Transition to Independent Surgical Practice and Burnout Among Early Career General Surgeons

Firdouse, Mohammed; Chrystoja, Caitlin C.; Montbrun, Sandra de; Escallón, Jaime; Cil, Tulin

doi:10.1177/15533506211039682

Surg Innov

2021

DOI: 10.1177/15533506211039682

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Transition to Independent Surgical Practice and Burnout Among Early Career General Surgeons

Mohammed Firdouse

Caitlin C. Chrystoja

Sandra de Montbrun³

et al.

Abstract: Background: The transition from surgical residency to independent practice is a challenging period that has not been well studied. Methods: An email invitation to complete a 55-item survey and the Maslach Burnout Inventory–Human Services Survey (MBI-HSS) was sent to early career general surgeons across Canada. The chi-square test or Fisher’s exact test was used to compare demographic and survey characteristics with burnout. Multivariable logistic regression was performed. Results: Of the 586 surgeons contacted… Show more

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Cited by 4 publications

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“…Transition to independent practice is a critical time in the development of new surgeons. 1 , 4 , 5 After graduation from a fellowship, surgeons are expected to perform the operations themselves, assume responsibility for patient selection, and direct pre- and postoperative care. 1 , 4 Surgical oncology fellowships were developed to help equip surgeons with the necessary skill set for independent practice in a field that involves technically challenging cancer operations.…”

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confidence: 99%

Practice Patterns and Outcomes Among Surgical Oncology Fellowship Graduates Performing Complex Cancer Surgery in the United States Across Different Career Stages

Tsilimigras,

Chatzipanagiotou,

Woldesenbet

et al. 2024

Ann Surg Oncol

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Background Practice patterns and potential quality differences among surgical oncology fellowship graduates relative to years of independent practice have not been defined. Methods Medicare claims were used to identify patients who underwent esophagectomy, pancreatectomy, hepatectomy, or rectal resection for cancer between 2016 and 2021. Surgical oncology fellowship graduates were identified, and the association between years of independent practice, serious complications, and 90-day mortality was examined. Results Overall, 11,746 cancer operations (pancreatectomy [61.2%], hepatectomy [19.5%], rectal resection [13.7%], esophagectomy [5.6%]) were performed by 676 surgical oncology fellowship graduates (females: 17.7%). The operations were performed for 4147 patients (35.3%) by early-career surgeons (1–7 years), for 4104 patients (34.9%) by mid-career surgeons (8–14 years), and for 3495 patients (29.8%) by late-career surgeons (>15 years). The patients who had surgery by early-career surgeons were treated more frequently at a Midwestern (24.9% vs. 14.2%) than at a Northeastern institution (20.6% vs. 26.9%) compared with individuals treated by late-career surgeons (p < 0.05). Surgical oncologists had comparable risk-adjusted serious complications and 90-day mortality rates irrespective of career stage (early career [13.0% and 7.2%], mid-career [12.6% and 6.3%], late career [12.8% and 6.5%], respectively; all p > 0.05). Surgeon case-specific volume independently predicted serious complications across all career stages (high vs. low volume: early career [odds ratio {OR}, 0.80; 95% confidence interval {CI}, 0.65–0.98]; mid-career [OR, 0.81; 95% CI, 0.66–0.99]; late career [OR, 0.78; 95% CI, 0.62–0.97]). Conclusion Among surgical oncology fellowship graduates performing complex cancer surgery, rates of serious complications and 90-day mortality were comparable between the early-career and mid/late-career stages. Individual surgeon case-specific volume was strongly associated with postoperative outcomes irrespective of years of independent practice or career stage.

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confidence: 99%

Practice Patterns and Outcomes Among Surgical Oncology Fellowship Graduates Performing Complex Cancer Surgery in the United States Across Different Career Stages

Tsilimigras,

Chatzipanagiotou,

Woldesenbet

et al. 2024

Ann Surg Oncol

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Trends in Surgeon Burnout in the US and Canada: Systematic Review and Meta-Regression Analysis

Etheridge¹,

Evans²,

Zhao³

et al. 2022

Journal of the American College of Surgeons

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BACKGROUND: Burnout among surgeons is increasingly recognized as a crisis. However, little is known about changes in burnout prevalence over time. We evaluated temporal trends in burnout among surgeons and surgical trainees of all specialties in the US and Canada. STUDY DESIGN: We systematically reviewed MEDLINE, Embase, and PsycINFO for studies assessing surgeon burnout from January 1981 through September 2021. Changes in dichotomized Maslach Burnout Inventory scores and mean subscale scores over time were assessed using multivariable random-effects meta-regression. RESULTS: Of 3,575 studies screened, 103 studies representing 63,587 individuals met inclusion criteria. Publication dates ranged from 1996 through 2021. Overall, 41% of surgeons met criteria for burnout. Trainees were more affected than attending surgeons (46% vs 36%, p = 0.012). Prevalence remained stable over the study period (−4.8% per decade, 95% CI −13.2% to 3.5%). Mean scores for emotional exhaustion declined and depersonalization declined over time (−4.1 per decade, 95% CI −7.4 to −0.8 and −1.4 per decade, 95% CI −3.0 to −0.2). Personal accomplishment scores remained unchanged. A high degree of heterogeneity was noted in all analyses despite adjustment for training status, specialty, practice setting, and study quality. CONCLUSIONS: Contrary to popular perceptions, we found no evidence of rising surgeon burnout in published literature. Rather, emotional exhaustion and depersonalization may be decreasing. Nonetheless, burnout levels remain unacceptably high, indicating a need for meaningful interventions across training levels and specialties. Future research should be deliberately designed to support longitudinal integration through prospective meta-regression to facilitate monitoring of trends in surgeon burnout.

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Mental health of general practitioners in Chongqing, China during COVID-19: a cross-sectional study

Xu,

Deng,

Tan

et al. 2023

BMJ Open

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ObjectivesIn the context of the COVID-19 pandemic, general practitioners (GPs) continue to face unprecedented challenges that affect their mental health. However, few studies have assessed the mental health status of GPs. This study aimed to provide preliminary understanding of stress, job burn-out and well-being levels among GPs to train and manage them during public health emergencies.DesignWe conducted a cross-sectional online self-report survey.SettingThe survey was conducted in Chongqing, China from July to August 2022.ParticipantsData were collected from 2145 GPs, with an effective response rate of 91.0%.Primary and secondary outcome measuresThe main evaluation indicators were stress (Cohen’s Perceived Stress Scale), job burn-out (Maslach Burnout Inventory-Human Services Survey Scale) and well-being (WHO-5 Well-Being Index). Multiple linear regression analysis was used to compare the effect of different demographic characteristics on the impact of stress, job burn-out and decreased well-being.ResultsStress, job burn-out and decreased well-being were common among GPs. In this study, 59.7% experienced job burn-out, 76.1% experienced high levels of stress and 52.0% may have experienced depression. The main factors that influenced stress, burn-out and well-being were differences in age, working hours per week, title, part-time management work, work–life balance, sleep disorders, whether GPs received adequate recognition by patients and the work team and mental toughness (p<0.05).ConclusionThis survey is the first to investigate stress, job burn-out and well-being levels among local GPs in China during the COVID-19 pandemic. Curbing stress and job burn-out levels and ensuring well-being among GPs could be achieved by reducing paperwork, management work and working hours; promoting life and work balance; and increasing resilience among GPs. The findings provide a basis for policy-makers to formulate strategies for developing general practice.

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Transition to Independent Surgical Practice and Burnout Among Early Career General Surgeons

Cited by 4 publications

References 32 publications

Practice Patterns and Outcomes Among Surgical Oncology Fellowship Graduates Performing Complex Cancer Surgery in the United States Across Different Career Stages

Practice Patterns and Outcomes Among Surgical Oncology Fellowship Graduates Performing Complex Cancer Surgery in the United States Across Different Career Stages

Trends in Surgeon Burnout in the US and Canada: Systematic Review and Meta-Regression Analysis

Mental health of general practitioners in Chongqing, China during COVID-19: a cross-sectional study

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