The public health crisis of physician burnout persists, as new evidence points to advancing age, physical pain, and work-life conflict as its predictors

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New research finds that a third of practicing vascular surgeons meet criteria for burnout, subsequently increasing the incidence of depression and suicide ideation within this cohort of physicians. Presenting these data at the Society of Vascular Surgery (SVS) Vascular Annual Meeting (VAM; 12–15 June, National Harbor, USA), Dawn Coleman (University of Michigan, Ann Arbor, USA) listed: advancing age, physical pain and work-life conflict as independent predictors for burnout.

Dawn Coleman

According to Coleman, physician burnout, currently defined as a “mental state characterised by emotional exhaustion, depersonalisation, and a diminished sense of personal accomplishment,” has been deemed a public health crisis.

Addressing the SVS delegates, she put forward: “Presently more than 50% of US physicians self-report burnout. This has a variety of both personal and professional repercussions.” In terms of the latter, Coleman said burn-out has been linked to a decrease in quality of care, patient satisfaction, productivity, medical effort, an increase in medical errors and an enhanced rate of physician turnover. She acknowledged that in relation to personal consequences, burn-out can result in broken relationships, alcohol and substance abuse, as well as depression and suicide.

Coleman also emphasised that, “In light of the increasing prevalence of cardiovascular disease, vascular surgeon burnout presents a legitimate public health concern due to the impact on the adequacy of the vascular surgery workforce, which is projected to be a rising issue in the future.”

Thus, in 2018, Coleman and colleagues set out to explicitly define the prevalence of burnout amongst practicing vascular surgeons in addition to identifying risk factors for burnout in order to facilitate future SVS initiatives to avert this crisis.

The study investigators anonymously surveyed active SVS members using a validated burnout assessment, the Maslach Burnout Index (MBI). Embedded within a questionnaire that also captured relevant demographic and practice-related characteristics, the MBI measured levels of emotional exhaustion and depersonalisation. Coleman said that the accepted threshold of a score of 27 or greater on the MBI Emotional Exhaustion module was used to identify surgeons suffering from burnout. Specifically, risk factors for such were identified using bivariate analyses, while multivariate logistic regression models were developed to identify independent risk factors for burnout.

Of the 2905 active SVS members, 960 (33%) responded to the survey. According to Coleman, after excluding retired surgeons and incomplete submissions, responses from 872 practicing vascular surgeons were analysed. In terms of responder demographics, the mean age was 49.7 (±11.0), the majority of respondents (81%) were male, and the mean number of years in practice was 15.7 (±11.7). Primary practice settings were academic (40%), community practice (41%), Veteran’s hospital (3.3%), active military practice (1.5%) or listed as ‘other’.

“In total, 41% of our respondents met criteria for burnout, 36% endorsed screened positive for symptoms of depression in the past month and 8% supported thoughts of taking their own life during the last 12 months, with the percentage increasing to 15% in SVS members with burnout,” Coleman stated.

Furthermore, through the unadjusted analysis, Coleman and colleagues found that the factors significantly associated with burnout (p<0.05) included clinical work hours, on-call frequency, electronic medical record (EMR) documentation requirements, perceived conflict between work and personal responsibilities, as well as physical pain.

Moreover, Coleman acknowledged that the multivariate analysis revealed that age, work-related physical pain, and conflict between work and personal responsibilities were expressed as independent risk factors for burnout. Specifically, when SVS members were questioned on whether they agree with the statement: “My work schedule leaves me enough time for my personal/family life,” 50% of responders disagreed or significantly disagreed. Commenting on this finding, Coleman said, “Importantly, there was a significant disparity when you consider those with high emotional exhaustion or depersonalisation scores, suggesting that in those responders meeting criteria for burnout, they had more or a disparity in this regard.”

She ultimately concluded that to mitigate the aforementioned personal, economic, and social impact of vascular surgeon burnout, findings such as these will facilitate SVS efforts to improve vascular surgeon well-being.

During the audience discussion, Julie Ann Freischlag, CEO of Wake Forest Baptist Medical Center (Winston-Salem, USA), stepped forward to commemorate Coleman for the current findings, and said: “These results are not dissimilar to what we have found in the American College of Surgeons 10 years ago. We have just repeated that survey, and it shows very similar [findings] in terms of stress and the inability to find joy in the workplace.”

During a final word to the SVS delegates, Coleman affirmed, “There is no question that a lot of what we feel as vascular surgeons is system level. I think that we are all naturally quite resilient. We all really like to operate, we like to work and we like to care for patients. We like responding to crises. [Yet] a lot of what we hear is the fact that we go back to our hospitals and we do not have a tremendous amount of support, or we do not feel valued or have control over our day-to-day lives.

“There are also people, who are not surrounded by healthy [work] cultures, and I would charge every member of the audience to be accountable for each other… because none of us are alone. What we are excited to consider moving forward as a taskforce, is a member programme that will allow an opportunity for community in a more standardised fashion. Essentially, peer support and even perhaps individual and group opportunities for coaching and culture change.

“Be kind and take care of each other, because we have bigger battles than microaggression, and a lot of patients to take care of.”

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