General surgery residents encounter frequent mistreatment by patients as well as attending physicians that leads to burnout and suicidal thoughts. This is the finding of a cross-sectional national survey of general surgery residents, which found that more than 50% of general surgery residents report some form of mistreatment (N Engl J Med. 2019;381:1741-1752). Mistreatment included gender discrimination for 31.9% (65% of women and 10% men), racial discrimination for 16.6% (19% and 15% men), verbal or physical abuse or both for 30.3% (33% women and 28% men), and sexual harassment for an astounding 10.3% (19.9% women and 3.9% men).
“This is likely the best estimate of burnout in any specialty to date, [given] the 99.3% response rate [to the survey],” said Yue-Yung Hu, MD, a pediatric surgeon at Lurie Children’s Hospital of Chicago and lead author of the study. Among the 7464 general surgery residents eligible to complete the survey, 7409 residents from all 262 surgical residency programs responded.
Overall, 38.5% of residents reported weekly burnout symptoms and 4.5% reported suicidal thoughts during the past year. When looking at the association among mistreatment and burnout and suicidal thoughts, the study found that residents reporting exposure to mistreatment at least a few times a month were more likely to report symptoms of burnout (odds ratio of 2.94; 95% CI, 2.58 to 3.36) as well as suicidal thoughts (odds ratio of 3.07; 95% CI, 2.25 to 4.19) as compared with residents reporting no mistreatment.
When looking at gender differences, the study found that women were more likely than men to report burnout symptoms (odds ratio of 1.33; 95% CI, 1.20 to 1.48). However, when adjusting for mistreatment, no difference in burnout was seen between women and men (odds ratio of 0.90; 95% CI, 0.80 to 1.00). According to Dr. Hu, the finding that there is no gender difference in burnout after adjusting for mistreatment suggests that mistreatment is largely responsible for the higher burnout in women.
The study also found considerable variability of mistreatment reported among residency programs. Verbal abuse, for example, ranged from none to 66.7%. “The good news is that there was a wide institutional variability in mistreatment rates, so some places have figured it out,” Dr. Hu said.
A follow-up study, the Surgical Education Culture Optimization through targeted interventions based on National Comparative Data (SECOND) Trial, will use what has worked to counter mistreatment and burnout in certain institutions, according to Dr. Hu. The study will “provide these tools for others to use to make surgery a safer, more inclusive, and more educational environment for us all,” she said.