-4.35; p < 0.01) and lack of program support (OR 3.85; 95% CI, 2.08-7.14; p < 0.01). Sixty-one percent of residents (403 of 656) met the criteria for hazardous alcohol use. Seven percent of residents (48 of 656) reported using recreational drugs in the previous year. Factors independently associated with hazardous alcohol use included being a man (OR 100; 95% CI, 35-289; p < 0.01), being Asian (OR 0.31; 95% CI, 0.17-0.56; p < 0.01), single or divorced marital status (OR 2.33; 95% CI, 1.47-3.68; p < 0.01), and more sleep per night (OR 1.92; 95% CI, 1.21-3.06; p < 0.01). Finally, single or divorced marital status was associated with drug use in the past year (OR 2.30; 95% CI, 1.26-4.18; p < 0.01).

CONCLUSIONS

The lack of wellness among orthopaedic surgery residents is troubling, especially because most of the associated risk factors are potentially modifiable. Programs should capitalize on the modifiable elements to combat burnout and improve overall wellbeing. Programs should also educate residents on burnout, focus on work volume, protect access to health maintenance, nurture those in the early years of training, and remain acutely aware of the risk of substance abuse. Orthopaedic surgery trainees should strive to encourage peer support, cultivate personal responsibility, and advocate for themselves or peers when faced with challenges. At a minimum, programs and educational leaders should foster an environment in which admitting symptoms of burnout is not seen as a weakness or failure.

LEVEL OF EVIDENCE

Level II, prognostic study.

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.

A Survey of Burnout Among Members of the American Society for Surgery of the Hand

PURPOSE

Physician burnout affects approximately half of US physicians, significantly higher than the general working population. The aims of this study were to determine the prevalence of burnout specifically among hand surgeons and to identify factors unique to the practice of hand surgery that may contribute to burnout.

METHODS

A Web-based survey, developed in conjunction with the American Medical Association, was administered to all active and lifetime members of the American Society for Surgery of the Hand using the Mini Z Burnout assessment tool. Additional data were collected regarding physician demographics and practice characteristics.

RESULTS

The final cohort included 595 US hand surgeons (American Society for Surgery of the Hand [ASSH] members) and demonstrated that 77% of respondents were satisfied with their job, although 49% regarded themselves as having burnout. Lower burnout rates were correlated with physicians aged older than 65, those who practice in an outpatient setting, practice hand surgery only, visit one facility per week, having a lower commute time, those who performed 10 or fewer surgeries per month, and being considered grandfathered for Maintenance of Certification. It was shown that sex, the use of physician extenders, compensation level, and travel club involvement had no impact on burnout rates.

CONCLUSIONS

The survey demonstrated that nearly half of US hand surgeons experience burnout even though most are satisfied with their jobs. There is a need to increase awareness and promote targeted interventions to reduce burnout, such as creating a strong team culture, improving resiliency, and enhancing leadership.

CLINICAL RELEVANCE

Burnout has been shown to affect physicians, their families, patient care, and the health care system as a whole negatively. The findings should promote awareness among hand surgeons and inform future quality improvement efforts targeted at reducing burnout for hand surgeons.

Quality Improvement and Patient Safety: How Leadership Can Create a Culture of Safety: AOA Critical Issues Symposium

Orthopaedic leaders need to create a shared vision and must establish trust, open lines of communication, and buy-in from all team members in order to establish a culture that is supportive of quality improvement. Leaders should encourage teams to follow evidence-based guidelines, reduce variation, take an active role in supply chain processes, and develop new ideas to improve quality and safety of care. With rapidly changing medical and surgical advancements, orthopaedic leaders must continually adapt in the face of evolving challenges.

Stimulating Intrinsic Motivation in Millennial Students: A New Generation, a New Approach

There has been a fundamental change in health care pedagogy to address the demands and challenges posed by the present generation of millennial students. There is also a growing recognition of the role of intrinsic motivation as a catalyst in a positive learning experience. The term intrinsic motivation refers to energizing behavior that comes from within an individual and develops due to an inherent interest in the activity at hand. However, stimulating intrinsic motivation in the present generation of millennial health care students is a daunting task, considering their diverse and disparate nature. In addition, the inherent generational differences between educators and students, and an increasing emphasis on technological tools have resulted in a dichotomy in the educational environment leading to the development of a greater incidence of burnouts among students. Hence, numerous innovative techniques have been introduced in health care education to enhance the levels of intrinsic motivation in these students. Unfortunately, most of these approaches have only been moderately successful due to their limited ability to address the unique educational expectations of millennial students. The cumulative evidence suggests that specific approaches to stimulate intrinsic motivation should aim at nurturing the learning efforts of students, bridging the generational barriers between educators and students, and ameliorating the stress associated with health care education. Hence, the specific aim of this narrative review is to suggest empirically proven curricular strategies and institutional reforms to enhance intrinsic motivation in health care students belonging to the Millennial Generation.

Burnout in orthopedic surgeons

Burnout corresponds to a state of exhaustion (emotional, physical, mental) that can result in complete psychological and/or physical breakdown. Burnout is a result of how our society has evolved. A recent phenomenon, it affects all strata of society, all corporations, and all countries. Physicians are not immune to it, whether they are in public or private practice and whether they are residents in training or seasoned practitioners. The orthopedic world is particularly affected because of multiple risk factors such as sustained work demands, increased malpractice lawsuits, patients no longer placing physicians on a pedestal, greater bureaucratic demands from hospitals and large practices, institutional control policies, reduced autonomy and aggressive media. This is a highly topical issue, hence this study. We sought to answer the following questions: What is burnout? Burnout has three components: emotional exhaustion, depersonalization, loss of personal accomplishment. Its manifestations are psychological, emotional and also physical. Six psychosocial risk factors have been described. The most relevant to our specialty are the intensity and complexity of the work, and the substantial emotional requirements. What is the frequency of burnout and the risk factors in the medical field? Burnout affects the healthcare sector, especially surgeons with a mean of 40% rate. All age groups, all types of practices and all countries are impacted. The mean suicide rate among surgeons (13.3%) is double that of the general population. The primary risk factors are physical and emotional overload, growing bureaucracy, the burden of malpractice lawsuits and regulatory bodies. How does burnout impact orthopedic and trauma surgery specifically? The burnout rate has been reported to be 30% to 40%, and greater than 50% in residents. The stress level is graded at more than 8/10 in 31% of us, with 40% of practitioners deeming this current stress level unacceptable. Administrative factors and the regulatory burden are said to be the most difficult to handle; consequently, orthopedic surgeons feel the best when they are operating. How can burnout be prevented and treated? The main elements of individual and collective prevention appear to be stress management seminars where surgeons can share their experiences, hear from others in the same situation and adjust their practices. We believe the priority should be placed on managing the work time and number of patients.