Best Paper at GSC 2019 addresses burnout among spine surgeons

Lead author Alisson R Teles

Results of a worldwide survey indicate that the overall prevalence of burnout among spine surgeons is 30.6%. They suggest that factors linked with higher likelihood of burnout include working in North America, being in training as a fellow, and working more than 60 hours per week. In addition, professional burnout was associated with depression, anxiety, pain, and difficulty with usual activities. This survey was conducted by Alisson R Teles (McGill University, Montreal, Canada) and colleagues, and won the Best Paper Award at the 2019 Global Spine Congress (GSC; 15–18 May, Toronto, Canada).

In a Special Report from 2011 on suicidal ideation among American surgeons, Tait D Shanafelt and colleagues conveyed that the suicide rate was three times higher among American surgeons than in the general population, and that burnout and depression were independently associated with suicide ideation after controlling for personal and professional characteristics. The authors noted that one in 16 surgeons had suicide ideation in the last year, while only 26% sought psychiatric help.

The authors note that there is no information on the prevalence of burnout among spine surgeons and factors associated with this condition. “This directly limits health policy interventions that could improve the well-being of both patients and spine surgeons,” they comment.

An electronic survey was used to assess general characteristics, the Maslach burnout inventory of emotional fatigue, depersonalisation, and personal fulfilment, and the EQ5D was used to assess quality of life.

The overall prevalence of professional burnout was 30.6%. Eighteen per cent experienced high emotional fatigue and 21% experienced high depersonalisation. The prevalence of these two factors was highest in North America, both at just over 30%. The prevalence of low personal fulfilment was 23% in total, with the highest rate for this category being in Europe, again at just over 30%.

According to the authors, independent factors associated with burnout among spine surgeons include working in North America, being in training as a fellow, and working more than 60 hours per week. In terms of the EQ5D scores, 33.6% reported pain, 28.4% reported anxiety or depression, and 10.8% difficulty with usual activities.

A total of 818 surgeons from 87 countries were given the survey, and the response rate was 13.2%. The majority of the cohort were male (93.4%) and the average age of the participants was 43.45. Just over three-quarters of the sample were married (76.3%) and the most common number of children they had was two (36.8%).

The majority of the surgeons who took the survey specialised in orthopaedics (62.2%) and just over half worked between 40 and 60 hours per week (54.4%). Just under half of the group (45.2%) had more than 10 years of experience. Participation from fellows, the group with the shortest duration of practice, was the lowest, at 13.7%. Most performed both adult and paediatric surgery (53.6%), followed by those who performed spinal surgery on adults only (44.3%). The remaining 2.1% performed paediatric cases only.

Teles acknowledges some limitations of the survey, including the low response rate, a possible non-response bias, and the fact that the burnout rate was measured at a single point in time. He recognised that “variations in the level of burnout may occur in individuals over time”. He noted that the short form of the survey had both a positive and negative impact on the results. While the format yielded improvement in the response rate among AOSpine members, it provided only a limited amount of data.

Overall, Teles and colleagues conclude: “We must recognise that burnout is an important problem affecting the lives of spine surgeons worldwide. This survey highlights the need for development of interventional programmes to better identify, prevent and manage this condition in this population.”

Given the high prevalence of burnout among the fellows included in this survey, the highest out of four groups based on duration of practice, they comment: “Fellowship programme directors should be aware of this and take measures to minimise and mitigate trainee burnout.”


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