Articles

Exploring Gender-Related Disparities in Mental Health and Parenthood Among Surgeons: A Systematic Review and Meta-Analysis. [1]Lech GE et al., Am J Surg. 2025 Nov 19;252:116732. Epub ahead of print. PMID: 41317679.

Among the surgical workforce in The Americas, there exist persistent inequities in parental leave and gendered caregiving expectations. Coupled with institutional cultures that penalize career interruptions, these structural and cultural barriers exacerbate mental health disparities and hinder professional advancement among women. Simultaneously, female surgeons face greater pressure balancing work and family responsibilities and are more likely to experience anxiety, depersonalization or detachment, depression, and exhaustion.

This meta-analysis included 37 studies, comprising 42,434 participants.

Female surgeons:

· Had increased burnout rates

· Had increased depression and exhaustion

· Were less likely to have children

The authors note understanding both domains of mental health and parenthood independently remains essential to understanding the barriers that affect surgeons’ well-being and career paths.

Gender disparities in surgery continue to shape who enters, advances, and thrives.

Instead of discouraging future female surgeons, these data can serve as a call to action for meaningful structural change, including:

· Building strong mentorship networks

· promoting women into leadership roles

· Fostering a more inclusive and equitable surgical culture

· Providing confidential and accessible mental health services

From Moral Injury Vulnerability to Protective Equity: The Voyage Every Surgeon Must Take. [2]Vimalathas P et al., Ann Surg. 2025 Jun 1;281(6):903-905. Epub 2024 Dec 18. PMID: 39692009.

Moral Injury: What is known Among surgeons, moral injury should be understood as resulting from an experience(s) that profoundly alters a surgeon’s sense of self in a persistent manner over time, contributing to both ongoing negative psychosocial outcomes for the surgeon as an individual.

Moral injury can lead to severe consequences:

· mental health issues like depression and anxiety

· decreased job satisfaction

· potential harm to patient care

· feelings of guilt, shame, and a loss of trust (both in oneself and in others)

· In severe cases, moral injury can contribute to self-harm, substance abuse, and even suicidal thoughts. 

Although surgeons invest years in surgical training, little attention is focused on the moral harm dynamics that surgical complications play in professional development as surgeons

Protective Equity: What is known Protective equity is what senior surgeons develop through an established track record. Protective equity in this context refers to a positive reputation that may be built over a career with demonstrated positive operative outcomes.

Moral Injury and Protective Equity: What this article Adds This is the first article (to our knowledge) discussing Moral Injury in terms of Protective Equity, and the relationship makes intuitive sense. When early career surgeons leave residency, they likely have a particular vulnerability to moral injury. This vulnerability to morally injurious events is multifactorial; lack of experience, enhanced scrutiny, (potential) recent complications, and personal stressors (social, mental, or physical).

The authors argue that protective equity is a direct counter to vulnerability and that “junior faculty members’ resilience can be enhanced through senior surgeon support during complex operations and assisting with difficult surgical planning” thus mitigating the effects of moral injury. They also propose “specific education on these dynamics during the faculty onboarding processes. An additional strategy entails a program that pairs early-career surgeons with surgical faculty trained in peer support. Which is a program APSA has highlighted for several years. If you want more information about mentoring or peer support, please reach out to myself Feltis, Brad < feltisb@etsu.edu>, Sarah Walker < sarah.k.walker@ttuhsc.edu>, Loren Berman, < loren.berman@nemours.org>, or anyone in APSA leadership.

What’s a Swenson?- Pediatric Surgical M&MC at Regional Children’s Hospitals: Overcoming Challenges and Embracing Opportunity Together. [3]Rellinger EJ et al., J Pediatr Surg. 2025 Jul 16:162478. Epub ahead of print. PMID: 40675440.

Historically, morbidity and mortality conference (M&MC) has been a key part of surgical training and has also more recently been integrated into quality-of-care conversations. Traditionally, M&MC was given in an auditorium with entire divisions or even departments of surgery attending. In areas where pediatric surgery has a small division, being lumped in with the entirety of the surgical department may provide broad but shallow exposure when discussing complications and interesting cases. New attendings pediatric surgeons have flocked to more metropolitan areas but not all practice in large quaternary pediatric surgery departments that may have their own M&MC. Another factor new attending pediatric surgeons looked for in their jobs was mentorship in their institution. The evolution of our workflow for meetings going from strict in person to teleconferencing through a variety of platforms has allowed groups who were separated by distance to meet and present seamlessly.

This letter to the editor in JPS describes the partnership between a regional children’s hospital and a larger quaternary hospital for M&MC, wherein both groups participate and share. This has increased collaboration and follow-up for patients shared between the institutions, allowed for a larger mentor pool for early-career surgeons and also shared common humanity of those experiencing surgical complications. While designed to discuss cases, this regional collaboration improved wellbeing and supported pediatric surgeons. This paper shows how a collaborative M&MC was formed to enhance the experience for both groups involved.

National Incidence of Physician Suicide and Associated Features.[4] Makhija H et al., JAMA Psychiatry. 2025 Feb 26:e244816. PMID: 40009369

Physicians experience numerous stressors during training and practice with the nature of the work such as life or death decisions over long working hours with decreased autonomy and increased regulatory and documentation burdens. As a result, physicians can have increased rates of job dissatisfaction, burnout, depressive symptoms and major depressive disorder, substance abuse and possible suicide. Nearly 1/3 resident physicians report depressive symptoms while 50% of practicing physicians reported burnout in the post COVID timeframe. Compared to nonphysicians, physicians have similar rates of depression and suicidal ideation (either past or current) is reported by 10% of physicians. Previous literature has demonstrated that compared to nonphysician counterparts, female physicians were more likely to die by suicide. Literature on male physician suicides was more heterogenous. The objective of this study was to use the most current US data available to estimate the sex-specific national incidence of suicide for physicians over a 5-year period (January 2017 to December 2021)

The study utilized the National Violent Death Reporting System (NVDRS) utilizing jurisdictions with data consistently available during the study period which was 30 states and Washington DC. Physicians were identified by occupation on the death certificate, and all total 631 physician and 136,689 nonphysician suicides were identified through all methods of investigation. Variables that were found in records included preceding crises, primary method involved in suicide, and toxicology. Due to missing sex and age data, 448 physician (354 [79%] male and 94 [21%] female; mean [SD] age, 60 [16] years) and 97 467 nonphysician (76 697 [79%] male and 20 770 [21%] female; mean [SD] age, 51 [17] years). Male physicians were markedly older than the general population. Compared to the female general population, female physicians had a significantly higher risk of suicide in 2017 (IRR, 1.88; 95% CI, 1.19-2.83) and 2019 (1.75; 95% CI, 1.09-2.65). Male physicians had a lower risk of suicide than male nonphysicians in 2019 and 2020, with an overall significantly lower 2017 to 2021 suicide risk (IRR,0.84; 95%CI,0.75-0.93). Physicians were more likely than nonphysicians to be married or in a domestic partnership. Physicians were also more likely to have depressed mood, criminal or noncriminal legal issues, leaving a note, history or current mental health problems, and job problems. Male physicians were more likely to utilize firearms and female physicians were more likely to die by poisoning. On toxicology, physicians were more likely to have caffeine, poisons, cardiovascular agents, narcotics, benzodiazepines and other drugs not prescribed for home use compared to general population. In thinking of harm reduction, several risk factors are identified as risk factors for physician suicide. Identifying those at risk of suicide due to risks of depression, legal issues, notes and job problems may be important for partners and supervisors. Methods for limiting ability for prescription or diversion from hospital could be one modality to employ. Further action to encourage mental health seeking practices especially be decreasing the need to report for state medical boards and job applications can also go further to encourage help seeking.

The joy of surgery: how surgeons experience joy, time, and support. [5] Hughes D et al., Surg Endosc. 2024 Jul;38(7):3494-3502. Epub 2024 Jun 13. PMID: 38872020.

Burnout is a prevalent problem in medicine. Much research has focused on the individual physician on ways to cope with and recover from burnout. Less literature has been focused on institutional changes that can affect a physician’s burnout experience such as that published by Tate Shanafelt. In their first publication, the SAGES RPS performed a series of targeted interviews to understand surgeon wellbeing. These interviews coalesced into domains in which an institution can act to affect changes in a surgeon’s stressors, satisfaction and support. This study is the SAGES Reimagining the Practice of Surgery Task Force’s (RPS) Joy in Surgery multiphasic research. In this second publication they sought to characterize the institutional factors that contribute to a surgeon’s joy and those that detract from it.

In this publication the SAGES RPS surveyed surgeons,223 are included in analysis. They found that surgeons reported facilitators of joy included “technical skills required by surgery, joy in curing disease, joy in working with a good team” lower joy was reported with leading administrative teams. For those involved in teaching and research, many did find joy in teaching, being a leader in the field and fewer in their research endeavors. In querying if those surveyed had specifics to do their best work, surgeons reported high levels of support and value from coworkers, the autonomy they needed, and having what they required in the OR and clinic settings. Fewer felt they had the support of hospital leadership and the lowest reported in the best work category were for the fairness and adequacy of third-party reimbursement. Many of the organizational factors this article identified were in line with the previous work of Tate Shanafelt which led the authors to recommend the following for organizations: having systems that address human needs and leaders with participative management competency that form and build community and reduce frustration and inefficiency. Organizations can begin by surveying their own to see the needs and finding the frustration and inefficiency especially in EMR and administrative tasks. Surgeons can take this article and the ones by Shanafelt et all back to their institutions to focus wellness not only on individual efforts but systemic. This is crucial as it is well established burnout is costly in terms of loss of workers, decrease in time in workforce, and increase in errors and costs. By addressing systemic issues, organizations can help support their physicians by allowing them the time, autonomy to do what they love and by decreasing the obstacles they face to accomplish these.

Surgeon Perception and Attitude Towards the Moral Imperative of Institutionally Addressing Second-Victim Syndrome in Surgery [6] siao LH et al., J Am Coll Surg. 2024 Aug 12. Epub ahead of print. PMID: 39133012

In general, surgeons view complications as personal failures. After a complication, it is common for a surgeon to experience a complex emotional, physical, and psychologic response, now known as the Second Victim Syndrome (SVS). SVS is defined by the health worker who experiences an error and is traumatized by the event. In this setting, the patient suffering the adverse event is the first victim, while the health care worker is the second victim. The second victim’s trauma can manifest psychologically (shame, guilt, anxiety, grief, and depression), cognitively (compassion dissatisfaction, burnout, secondary traumatic stress), and/or physically (insomnia, irritability, fatigue). Almost half of all heath care workers identify as second victims and the degree of support from one’s peers, institutions, and networks often influences the impact of the complication on the individual. The authors note that the overall incidence of in-hospital adverse events is 9.2%. Of the adverse events, 39% were operation related, 58% took place under the care of a surgical care provider, and 41% occurred in the operating room. Therefore, because adverse surgical outcomes are an inevitable reality of surgical care, there exists an ethical imperative to address the aftermath of adverse surgical outcomes not only for the patient, but for the surgeon as well. The author’s document the multiple undesirable effects of SVS and conclude that “compromises in the psychological safety of surgeons can translate into deterioration in patient safety”. Thus, this study aimed to “examine surgeons’ perceptions and attitudes regarding the moral imperative of institutionally responding to SVS in operation.”

Several concepts emerged from this mix-methods study with both a quantitative and qualitative component conducted at a large university tertiary medical center.

1. SVS is a universal experience amongst surgeons and surgeons have not been sufficiently prepared to navigate the symptoms of SVS in medical training
2. Surgical residents during their formative years perceive professional support, through a counsellor or psychologist, in navigating adverse outcomes to be much more valuable than their senior counterparts.
3. Any effective mitigation strategy must voluntary, accessible, supported by the institution, and receive legal protection similar to morbidity and mortality (M&M) conferences.
4. The culture, tenor, and tone of review processes after surgical complications can either reduce or exacerbate the burden of SVS.
5. Successful interventions must be easily accessible, voluntary, and culturally acceptable.
6. Surgeons likely suffer greater SVS compared with non-procedural physicians
7. Healthcare organizations have a moral obligation and imperative to assist surgeons (and other HCW’s) in navigating the psychosocial impacts of SVS after adverse surgical outcomes.

Deep rest: An integrative model of how contemplative practices combat stress and enhance the body’s restorative capacity[7] Crosswell AD et al., Psychol Rev. 2024 Jan;131(1):247-270. Epub 2023 Dec 25. PMID: 38147050

Although ‘Stress’ is a common occurrence in many areas of medicine, surgeons are subject to additional work place stressors causing increased physiological and psychological stress states1. This may explain the higher rates of burnout amongst surgeons compared to non-surgical physicians. An active area of research is contemplative practices, which are being studied as ways to help people better manage distressing emotions and increase well-being2. Contemplative practices are mind–body exercises that are intentionally practiced to work toward inner well-being, psychological flourishing, and deep connection with self, the world, or a higher power. Multiple RCT’s demonstrate that contemplative practices improve a wide range of psychosocial and health outcomes despite differences in content and format3. Recent research has focused on understanding the biological pathways linking contemplative practices to improved health by: lowering blood pressure, lowering systemic inflammation, decreasing energy expenditure, improving metabolic efficiency, and improving aging-related biomarkers (telomere length, telomerase, and insulin-like growth factor). With this paper, the authors aim to “integrate divergent scientific literatures on contemplative practice interventions, stress science, and mitochondrial biology” to propose “a unified biopsychosocial model of how contemplative practices reduce stress and promote physical health.” The authors coin the term “deep rest,” which is characterized by parasympathetic dominance, and encourages cellular restoration. Deep rest is facilitated via contemplative processes (Fig 1)

Deep rest is facilitated via contemplative processes

This study is an in-depth review of current scientific understanding of the psychology and physiology associated with chronic stress. The authors hypothesize people spend most of their days in an “energetically costly state” of “moderate threat arousal”. It is straightforward to extrapolate this concept to surgeons who are likely practicing routinely in a “severe” threat arousal” state. The authors also opine that, short of REM sleep, “deep rest” is seldom achieved for an individual. This is a lengthy paper divided into 5 sections. stress physiology, safety signaling, contemplative practices and autonomic functioning, contemplative practices and cellular optimization, and sleep. Sleep is presented as the ultimate state of deep rest and the article highlights how sleep science might inform our understanding of contemplative practice. Many of us are familiar with the concept of chronic stress being energetically demanding due to multiple neuro-endocrine responses driving sympathetic activity. The authors propose that signals of safety are critical in allowing the body to shift away from high threat arousal into a rest state. Safety signals, are “learned cues that predict the nonoccurrence of an adverse event … [and] are potent inhibitors of fear and stress responses”; they are the signals of being safe that the physical body interprets either consciously or unconsciously4. The authors propose a two-step process to entering a state of deep rest. “The first step is a felt sense of external safety—physical and social safety. Physical safety means the environment is free of threats to the physical integrity of the person. Social safety means the environment offers experiences of acceptance, belonging, and inclusion and is free of social threats in the form of emotional distress or social status harm such as judging, shaming, or excluding. Multiple different contemplative practices (meditation, prayer, yoga, etc) can lead to deep rest. The author’s detail the science behind parasympathetic dominance as a key component of contemplative practice and they present evidence that long-term engagement in contemplative practices can change resting state autonomic nervous system activity. Finally, the authors review the molecular biology of stress, particularly how stress impairs mitochondrial function and they cite recent evidence that ties mitochondrial dysregulation to multiple chronic inflammatory, metabolic, degenerative diseases and aging. What this means for Pediatric Surgeons: Our jobs are extraordinarily stressful. There is a 1:1 relationship between chronic stress and several psychologic and physiologic disease states. We can mitigate these effects to the degree we can pursue contemplative practices.

Home Is Not Always Where the Sleep Is: Effect of Home Call on Sleep, Burnout, and Surgeon Well-Being[8]Coleman JJ, et al. J Am Coll Surg. 2024 Apr 1;238(4):417-422. Epub 2024 Mar 15. PMID: 38235790

Acute care surgeons with a 1.0 clinical FTE take average of 4 to 5 nights of in-house call (IHC) per month.1 Because IHC results in a defined number of work hours, it is commonly taken into consideration when schedules are made. Home call is by definition variable, and the actual workload of home call cannot be predetermined. Resultantly, surgeons make fewer adjustments to work schedules on days after a night of home call. Both home call and in-house call have the potential to damage health and well-being by disrupting normal circadian sleep patterns. Previous work has demonstrated a clear association between number of nights on-call and work and home conflicts, burnout, and depression.2 Additionally, previous work has shown that IHC results not only in loss of sleep, but abnormal sleep patterns persist into subsequent nights. This loss of restorative sleep on nights after IHC leads to increased feelings of burnout.3 Studies on the physiological effects of home call are lacking, including the impact of home call on surgeon sleep and burn out. The goal of this study was to quantify the effect of home call on sleep, surgeon well-being, and burnout.

The authors collected data from 224 acute care surgeons over six months. Participants wore a physiologic tracking device and responded to daily surveys. A standardized burnout inventory was administered at the beginning and ending of the study. Key findings 52.5% of surgeons taking home call received at least one call per night 38.5% of calls resulted in a return to the hospital. Although minor, home call without calls was significantly associated with sleep loss. All variations of home call (no calls, calls but no return to hospital, and return to hospital) resulted in decreased feelings of restedness and increased feelings of burnout. The authors conclude that home call is deleterious to sleep and contributory to burn out. Even home call without calls or returns to the hospital is associated with increased burnout. In their discussion, the authors inform that sleep duration significantly predicted burnout. However, the direct effect of home call on sleep was only slightly diminished. These findings suggest that home call leads to burn out for reasons that are largely independent of sleep loss.

We Orient Residents to Surgical Life: Why Not Their Families Too?[9]DeCaporale-Ryan LN, et al. J Surg Educ. 2020 Jul-Aug;77(4):726-728. Epub 2020 Mar 13. PMID: 32173296

Surgical resident training is an intense period of professional life requiring focus and resilience. Much focus has been placed on burnout identification, education with an emphasis on personal coping and some on institutional changes and support that can help trainees. Personal relationships (family, friends, and community) can make an impact on trainees coping, but little emphasis has been placed previously on people in those roles. The group sought to engage interns’ support system to improve overall wellness and coping.

This study was a single center intervention in which trainees were invited to have family, friends or community support attend an orientation for surgical trainees’ family and friends approximately 2 months into intern year. There was an option for in person and virtual attendance, and the intern was notified this would be made available after the match. Participants in the orientation included the department chair, residency program director, associate program directors, resident ombudsman, 3rd year resident, other educational leaders and spouses of surgeons and non-surgeons. The format included an introduction, overview of resident life, reflection time for families about the first two months, and faculty and spouses shared broader perspective including time after training. Following that, representatives from the school’s Employee Assistance Program and Behavioral Health Partner’s presented about warning signs of burnout in physicians and the resources available for help. Follow-up survey of residents and family members was overwhelmingly positive with 100% agreeing that the program should continue. This intervention for family and friend orientation to surgery residency is novel and can be replicated for other programs including fellowships and attending life. This has the opportunity to normalize experiences, help residents and family cope with surgical training and educate about resources and support available.

Leadership and Impostor Syndrome in Surgery[10]. Iwai Y, et al. J Am Coll Surg. 2023 Oct 1;237(4):585-595. Epub 2023 Jun 23. PMID: 37350479

“Impostor syndrome” (also known as “impostor phenomenon”) is an internal experience of “intellectual phoniness” or undeserved success despite objective measures. The syndrome is further characterized as the persistent inability to believe that one’s success is deserved or has been legitimately achieved as a result of one’s own efforts or skills. Impostor syndrome is well documented among health care professionals, medical students, and post-graduate trainees across all specialties. Rates as high as 76% have been reported among residents in general surgery and higher rates are also consistently observed among women. There is a paucity of data concerning the prevalence and impact of imposter syndrome at the medical faculty level, particularly concerning underrepresented faculty. Impostor syndrome has been associated with anxiety, burnout, suicidal ideation, and a lower sense of professional fulfillment. Addressing Impostor syndrome has gained traction as a target for improving well-being and resilience among physicians and trainees.

This paper analyzes the results of a nationwide survey of attending and retired physicians. The survey utilized multiple validated instruments to assess imposter syndrome. Key Findings: 1. 90% of female surgeons and 68% of male surgeons in this study reported imposter syndrome (p < 0.001) 2. Being in a surgical vs nonsurgical specialty was not associated with experiencing imposter syndrome 3. Being in a leadership position was associated with lower odds of imposter syndrome, with female surgeons retaining a higher rate than their male colleagues (82% female vs 55% male) 4. No significant differences in imposter syndrome were reported amongst those identifying as underrepresented in medicine. In discussing these results, the authors opine that the gender disparities revealed in this data may arise from previously documented “bias, mistreatment, and workplace harassment” potentially contributing to women “calling into question their place in medicine, particularly as it relates to holding a leadership role”. The authors conclude that these findings underscore the need for targeted and intentional support of those at high risk for experiencing imposter syndrome. Effective interventions include: awareness campaigns, group coaching, and peer mentoring. A final discussion is made commenting on “potential benefits” of “limited” imposter syndrome. It is previously documented that high performing individuals are more likely to underestimate their knowledge while poorer performers significantly overestimate their knowledge. This is known as the Dunning-Kruger effect. And the authors opine that in a high-stakes environment (such as an OR) “moderated imposter syndrome” may be more favorable than overconfidence.

A significant limitation of the study (which the authors readily acknowledge) is the 7.5 % response rate (over 29,000 invitations with about 2200 responses). That being said, there is a significant and developing body of peer reviewed literature citing the high prevalence of imposter syndrome in medicine and surgery, starting in medical school and continuing well into practice. Undoubtedly, this phenomenon is contributing to increasing burnout. Current APSA initiatives concerning coaching and mentoring and self-care should be applauded, embraced, employed, and expanded as our knowledge of mental health contributors to burnout matures.

Complication Is Inevitable, but Suffering is Optional-Psychological Aspects of Dealing with Complications in Surgery Hau D Le, Justyna M Wolinska et al. Eur J Pediatr Surg. 2023 Jun;33(3):181-190. Epub 2023 Mar 22.

Surgical complications have been defined as “any deviation from the ideal postoperative course that is not inherent in the intervention and does not comprise a failure to cure”[11] In the USA, multifaceted efforts to improve safety and reduce adverse events have resulted in reducing overall rates of death associated with surgery from 1.5 to 0.8% and inpatient complications from 11 to 7%[12][13]. Globally, 310 million major surgeries are performed annually and it is estimated that 1–4% of these patients will die, up to 15% will have serious postoperative morbidity, and 5–15% will be readmitted within 30 days[14]. The notion that a surgical complication is an inevitable part of a surgeon’s career has led to a famous aphorism: “the reason you haven’t had a complication is you haven’t operated long enough”.

In general, surgeons view complications as personal failures. After a complication, it is common for a surgeon to experience a complex emotional, physical, and psychologic response. The second victim syndrome[15] (SVS) is defined as the health worker who ? experiences an error and is traumatized by the event. This trauma can manifest psychologically (shame, guilt, anxiety, grief, and depression), cognitively (compassion dissatisfaction, burnout, secondary traumatic stress), and/or physically (insomnia, irritability, fatigue). The degree of support from one’s peers, institutions, and networks often influence the impact of the complication on the surgeon.

This excellent review contributes to the accumulating literature documenting best practices and preparation concerning both an individual and system approach to surgical complications. The review explores the internal and external factors which impact the severity of one’s response to an adverse event. The paper then expands the discussion exploring how to improve the psychologic outcomes of Second Victims. Again, both external and internal factors are explored. Externally, there is a call for having a well organized and defined SUPPORTING NETWORK in place. This includes peers, especially senior and highly respected surgeons willing to discuss their own complications and associated emotional struggles. Additionally, the concepts of promoting compassion, empathy, and confidentiality are re-enforced. A novel part of the discussion is the observation that “surgeon’s have some degree of control over their patients’ psychologic responses and outcomes after complications”. The information presented discussed how surgeons are not generally well versed in matters of communication, especially news about a complication. Transparency and honesty are stressed. Additionally noted is that unprepared or poorly delivered information concerning a complication can further exacerbate the negative impact on all parties. And the converse is also true – patient’s exhibiting acceptance of a sub-optimal outcome can provide relief for the surgeon. The authors conclude that all of us will, at some time, be in the position of a second victim or of a supporting peer. We must normalize the expected individual responses to complications and must strive to provide a robust empathetic institutional support system that is ideally proactive. Familiarizing ourselves with best practice strategies to mitigate adverse outcomes in the arenas of emotional, psychologic, and physical well-being will be crucial in “choosing not to suffer”.

Trends in Surgeon Burnout in the US and Canada: Systematic Review and Meta-Regression Analysis[16]. Etheridge JC, et al. J Am Coll Surg. 2023 Jan 1;236(1):253-265. Epub 2022 Dec 15.

Burnout is described as a syndrome characterized by exhaustion, cynicism, and reduced self efficacy (person’s belief in their ability to complete a task or achieve a goal). Burnout is further defined in the context of 3 key dimensions that drive a syndrome that develops in response to chronic stressors: emotional exhaustion, depersonalization, and feeling incompetent (or lacking self-confidence). The consequences of burnout are numerous and include: negative affect on patient care, increased absenteeism (and presenteeism), decreased productivity, increased errors, and decreased satisfaction. Depending on the study, burnout in surgeons is estimated at 35-50% in attending surgeons and up to 70% in trainees. Addressing burnout is not only a practical necessity, it is a moral imperative.6 The ACS and ACGME (amongst others) have issued calls to action and implemented programs to mitigate burnout. Data on burnout trajectory (or how has burnout changed over time) for surgeons is lacking.

This metanalysis represents 103 studies with over 63,000 surgeons from 1996-2021. Forty-one percent met criteria for burnout. Trainees had a higher incidence than faculty (46% vs 36%). The authors conclude that there is no evidence for the claim of rising burnout. Instead, increased awareness of surgeon burnout may lead to perceptions of a growing epidemic. Indeed, there was consistent suggestion in the analysis that components of burnout, especially emotional exhaustion, are on the decline. The authors are careful to state that surgeon burnout remains worrisome, and at the current rate of decline it would require “several decades” for the US to reach European burnout rates (< 19%). Importantly, the authors stress that “Burnout is not simply a failure of resilience at the individual level, it stems from mismatch between job demands and available resources”.

Addressing Surgeon Burnout Through a Multi-level Approach: A National Call to Action[17]. Golisch KB, et al. Curr Trauma Rep. 2023 Jan 17;1-12. Online ahead of print.

Surgeons have one of the highest rates of burnout in medicine (42%). Although some studies suggest a stagnant or declining rate of surgeon burnout, others do not and the US Surgeon General recently released a report sounding an alarm on health care worker burnout. As the root causes of burnout are multi-factorial and complex, the authors advocate for a novel conceptual model to address burnout at the individual, institutional, and national level.

This paper is a “Call to Action” to mitigate surgeon burnout and presents a comprehensive overview of burnout, including key factors and effects. By analyzing 35 recent papers (2017-2022) the authors develop a strategy to classify and implement solutions to improve well-being using a 3-layer approach. At the individual level; emotional intelligence, mindfulness, and resilience is taught. At the institutional level; initiative, mentoring, and support is stressed. Finally, nationally, policies, opportunities, and leadership are discussed. Each of these areas has an easily digestible 2-3 paragraph section with informative and meaningful content for those wishing to further explore.

References