Risk Factors for Burnout: Outcomes of a National Survey of Practicing Plastic Surgeons

PURPOSE:  Recent studies by the American College of Surgeons demonstrated that surgeon “burnout” is the primary determinant of career satisfaction and is linked to physician quality of life, patient care, and medical errors. The purpose of this study was to evaluate risk factors for burnout, career satisfaction, and quality of life among practicing plastic surgeons.

METHODS: We distributed an online survey to ASPS members and program directors in the US. The survey contained validated measures of burnout (Maslach Burnout Inventory), quality of life (SF-8 Health Survey), depression (PRIME-MD) and substance abuse (AUDIT). Additionally, the survey evaluated surgeon demographics, practice characteristics (hours worked, number of overnight calls, salary, practice type, subspecialty, academic rank, time devoted to non-clinical academic activities), career satisfaction,  and self-perceived medical errors.

RESULTS: To date, 717 practicing plastic surgeons have completed the survey. While 88.9% of responding surgeons reported being “satisfied” or “very satisfied” with their career, 27.8% met validated criteria for “burnout.”  Statistically significant factors (p <0.05) associated with burnout included working greater than 80 hours a week, more frequent call, salary less than $200,000 or greater than $500,000.   Additional statistically significant factors associated with burnout included subspecialization, practice type (academic vs. private), and gender.  Among academic surgeons, junior academic rank (assistant vs. associate or full professor) and lack of protected time for research and teaching were associated with burnout.  Surgeons who were burned out were more likely to report having a major medical error in the past 6 months (23.2% vs. 13.3%, p <0.01).  Furthermore, burned out surgeons were more likely to screen positive for depression (22.7% vs. 13.8%, p <0.05), have a significantly lower quality of life score (mean 60.4 vs. 78.3, p <0.005) and demonstrate unhealthy substance use (17.3% vs. 6.5%, p <0.01) then surgeons without burnout.

CONCLUSIONS: Although career satisfaction amongst practicing plastic surgeons is high, this survey demonstrates that burnout affects over one-fourth of our colleagues.  Practice characteristics and workload were identified as clear risk factors for burnout.  In addition, burnout in plastic surgery is associated with self-perceived increase in medical errors and poorer surgeon wellbeing. This is the first validated, national survey to investigate risk factors of burnout in plastic surgery.