Career Satisfaction and Burnout In the Reconstructive Microsurgeon

Purpose: To determine motivating factors, practice patterns and career longevity of surgeons who perform microvascular free flaps (MVFF).  To identify modifiable risk factors to reduce MVFF surgeon burnout.

Methods: A cross-sectional observational study was performed using a web-based survey sent to members of the American Society of Reconstructive Microsurgery (ASRM). The survey evaluated demographic variables, practice characteristics, and career satisfaction. Questions inquiring about career motivating/demotivating factors were graded from none, mild, moderate, to highly significant.

Results: Ninety-nine of 412 surveys sent to participating surgeons were completed (24.0%). Sixty-three percent of respondents underwent microsurgery fellowship training. Fifty-eight percent of survey respondents performed >25 flaps/year.  The types of free flaps performed included breast (65.2% of respondents), head and neck (54.3%), chest/trunk/abdominal (33.7%), extremity (78.3%), and vaginal/perineal (19.6%) reconstruction. The greatest significant stressor was reimbursement (23.9%), with moderate stress deriving from lack of time for personal development/growth (44.0%), excessive workload (40.7%), and invasion of family relationships (39.1%).  The most significant motivating factors for performing microvascular free flaps were personal gratification from work (65.2%) and patient gratitude (54.9%).  The most significantly important demotivating factor for performing microsurgical flap reconstruction was amount of work to reimbursement ratio (30.8%).  Fifty-six percent of microsurgeons expected their microsurgical volume to stay the same, while 23.9% predicted a decrease and 19.6% predicted an increase in the next 5 years. Ninety-five percent of survey respondents said they would pursue microsurgery again as a field of practice if given the choice.

Conclusions: Recent literature has demonstrated an increasing level of surgeon dissatisfaction and burnout, particularly amongst those performing microsurgical reconstruction^1-3. In contrast, this study demonstrates high career satisfaction amongst reconstructive microsurgeons.  However, there remains significant stressors which may decrease motivation for performing microsurgical free flaps; of these, work to reimbursement ratio was the most significant stressor and demotivating factor.

References: 

1. Contag SP et al. “Professional burnout among microvascular and reconstructive free-flap head and neck surgeons in the United States.” Arch Otolaryngol Head Neck Surg. 2010 Oct; 136(10):950-6

2. Balch et al. “Distress and career satisfaction among 14 surgical specialties, comparing academic and private practice settings.” Ann Surg. 2011 Oct;254(4): 558-68

3. Shanafelt et al.” Burnout and career satisfaction among American surgeons.” Ann Surg. 2009 Sept;250(3): 463-71