- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States.
DOI:10.25259/SNI_736_2020Copyright: © 2020 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Matthew T. Neal, Mark K. Lyons. Burnout and work-life balance in neurosurgery: Current state and opportunities. 22-Dec-2020;11:456
How to cite this URL: Matthew T. Neal, Mark K. Lyons. Burnout and work-life balance in neurosurgery: Current state and opportunities. 22-Dec-2020;11:456. Available from: https://surgicalneurologyint.com/surgicalint-articles/10481/
Background: Burnout is a syndrome characterized by emotional exhaustion, depersonalization, and reduced sense of personal accomplishment. The syndrome has been recognized as a pandemic among physicians. The demanding nature of neurosurgery makes neurosurgeons, particularly prone to burnout. In recent years, pioneering work has shed light on burnout in the field of neurosurgery.
Methods: We have reviewed the literature in PUBMED on burnout in physicians, focusing on neurosurgical publications.
Results: In this manuscript, we explore the topic of burnout in neurosurgery by reviewing definitions, magnitude, etiologies, sequelae, and mitigation strategies.
Conclusion: Ongoing education, recognition, and targeted interventions for neurosurgeons at different career stages are needed to manage burnout proactively and ensure a resilient neurosurgery workforce.
Keywords: Burnout, Neurosurgery, Work-life balance
Burnout, a syndrome which has been characterized by “exhaustion, cynicism, and reduced effectiveness,”[
Despite increased awareness of the topic in the past decade, burnout rates among neurosurgeons remain problematic, and opportunities for improvement remain. In this manuscript, we explore the topic of burnout in neurosurgery by reviewing definitions, magnitude, etiologies, sequelae, proposed solutions, and additional opportunities for improvement.
To understand well-being for a neurosurgeon, several inter-related concepts must be defined. Work-work balance for a neurosurgeon refers to balancing clinical and nonclinical duties such as teaching, research, administrative work, and leadership roles. Once work-related responsibilities are balanced, work must then be carefully integrated with other aspects of life to achieve work-life balance.
Work-life balance is challenging to define. Life involves everything outside of work such as family, friends, religion, sleep, exercise, hobbies, and other leisure activities. What is needed for work-life balance is not only unique for each neurosurgeon but it also changes during different stages of his/her life and career.[
The concept of “burnout” emerged in the social psychology literature in the 1960s and 1970s. Early descriptions of burnout focused on groups such as lawyers serving vulnerable populations, volunteers working in urban clinics with drug addicts, and probation officers. Around 2000, dialog and investigation expanded to include broader populations such as health care workers.[
Burnout is a psychological syndrome characterized by emotional exhaustion (EE), depersonalization (DP) of others, and decreased feelings of personal accomplishment.[
Within medicine, burnout is a pandemic that does not spare specific specialties or geographical areas. Burnout has been reported in medical specialties including anesthesia, cardiology, internal medicine, neurology, oncology, and radiology.[
In a landmark, cross-sectional study of the American College of Surgeons, which included almost 8000 respondents, Shanafelt et al. reported 40% rate of burnout, defined as a high score for EE or DP.[
In addition to attending physicians, burnout affects medical students and resident trainees as well.[
Specifically within neurosurgery, survey results have demonstrated burnout rates ranging from 27% to 57% among attending neurosurgeons.[
Many factors have been associated with burnout among physicians including administrative workload, alignment of values between administrators and physicians, a sense of control over the workplace, excessive number of call days, high patient quotas, inattention to personal wellness, long work hours, mistakes, poor cohesiveness among coworkers, poor patient outcomes, and technology allowing “constant access” to work.[
At different career stages, different factors have been associated with burnout. Among residents, reported factors include sleep deprivation, working more than 80 h/week, and verbal abuse from faculty.[
Researchers have also studied reasons why surgical residents leave their specialties. Poor work-life balance and “uncontrollable lifestyle” are commonly cited as the most important factors for quitting a residency.[
It is also notable that specific subpopulations, such as female physicians, face unique challenges relating to burnout.[
Among board-certified neurosurgeons, a 2013 survey identified low income, low collections, and concerns about future income and health-care reform as stressful factors contributing to burnout.[
The sequelae of burnout are significant and broad. Burnout affects physician health, family and social harmony, professional satisfaction, quality of medical care, and health-care costs.
Physicians with burnout are more likely to have systemic illness and psychiatric comorbidities such as depression.[
Burnout has also been associated with tumultuous family and social lives. Studies have found increased rates of divorce, failed relationships, and work-home conflicts due to burnout.[
Work dissatisfaction and burnout lead to job changes, transition away from clinical practice, and early retirement.[
Quality of health care is also associated with burnout among physicians. Several studies have demonstrated an association between burnout and medical errors, malpractice suits, and poor patient satisfaction scores.[
From a business perspective, burnout is expensive and multifaceted. There are increased costs associated with turnover, decreased productivity, reduced overall quality in an organization, and physician recruitment and training.[
Burnout affects individuals and organizations. Addressing burnout ideally involves effort on both fronts.
Physicians with perceived positive work-life balance are less likely to suffer from burnout. Suggested strategies, within a neurosurgeon’s control, to improve work-life balance include defining personal and professional values, defining limits, budgeting time, pursuing wellness, maintaining strong relationships, and keeping a positive and grateful attitude.[
Evidence has shown that interventions on an organizational level can help mitigate burnout.[
One organization that has emphasized the shared responsibility between individual physicians and the organization for tackling physician satisfaction and burnout is Mayo Clinic. In a recent article by Tait and Noseworthy,[
Reducing resident burnout and improved wellness are priorities for the US Accreditation Council for Graduate Medical Education (ACGME). Education about burnout and implementation of programs to mitigate burnout are goals of the ACGME’s Clinical Environmental Review (CLER) Program.[
In the past, burnout has been a silent pandemic harming neurosurgeon. More recently, pioneering work has been done to understand the prevalence of burnout and to increase awareness of the problem for neurosurgeons.[
However, improved awareness of burnout and its deleterious effects is still needed. A recent editorial on burnout in neurosurgeons compared the recognition of burnout to identifying “the edge of a cliff in the dark.”[
Ongoing education and targeted interventions for neurosurgeons at different career stages are needed to manage burnout proactively and ensure a resilient neurosurgery workforce.
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