The neurosurgical marriage: evaluating the interplay of work life and home life from the perspective of partners of neurosurgical residents

William J. Ares Department of Neurosurgery, Northshore University HealthSystem, Evanston, Illinois;

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Brian T. Jankowitz Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania;

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Peter Kan Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas;

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Alejandro M. Spiotta Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina;

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Peter Nakaji Department of Neurosurgery, Banner University Medical Center, Phoenix, Arizona;

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Jason D. Wilson Department of Neurosurgery, Louisiana State University Health, New Orleans, Louisiana;

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Kyle M. Fargen Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina;

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Edwin Ramos Division of Neurosurgery, University of Chicago Medicine, Chicago, Illinois;

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Jody Leonardo Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania; and

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Ramesh Grandhi Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah

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OBJECTIVE

Burnout and work-life balance have been noted to be problems for residents across all fields of medicine, including neurosurgery. No studies to date have evaluated how these factors may contribute to issues outside of the hospital, specifically residents’ home lives. This study aimed to evaluate the interplay between home life and work life of neurosurgical residents, specifically from the point of view of residents’ significant others.

METHODS

Online surveys were distributed to the significant others of neurosurgical residents at 12 US neurosurgery residencies. Residents’ partners were asked about relationship dynamics, their views on neurosurgery residency (work-life balance and burnout), and their views of neurosurgery as a career.

RESULTS

The majority of residents’ significant others (84%) reported being satisfied with their relationship. Significant others who reported dissatisfaction with their relationship were more likely to report frustration with work-life balance and more likely to report their resident partner as having higher levels of burnout.

CONCLUSIONS

From the perspective of neurosurgery residents’ significant others, higher perceived levels of burnout and lower satisfaction with work-life balance are correlated with lower levels of relationship satisfaction. These findings speak to the complex interplay of work life and home life and can be used to inform future interventions into improving the quality of life for both the resident and the significant other.

ABBREVIATIONS

MBI = Maslach Burnout Inventory.

OBJECTIVE

Burnout and work-life balance have been noted to be problems for residents across all fields of medicine, including neurosurgery. No studies to date have evaluated how these factors may contribute to issues outside of the hospital, specifically residents’ home lives. This study aimed to evaluate the interplay between home life and work life of neurosurgical residents, specifically from the point of view of residents’ significant others.

METHODS

Online surveys were distributed to the significant others of neurosurgical residents at 12 US neurosurgery residencies. Residents’ partners were asked about relationship dynamics, their views on neurosurgery residency (work-life balance and burnout), and their views of neurosurgery as a career.

RESULTS

The majority of residents’ significant others (84%) reported being satisfied with their relationship. Significant others who reported dissatisfaction with their relationship were more likely to report frustration with work-life balance and more likely to report their resident partner as having higher levels of burnout.

CONCLUSIONS

From the perspective of neurosurgery residents’ significant others, higher perceived levels of burnout and lower satisfaction with work-life balance are correlated with lower levels of relationship satisfaction. These findings speak to the complex interplay of work life and home life and can be used to inform future interventions into improving the quality of life for both the resident and the significant other.

In Brief

The researchers queried partners of neurosurgery residents to assess their perspective on how neurosurgery residency affects their relationship. Satisfaction with the resident's work-life balance was an independent predictor of relationship satisfaction. These findings may allow residency programs to better tailor well-being initiatives to support residents' home lives as well as work lives.

Burnout, a stress-related condition that manifests with symptoms of emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment, has been identified as a significant problem in medicine. Increased recognition of burnout in the neurosurgical resident community has stimulated conversations about physical and mental health, sleep, resilience, and mentorship in residency.18 With the focus primarily on residents’ work lives, there have been fewer examinations of a resident’s home life, specifically with their significant other. Neurosurgeons’ relationships may face different stressors than those of the general public given the length of neurosurgical training, long work hours, daily physical and emotional demands, and the resultant levels of burnout associated with neurosurgery residency.1,3,911 A study by Attenello et al.11 showed that having substantial social and personal stressors outside of work was an independent predictor of burnout in neurosurgery residents. Moreover, residents who have been divorced demonstrated a threefold higher likelihood of reporting symptoms of burnout. Higher levels of burnout may, in turn, be associated with medical errors and poor patient outcomes, which may perpetuate dissatisfaction.1214

Although the influence of meaningful relationships with significant others for neurosurgery residents has been examined, there are no data relating to how neurosurgical residency affects the partners of residents themselves. Understanding the perceptions of residents’ partners is important because those perceptions influence the relationship of the pair, the social stressors outside of work, and in turn, the well-being of the neurosurgery trainee. Through an online questionnaire, we sought to understand how the partners of neurosurgery residents view their partners’ training, satisfaction with their relationships, assessment of work-life balance, and other quality-of-life variables. Taken through the lens of an intense training environment, our belief is that these data underscore a particularly complex interplay of work-life balance in neurosurgical training, with potential future interventions to improve resident well-being having the added benefit of improving relationship health and support systems at home.

Methods

Participants

The significant others of residents from 12 neurological surgery programs were identified by residency program coordinators, contacted via email, and asked to complete an online survey (SurveyMonkey) regarding their experiences as a partner of a neurosurgery resident (see Supplement 1). For this survey, we considered a "significant other" as someone who was a spouse, engaged to be married, or a long-term domestic partner (self-identified by the partner). Participation was voluntary, and all responses were anonymous. A response was considered consent to participate. Email invitations were sent to 93 resident partners in April 2019, with reminder requests sent in the 2 following weeks.

Study Design

Respondents were asked about their demographic information (age, sex, and employment status), their resident partners’ demographics (age, sex, and level of training), and relationship dynamics (relationship status and length, presence of children, relationship satisfaction, and recent consideration of divorce). Utilizing language similar to that used in a national survey of spouses and partners of US physicians by Shanafelt et al.,15 respondents were asked to assess their feelings about work-life balance, and, in addition, were asked questions related to neurosurgical residency factors and neurosurgical career factors. Work-life balance has been defined a number of different ways in the literature. For this study, we favored the definition of work-life balance as "a fulfilment of role salience between multiple roles" and have focused our questions on whether the neurosurgical partner feels that the resident is capable of fulfilling their role as a partner.16 Work-life balance questions touched on time spent together (minutes per day and meals eaten together) and significant others’ perceptions regarding their resident partners’ ability to detach from work life. Neurosurgical residency–related factors included both resident responsibilities (hours per week spent at work and days per week spent on call) and assessment of support structures in place within the residency program. Neurosurgical career–related factors attempted to ascertain the partner’s feelings about the resident’s career in neurosurgery.

There is no validated tool that can be used to measure "perceived burnout" (a partner’s perception of how much the resident is suffering from symptoms of burnout), so to assess the significant others’ perception of the residents’ levels of burnout, the partner was asked to answer the questions of the Maslach Burnout Inventory (MBI) (Mind Garden, Inc.) in regard to how they perceived their resident partner’s approach to work.17 The MBI assesses levels of occupational burnout across three categories (personal achievement, depersonalization, and emotional exhaustion). The primary outcome measure was relationship satisfaction, evidenced by an answer of "extremely satisfied" or "somewhat satisfied" to the question, "How would you describe your satisfaction with your relationship?"

Statistical Analysis

Standard descriptive statistics were used to summarize responses. Continuous variables were analyzed using the Student t-test. Categorical variables and Likert-scale questions were analyzed using the chi-square test. Before logistic regression, a Spearman coefficient was computed for all significant variables, and highly correlated variables (> 0.5) were removed before regression. Significance was defined as p ≤ 0.05. Analyses were performed using JASP software.

Results

Demographics

Of the 93 surveys sent, 80 completed surveys (response rate 86%) were included in the final analysis. Twelve different neurosurgery residency programs were represented by responding partners (University of Pittsburgh Medical Center, 20; Baylor University, 10; Medical University of South Carolina, 8; Barrow Neurological Institute, 7; University of Florida, 6; Louisiana State University, 6; Wake Forest University, 5; Cooper University, 5; University of Minnesota, 5; University of Utah, 4; University of Chicago, 2; and Allegheny General Hospital, 2). Demographic characteristics of the significant others and their resident partners are summarized in Table 1. Half of the significant others were between 30 and 33 years of age, and 84% were female. Of the 81% of respondents employed outside the home, 57% were physicians or nonphysician medical workers, and 43% were nonmedical professionals. Slightly less than half (49%) of the resident partners were between 30 and 33 years old, 86% were male, and 49% were postgraduate year 3–5 residents. Among the relationships, 78% were marriages and just over half (52%) were longer than 6 years. Nearly one-third of respondents indicated that the couple had children.

TABLE 1.

Demographic and relationship data of respondents and their resident significant others

VariableNo. of Respondents (%)
Self
 Sex
  Female67 (84)
  Male13 (16)
 Age, yrs
  26–2923 (29)
  30–3340 (50)
  >3417 (21)
 Employed outside home65 (81)
  Physician21 (32)
  Nonphysician medical16 (25)
  Nonmedical professional28 (43)
Resident partner
 Sex
  Female11 (14)
  Male69 (86)
 Age, yrs
  26–2919 (24)
  30–3339 (49)
  ≥3421 (27)
 Residency position
  Junior (PGY1–2)19 (24)
  Middle (PGY3–5)39 (49)
  Senior (PGY6–7)22 (28)
Relationship characteristics
 Relationship type
  Married62 (78)
  Engaged11 (14)
  Dating7 (9)
 Duration, yrs
  <11 (1)
  1–316 (20)
  4–621 (26)
  7–918 (22)
  ≥1024 (30)
 Children
  Yes26 (32)
  No54 (68)
 Contemplated divorce/relationship termination in last 12 mos
  Yes14 (18)
  No66 (82)
 Relationship satisfaction (n = 79)
  Satisfied (extremely/somewhat)66 (84)
  Neutral5 (6)
  Dissatisfied (extremely/somewhat)8 (10)

PGY = postgraduate year.

Nearly 1 of 5 (18%) significant others acknowledged considering divorce (or relationship termination) in the last 12 months. Most (84%) significant others reported being either somewhat or extremely satisfied with their relationship, while 6% reported feeling neutral about their satisfaction and 10% reported feeling either somewhat or extremely dissatisfied.

Neurosurgical Residency–Related Factors

Table 2 summarizes the significant others’ perceptions regarding neurosurgery residency– and career–related factors. Most respondents (82%) stated that their resident partners regularly worked more than the 80-hour mandated Accreditation Council for Graduate Medical Education work week. Among these respondents, more than three-quarters (43/57) stated that their resident partner works 80–100 hours and 11% stated that their resident partner works > 120 hours per week. Most respondents (53%) stated that their resident partner takes 2–3 days of call per week, while 30% reported their resident partner takes ≥ 4 days of call per week. Although 57% of respondents stated that their partner’s neurosurgical residency program has a formalized wellness program (a structured support system, ostensibly in place to combat the deleterious effects of burnout), only one-third of these respondents (15/44) noted an opportunity for them, as the significant other, to participate in these structured events with their partner. According to the respondents, nearly two-thirds of these residency programs have an informal partner support system (typically organized by a resident partner), but only 22% have a formal, department-organized partner support system.

TABLE 2.

Responses of significant others to neurosurgery residency– and career–related questions

Question & ResponseNo. of Respondents (%)
Residency related
 Averaged over 4 weeks, how many hours a week does your partner work?
  <201 (1)
  21–400
  41–602 (2)
  61–8020 (25)
  81–10043 (54)
  101–1208 (10)
  ≥1206 (8)
 Averaged over 4 weeks, how many days a week does your partner take call?
  0–114 (18)
  2–342 (52)
  4–513 (16)
  6–711 (14)
 Does your partner’s department have a wellness program?
  Yes44 (57)
  No33 (43)
 Does your partner’s department have a formalized spouse/significant other support system (i.e., events planned by or supported financially by the department)?
  Yes8 (22)
  No29 (78)
 Does your partner’s department have an informal spouse/significant other support system (i.e., events organized by one of the residents’ significant others)?
  Yes24 (65)
  No13 (35)
Neurosurgical career related
 Would you choose a neurosurgeon as a partner again?
  Yes54 (68)
  No25 (32)
 If you could do it over, would you encourage your partner to choose a different path?
  Yes18 (22)
  No62 (78)
 Would you encourage your child to pursue a career as a neurosurgeon?
  Yes26 (32)
  No54 (68)

Neurosurgical Career–Related Factors

Just over two-thirds of the significant others surveyed stated that they would choose a neurosurgeon as a partner again; 22% reported that they would, if they could "do it over," encourage their resident partner to choose another career path. Two-thirds of respondents stated that they would not encourage their child to pursue a career as a neurosurgeon.

Work-Life Balance and Burnout-Related Factors

With respect to work-life balance, only 18% of respondents agreed with the statement that their resident partner’s work schedule leaves enough time for personal and family life while 73% disagreed or strongly disagreed (Table 3). Twenty-five percent of respondents reported spending ≤ 45 minutes with their resident partner on a daily basis, whereas 64% reported spending between 46 minutes and 2 hours together. Ten percent of significant others reported spending more than 2 hours of awake time with their resident partner daily. More than 80% of respondents stated that their resident partner was preoccupied with work while at home either a few times a week or every day; 74% noted that their partner comes home from work too tired to do things together either a few times a week or every day. Additionally, 43% of respondents stated that their partner comes home from work irritable either a few times a week or every day.

TABLE 3.

Partner responses to questions about work-life balance

Work-Life Balance QuestionsNo. of Respondents (%)
How much do you agree with the statement "My partner’s work schedule leaves us enough time for personal/family life."?
 Strongly agree2 (3)
 Agree12 (15)
 Neutral7 (9)
 Disagree35 (44)
 Strongly disagree23 (29)
How much time do you spend with your partner awake in a day?
 <20 minutes8 (10)
 21–45 minutes12 (15)
 46–90 minutes24 (31)
 91–120 minutes26 (33)
 ≥120 minutes8 (10)
How often does your partner come home too tired to do some of the things you would like to do?
 Never2 (3)
 A few times a year2 (3)
 A few times a month17 (22)
 A few times a week32 (41)
 Every day26 (33)
How often does your partner come home irritable?
 Never2 (3)
 A few times a year6 (8)
 A few times a month37 (47)
 A few times a week27 (34)
 Every day7 (9)
How often is your partner preoccupied with work when they are home?
 Never0
 A few times a year3 (4)
 A few times a month9 (11)
 A few times a week32 (41)
 Every day35 (44)

Significant others’ responses to the MBI are summarized in Table 4, showing that nearly 90% of them perceive that their resident partners fall in the moderate or severe range of burnout in at least one of the three MBI subscales. The majority of residents (53%) are thought to fall into the moderate to severe range in one subscale only, but 23% and 14% of residents are perceived to fall into the moderate to severe range in two or three subscales, respectively. Only 10% of significant others perceived their resident partner to have low burnout scores across all three subscales. Significant others most often ranked their resident partner as in the moderate or severe burnout range in emotional exhaustion; nearly 90% of significant others perceived their resident partner to be either moderately (45%) or severely (55%) emotionally exhausted. Substantially fewer partners ranked their resident partner in the moderate to severe burnout range for depersonalization (29%) or personal achievement (23%).

TABLE 4.

Significant others’ scoring of resident partner on the MBI

MBI SubscalesNo. of Respondents (%)
Total no. of respondents78
No. of subscales scored as moderate/severe
 08 (10)
 141 (53)
 218 (23)
 311 (14)
Subscale scored as moderate/severe burnout
 Personal achievement18 (23)
 Depersonalization23 (29)
 Emotional exhaustion69 (88)

Indicators of Satisfaction

Significant others who reported satisfaction in their relationship with their resident partners were more likely to have worked outside the home (OR 1.3, p = 0.05), less likely to have children (OR −1.8, p = 0.002), and less likely to have considered divorce in the prior 12 months (OR −2.7, p < 0.001) (Table 5). A greater likelihood of relationship satisfaction among significant others was correlated with their resident partner working fewer hours (p = 0.005) and spending more time with their partner (p = 0.02) (Fig. 1). Relationship satisfaction was also associated with more time for personal/family life (p < 0.001). Neutral and dissatisfied partners reported that they were less likely to choose a neurosurgeon as a partner again (OR 2.9, p < 0.001) and were less likely to encourage their child to pursue a career in neurosurgery (OR 1.9, p = 0.04). No correlation was identified between the resident partner’s stage in residency and relationship satisfaction (p = 0.3). Spearman’s coefficients showed significant negative correlations between having children and working outside the home (ρ −0.554, p < 0.001) and between contemplation of divorce and likelihood of choosing a neurosurgeon as a partner again (ρ −0.538, p < 0.001). Because of the strong inverse correlations, one of each of these pairs was removed from the logistic regression analysis. Presence of children and choice of partner were determined to be the most immutable of these variables and were removed from the final analysis. Following logistic regression, satisfaction with work-life balance remained positively correlated with relationship satisfaction (p = 0.02) and consideration of divorce remained negatively correlated (p = 0.01).

TABLE 5.

Indicators of satisfaction among neurosurgery residents’ significant others

CharacteristicNo. of Respondents (%)p Value
Satisfied (n = 66)Dissatisfied/Neutral (n = 13)
Respondent characteristics
 Employed outside home56 (85)8 (62)0.05
Relationship characteristics
 Has children17 (26)9 (69)0.002
 Contemplated divorce in last 12 mos6 (9)8 (62)<0.001
Neurosurgical career–related characteristics
 Would choose a neurosurgeon as a partner again51 (77)2 (15)<0.001
 Would encourage child to pursue career as neurosurgeon24 (36)1 (8)0.04
FIG. 1.
FIG. 1.

Satisfied partners are more likely to report their resident partner working less hours (p < 0.005; A), spending more time with their resident partner (p = 0.02; B), and being content with measures of work-life balance (p < 0.001; C).

Discussion

A healthy and supportive home relationship can be a vital part of tolerating the trials of neurosurgery residency for not only the resident but the resident’s significant other. By surveying the significant others of neurosurgery residents, we hoped to better understand the interplay between the stressors of neurosurgical residency and satisfaction with this important relationship from this underreported perspective. In this analysis, the majority of significant others surveyed were female (84%) and the majority of resident partners were male (86%). This is consistent with the proportion of female residents in the current neurosurgery cohort, reported as 12% of matched residents in 2000–2009.18 The majority of significant others were satisfied with their relationships (84%) while reporting high levels of dissatisfaction with work-life balance. With most significant others reporting their resident partner being too tired to participate in family activities, being preoccupied with work, and working more than 80 hours in a week, only 18% agreed that they are satisfied with the work-life balance afforded by their resident partner’s work schedule. We found that work-life balance remained one of the two indicators of relationship satisfaction after logistic regression. This is consistent with data reported by Shanafelt et al.,15 showing that 87% of physicians’ partners (26% surgical specialists) report being either somewhat or extremely satisfied with their relationship. This is not a direct comparison, however, as the previously published data included only partners of attending physicians and not those of residents.

The concerns of the surveyed partners mirror those of practicing neurosurgeons themselves. In their survey of 6880 physicians, Shanafelt et al.19 found that neurosurgeons were, by far, the least satisfied subspecialists when it comes to satisfaction with work-life balance (< 20% reporting satisfaction, compared with a mean across specialties of 42%). Moreover, in a study of 783 neurosurgeons, McAbee et al.20 demonstrated that satisfaction with work-life balance was both positively correlated with career satisfaction (OR 10) and negatively correlated with development of burnout (OR 0.45). Clearly, neurosurgeons’ dissatisfaction with work-life balance can lead to symptoms of burnout, depression, and substance abuse. Our data add to a growing number of studies that show that significant others’ dissatisfaction with work-life balance can contribute to problems at home as well.21 In a separate study, Shanafelt et al.15 found that "spouse’s/partner’s lack of time for family activities due to work responsibilities" was ranked by significant others as the greatest of 6 stress generators in their family. Furthermore, in interviews of the partners of both residents and attending physicians in response to their departmental antiburnout initiative, Estrella et al.2 reported that 4 of the 7 spouses interviewed specifically mentioned how important work-life balance is to them as partners of a neurosurgeon, while all applauded the efforts in place to try to support the physicians’ mental and physical health.

In our study, 16% of respondents were neutral, somewhat dissatisfied, or extremely dissatisfied in their relationships. Multivariate logistic regression showed that neutral and dissatisfied partners were more likely to have considered divorce in the last 12 months. Sixty-two percent of those who had considered divorce reported that they were dissatisfied or neutral with respect to their relationship satisfaction. This percentage of respondents is higher than in the study of attending physicians by Shanafelt et al.19 (12% of partners reported considering divorce in the last 12 months) and may suggest a higher level of relationship stress placed on those physicians still in training.

It appears that at least some of this dissatisfaction is related to the significant others’ perceptions of neurosurgery as a profession. When compared with significant others who were satisfied in their relationship with their neurosurgery resident partner, dissatisfied and neutral significant others were less likely to report that they would choose a neurosurgeon as a partner again (77% vs 15%) or would encourage their child to pursue a career in neurosurgery (36% vs 8%). Significant others’ relationship satisfaction also correlated with the perceived level of burnout that they reported in their resident partner. Although previously published data indicate the self-reported burnout rate in neurosurgery residents is between 37% and 67%, the rate of perceived burnout by their partners is significantly higher.1,3,11 In fact, 90% of the significant others surveyed in our study perceived their resident partner as experiencing moderate to severe burnout in at least one of the three MBI subscales, and 14% scored their resident at moderate to severe in all three (Table 6). These responses appear to be correlated with relationship satisfaction (although whether burnout causes relationship dissatisfaction or unhealthy relationships lead to burnout cannot be defined), because significant others who were dissatisfied with their relationship were more likely to score their resident partners as experiencing greater burnout, especially in the depersonalization and emotional exhaustion subscales. While the MBI has not been validated for this particular use (i.e., evaluating the burnout of others), the correlations here do provide a novel perspective on how burnout in resident physicians, as perceived by their partners, may correlate with dissatisfaction in their home life.

TABLE 6.

Significant others’ scoring (level of burnout) of resident partner on MBI subgroup scale

MBI SubgroupAverage Response (n = 77)Average Response by Relationship Satisfaction
Satisfied (n = 64)Neutral (n = 5)Dissatisfied (n = 8)
Personal achievement14.8 (low)14.8 (low)15 (low)15.6 (low)
Depersonalization4.9 (low)4.7 (low)2.8 (low)8 (moderate)
Emotional exhaustion11.6 (moderate)11.4 (moderate)10.2 (moderate)14 (severe)

Scores for each subgroup are out of 18.

Where Do We Go From Here?

We believe that the partner’s perception is just as salient as the lived experience of the resident because this perception is clearly correlated with the partner’s reality, with more dissatisfied partners rating their resident partner as more affected by burnout. Would the knowledge that their resident partner is not as burnt out as they perceive make the surveyed partner more satisfied with their relationship? This seems very unlikely. There are numerous examples in medicine of perception, even if incorrect, driving one’s reality, and this paradigm should not be discounted as an important effector in driving partner satisfaction. We believe that the results of this survey are likely to be representative of the neurosurgical residency cohort in general, and while improving conditions will likely require department-specific analysis and intervention, there do seem to be some simple opportunities for improvement. In our survey, only 22% of partners report a formalized, department-driven support system that includes them. As more neurosurgical departments develop initiatives to combat the effects of burnout, it would be very easy to include residents’ partners in activities. This would both provide extrinsic support for the partners (many of whom may lack social support in a new community to which they have moved when residency started) as well as more quality time spent with their resident partners. An excellent example of a site-specific attempt to engage and involve residents’ partners is the Medical University of South Carolina’s La Sierra program, a program that focuses on healthy lifestyle adaptations that was specifically designed to incorporate resident spouses, which has received positive feedback from resident physicians and partners alike.2,8

Limitations

Our study is subject to several limitations. First, despite geographic diversity among the neurosurgical programs invited to participate, the sample represents only a small number of the US neurosurgery residency programs and therefore may be subject to selection bias. Moreover, programs were not compelled to participate after being invited to do so, potentially resulting in self-selection of outcomes. Similarly, despite a very high response rate, the sample size of responding partners is relatively small and may also be affected by selection bias. Furthermore, the gender bias of more female partners, although reflective of the proportions seen in the neurosurgery cohort, may have created some bias related to traditional gender role stereotypes. Second, the voluntary nature of such a survey may lead to aberrant reporting of dissatisfied partners, as dissatisfied partners may be more willing to speak up in an effort to have their needs met or less willing to do so if they feel personal and/or societal pressures that would lead them to not want to acknowledge their dissatisfaction in a survey. Finally, and perhaps most contentiously, the MBI is not validated to assess the burnout of others, and its interpretation in this survey may not accurately represent the true prevalence of burnout symptoms in the US neurosurgical resident population. Although the residents themselves could have also been surveyed and responses compared within each couple, there is no clear benefit to doing so other than to devalue the perception of the partner who views their resident as profoundly burnt out. Without a validated alternative, we chose to use the MBI in this unvalidated manner.

Conclusions

Our study suggests a link between significant others’ perceptions of resident work-life balance (or lack thereof) and their relationship satisfaction. Additionally, these data would suggest that there are also correlations between relationship satisfaction and a partner’s perception of the extent of their resident partner’s level of burnout. Admittedly, it remains unclear whether these findings demonstrate that the stressors of neurosurgery residency can hurt a healthy relationship or whether they uncover a vicious cycle in which an unhealthy relationship may foster more burnout in a resident already at risk. That said, these data are clear in their support of the concept that work-life balance, particularly seen through the eyes of a significant other, can be an important determinant in the neurosurgery resident’s relationship health and provides some starting points for what can be addressed to improve satisfaction in the neurosurgical marriage.

Disclosures

Dr. Spiotta: consultant for Terumo, RapidAI, Stryker, and Penumbra; and non–study-related clinical or research effort from Penumbra, Stryker, Medtronic, and RapidAI.

Author Contributions

Conception and design: all authors. Acquisition of data: all authors. Analysis and interpretation of data: Ares, Jankowitz, Grandhi. Drafting the article: Ares. Critically revising the article: all authors. Reviewed submitted version of manuscript: Ares, Jankowitz, Grandhi. Approved the final version of the manuscript on behalf of all authors: Ares. Study supervision: Jankowitz, Grandhi.

Supplemental Information

Online-Only Content

Supplemental material is available with the online version of the article.

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    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Gray K, Kaji AH, Wolfe M, et al. Influence of student loan debt on general surgery resident career and lifestyle decision-making. J Am Coll Surg. 2020;230(2):173181.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):13771385.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Attenello FJ, Buchanan IA, Wen T, et al. Factors associated with burnout among US neurosurgery residents: a nationwide survey. J Neurosurg. 2018;129(5):13491363.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):9951000.

  • 13

    Halbesleben JRB, Rathert C. Linking physician burnout and patient outcomes: exploring the dyadic relationship between physicians and patients. Health Care Manage Rev. 2008;33(1):2939.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136(5):358367.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Shanafelt TD, Boone SL, Dyrbye LN, et al. The medical marriage: a national survey of the spouses/partners of US physicians. Mayo Clin Proc. 2013;88(3):216225.

  • 16

    Kalliath T, Brough P. Work–life balance: a review of the meaning of the balance construct. J Manage Organ. 2008;14(3):323327.

  • 17

    Maslach C, Jackson S, Leiter M, Schaufeli W, Schwab R. Maslach Burnout Inventory. Vol 21. Consulting Psychologists Press; 1986.

  • 18

    Renfrow JJ, Rodriguez A, Liu A, et al. Positive trends in neurosurgery enrollment and attrition: analysis of the 2000-2009 female neurosurgery resident cohort. J Neurosurg. 2016;124(3):834839.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):16001613.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    McAbee JH, Ragel BT, McCartney S, et al. Factors associated with career satisfaction and burnout among US neurosurgeons: results of a nationwide survey. J Neurosurg. 2015;123(1):161173.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Dyrbye LN, Freischlag J, Kaups KL, et al. Work-home conflicts have a substantial impact on career decisions that affect the adequacy of the surgical workforce. Arch Surg. 2012;147(10):933939.

    • PubMed
    • Search Google Scholar
    • Export Citation

Supplementary Materials

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A mosaic of photos submitted by female neurosurgeons, overlaid with the shape of the female symbol. The mosaic is a demonstration of a crucial but underrepresented population in the neurosurgery workforce. © Sarah Woodrow, published with permission. See the article by Mulligan et al. (pp 1088–1097).

  • FIG. 1.

    Satisfied partners are more likely to report their resident partner working less hours (p < 0.005; A), spending more time with their resident partner (p = 0.02; B), and being content with measures of work-life balance (p < 0.001; C).

  • 1

    Ares WJ, Maroon JC, Jankowitz BT. In pursuit of balance: the UPMC Neurosurgery wellness initiative. World Neurosurg. 2019;132:e704e709.

  • 2

    Estrella M, Henderson BG, Porto SC, et al. The pursuit of wellness in neurosurgery: Investing in residents’ current and future health: spouses’ perspectives. Neurol India. 2019;67(1):4452.

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  • 3

    Shakir HJ, McPheeters MJ, Shallwani H, Pittari JE, Reynolds RM. The prevalence of burnout among US neurosurgery residents. Neurosurgery. 2018;83(3):582590.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Shakir HJ, Cappuzzo JM, Shallwani H, et al. Relationship of grit and resilience to burnout among U.S. neurosurgery residents. World Neurosurg. 2020;134:e224e236.

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    • Search Google Scholar
    • Export Citation
  • 5

    Spiotta AM. Pursuing wellness in neurosurgery: resiliency. Neurosurgery. 2019;84(2):339340.

  • 6

    Spiotta AM, Fargen KM, Patel S, Larrew T, Turner RD. Impact of a residency-integrated wellness program on resident mental health, sleepiness, and quality of life. Neurosurgery. 2019;84(2):341346.

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    • Search Google Scholar
    • Export Citation
  • 7

    Spiotta AM, Kalhorn SP, Patel SJ. Letter: How to combat the burnout crisis in neurosurgery? Cathedrals and mentorship. Neurosurgery. 2019;84(4):E257E258.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Spiotta AM, Fargen KM, Denham SL, et al. Incorporation of a physical education and nutrition program into neurosurgery: a proof of concept pilot program. Neurosurgery. 2016;79(4):613619.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Gray K, Kaji AH, Wolfe M, et al. Influence of student loan debt on general surgery resident career and lifestyle decision-making. J Am Coll Surg. 2020;230(2):173181.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):13771385.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Attenello FJ, Buchanan IA, Wen T, et al. Factors associated with burnout among US neurosurgery residents: a nationwide survey. J Neurosurg. 2018;129(5):13491363.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):9951000.

  • 13

    Halbesleben JRB, Rathert C. Linking physician burnout and patient outcomes: exploring the dyadic relationship between physicians and patients. Health Care Manage Rev. 2008;33(1):2939.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136(5):358367.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Shanafelt TD, Boone SL, Dyrbye LN, et al. The medical marriage: a national survey of the spouses/partners of US physicians. Mayo Clin Proc. 2013;88(3):216225.

  • 16

    Kalliath T, Brough P. Work–life balance: a review of the meaning of the balance construct. J Manage Organ. 2008;14(3):323327.

  • 17

    Maslach C, Jackson S, Leiter M, Schaufeli W, Schwab R. Maslach Burnout Inventory. Vol 21. Consulting Psychologists Press; 1986.

  • 18

    Renfrow JJ, Rodriguez A, Liu A, et al. Positive trends in neurosurgery enrollment and attrition: analysis of the 2000-2009 female neurosurgery resident cohort. J Neurosurg. 2016;124(3):834839.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):16001613.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    McAbee JH, Ragel BT, McCartney S, et al. Factors associated with career satisfaction and burnout among US neurosurgeons: results of a nationwide survey. J Neurosurg. 2015;123(1):161173.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Dyrbye LN, Freischlag J, Kaups KL, et al. Work-home conflicts have a substantial impact on career decisions that affect the adequacy of the surgical workforce. Arch Surg. 2012;147(10):933939.

    • PubMed
    • Search Google Scholar
    • Export Citation

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