Factors associated with burnout among US neurosurgery residents: a nationwide survey

Frank J. Attenello 1 , Ian A. Buchanan 1 , Timothy Wen 1 , Daniel A. Donoho 1 , Shirley McCartney 2 , Steven Y. Cen 1 , Alexander A. Khalessi 3 , Aaron A. Cohen-Gadol 4 , Joseph S. Cheng 5 , William J. Mack 1 , Clemens M. Schirmer 6 , Karin R. Swartz 7 , J. Adair Prall 8 , Ann R. Stroink 9 , Steven L. Giannotta 1 and Paul Klimo Jr. 10
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  • 1 Department of Neurosurgery, University of Southern California Keck School of Medicine, Los Angeles, California;
  • 2 Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon;
  • 3 Department of Neurosurgery, University of California, San Diego, California;
  • 4 Goodman Campbell Brain and Spine, Department of Neurosurgery, Indiana University, Indianapolis, Indiana;
  • 5 Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio;
  • 6 Geisinger Health System, Wilkes-Barre, Pennsylvania;
  • 7 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin;
  • 8 Department of Neurosurgery, Littleton Adventist Hospital, Littleton, Colorado;
  • 9 Central Illinois Neuro Health Science, Bloomington, Illinois; and
  • 10 Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
DOI:
https://doi.org/10.3171/2017.9.JNS17996
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OBJECTIVE

Excessive dissatisfaction and stress among physicians can precipitate burnout, which results in diminished productivity, quality of care, and patient satisfaction and treatment adherence. Given the multiplicity of its harms and detriments to workforce retention and in light of the growing physician shortage, burnout has garnered much attention in recent years. Using a national survey, the authors formally evaluated burnout among neurosurgery trainees.

METHODS

An 86-item questionnaire was disseminated to residents in the American Association of Neurological Surgeons database between June and November 2015. Questions evaluated personal and workplace stressors, mentorship, career satisfaction, and burnout. Burnout was assessed using the previously validated Maslach Burnout Inventory. Factors associated with burnout were determined using univariate and multivariate logistic regression.

RESULTS

The response rate with completed surveys was 21% (346/1643). The majority of residents were male (78%), 26–35 years old (92%), in a stable relationship (70%), and without children (73%). Respondents were equally distributed across all residency years. Eighty-one percent of residents were satisfied with their career choice, although 41% had at some point given serious thought to quitting. The overall burnout rate was 67%. In the multivariate analysis, notable factors associated with burnout included inadequate operating room exposure (OR 7.57, p = 0.011), hostile faculty (OR 4.07, p = 0.008), and social stressors outside of work (OR 4.52, p = 0.008). Meaningful mentorship was protective against burnout in the multivariate regression models (OR 0.338, p = 0.031).

CONCLUSIONS

Rates of burnout and career satisfaction are paradoxically high among neurosurgery trainees. While several factors were predictive of burnout, including inadequate operative exposure and social stressors, meaningful mentorship proved to be protective against burnout. The documented negative effects of burnout on patient care and health care economics necessitate further studies for potential solutions to curb its rise.

ABBREVIATIONS AANS = American Association of Neurological Surgeons; CSNS = Council of State Neurosurgical Societies; MBI = Maslach Burnout Inventory.

Downloadable materials

  • Appendix Table (PDF 444 KB)

Volume 129: Issue 5 (Nov 2018): Pages 1107-1375

in Journal of Neurosurgery
Cover Journal of Neurosurgery

Article Information

Correspondence Frank J. Attenello: Keck School of Medicine, University of Southern California, Los Angeles, CA. attenell@usc.edu.

INCLUDE WHEN CITING Published online February 9, 2018; DOI: 10.3171/2017.9.JNS17996.

Disclosures Dr. Schirmer has received support from the NIH/NINDS for non–study-related clinical or research effort, has ownership of NTI, and has received an honorarium from the AANS.

Keywords:
national survey; physician burnout; career satisfaction; neurosurgery; residency training
Page Count:
1349–1363

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Neurosurgery resident career and personal satisfaction. Figure is available in color online only.

  • View in gallery

    Professional and personal stressors encountered by neurosurgery resident trainees. Figure is available in color online only.

  • View in gallery

    Breakdown of perceptions among neurosurgery residents regarding the trajectory of their careers. Figure is available in color online only.

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    Professional burnout indices among neurosurgery residents according to the MBI subscales. Figure is available in color online only.

  • View in gallery

    Maslach Burnout Inventory and career satisfaction trends by postgraduate year. Figure is available in color online only.

Neurosurgery resident career and personal satisfaction. Figure is available in color online only.

Professional and personal stressors encountered by neurosurgery resident trainees. Figure is available in color online only.

Breakdown of perceptions among neurosurgery residents regarding the trajectory of their careers. Figure is available in color online only.

Professional burnout indices among neurosurgery residents according to the MBI subscales. Figure is available in color online only.

Maslach Burnout Inventory and career satisfaction trends by postgraduate year. Figure is available in color online only.

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