Most microvascular and reconstructive free-flap head and neck surgeons experience at least moderate professional burnout, according to a study published in October 2010 in the Archives of Otolaryngology and Head and Neck Surgery (136(10):950-956).
How is burnout defined? It’s not the same thing as depression, said Ted Teknos, MD, one of the co-authors of the study, professor and division director of head and neck surgery and David E. Schuller, MD, and Carol H. Schuller chair of head and neck oncologic surgery at the Ohio State University Medical Center in Columbus."Burnout is defined as a high degree of emotional exhaustion and depersonalization and a low sense of personal accomplishment. It’s your view of your job."
In some respects, otolaryngologists are fortunate when it comes to burnout, Dr. Teknos said."There have been a number of studies looking at burnout amongst different disciplines, and otolaryngology actually ranks better than ob-gyn and a number of other surgical disciplines, like general surgery," he said."We’re in a little bit better shape."
Indeed, perhaps one of the most surprising findings in the study was how little severe burnout there was among the surgeons surveyed. Among the 60 practicing microvascular free-flap head and neck surgeons who responded, just one reported high burnout. Moderate burnout affected 73 percent of the respondents, and a full 25 percent of surgeons actually said their burnout levels were low. (The study defined burnout as"the triad of high emotional exhaustion (EE), high depersonalization (DP) and low personal accomplishment.")
"That surprised us," said Brian Nussenbaum, MD, FACS, Christy J. and Richard S. Hawes III professor of otolaryngology and head and neck surgery at Washington University School of Medicine in St. Louis, Mo., also a co-author of the study."We thought the distribution would be more towards high-moderate burnout, rather than moderate to low."
When the authors looked at the data further, they uncovered the reason for their unexpected results."The reason why burnout wasn’t at a higher level was because of the high sense of personal accomplishment most respondents reported," Dr. Nussenbaum said."In fact, 95 percent of people in the study said that they would become microsurgeons again."
But that doesn’t mean that burnout isn’t a problem in otolaryngology. Other related studies such as a 2005 study in the Laryngoscope (115(11):2056-2061) that focused on chairs of otolaryngology and head and neck surgery, have similarly found moderate levels of burnout in different populations within the field.
How can burnout among otolaryngologists be alleviated? Part of the challenge, Dr. Teknos said, is the fact that the level of burnout, and the reasons for it, vary depending on the level of a physician’s career. "Based on this and other studies that have been done, we can see that residents are in the worst shape. Essentially, 86 percent of residents in otolaryngology are either highly or moderately burnt out," he explained. "Next are the chairs, followed by microvascular surgeons, followed by academic faculty."
For residents, the biggest determinant of burnout is emotional exhaustion, caused primarily by a lack of balance between personal and professional life. "The number one thing that residents say really affects their burnout level is insufficient time for exercise and insufficient extracurricular time."
Chairs, on the other hand, report that their biggest stressors relate to departmental budgets and deficits, billing audits, disputes with the dean and loss of faculty. "Theirs are more global, high-level issues," Dr. Teknos said. "For faculty in general, their biggest stressors are inadequate research time and low collections, then departmental budgets and inadequate administrative time. Microvascular surgeons are most stressed by excess workload and work invading family life."
With all these varied stressors, why is it that residents in otolaryngology are the most burnt out of all? It’s what they don’t have, Dr. Teknos said. "For most faculty, what balances off the emotional exhaustion and depersonalization of their careers is that they have a high sense of personal accomplishment. Residents, because of where they are professionally, don’t have that sense of achievement."
This particular insight may point to useful interventions for combating burnout, said Michael Johns III, MD, director of the Emory Voice Center and associate professor of otolaryngology at Emory University School of Medicine in Atlanta and a author of both studies. "Medicine is a flow experience; if you really enjoy what you’re doing and have a strong sense of personal accomplishment, you’re not worried about hours spent doing it. Across the board, the less control you have over your own destiny, the more burnt out you’re going to be. So trying to create situations where residents, faculty and chairs have some control over what they’re doing is key."
In an academic medical center setting, that might mean building in a certain amount of discretionary "clinical-academic" time for faculty members. "I’ve got some of that time, and it’s my choice as to whether I see patients, take on a teaching role in the school of medicine or apply for more research grants," Dr. Johns said. "It gives me a certain autonomy." For residents, that’s harder to do, Dr. Johns acknowledged. "You can give them some elective time, but they’re already overloaded."
Another option is for departments and institutions to provide faculty, chairs and residents with career support and counseling that helps them find that sense of accomplishment that is so critical to combating burnout. "By identifying the priorities of their personal and professional life, surgeons can identify values, choose the optimal practice type, manage the stressors unique to that career path, determine the optimal personal work-life balance and nurture their personal wellness," wrote Charles Balch, MD, FACS, professor of surgery, oncology and dermatology and deputy director at Johns Hopkins Institute for Clinical and Translational Research in Baltimore, in "Combating stress and burnout in surgical practice: a review," published last year in Advances in Surgery (44:29-47).
Chairs also need to work with residents to help them find that sense of satisfaction in their work – even if their autonomy is low. "We need to help residents realize what an important role they play in patient care, and how critical they are to the overall well-being of the patients we deal with," Dr. Teknos said. "That may give residents more of a sense of personal achievement."
For all otolaryngologists, no matter what their career level, work-life balance is key to combating burnout, Dr. Teknos said. "It’s essential to have a support system outside of work that can balance out the stresses, emotional exhaustion and depersonalization of your job."