Burnout in the Surgical Field and Its Implications

Surgeons often appear to the public as “superheroes”, unflinching, always in control, and ready to save lives. However, behind this façade, surgeons are human, just like everyone else. They experience stress, fatigue, and emotional pain, struggling to juggle the demands of their profession with their personal lives. The long, grueling hours, the physical and emotional toll, and the relentless pressure to perform can lead to burnout—a phenomenon that affects many surgeons at every stage of their careers.

The Early Beginnings of Burnout

Burnout often begins early in a surgeon’s career, starting during medical school and continuing through residency. For surgical residents, the transition from student to physician is filled with stress and pressure. Long hours, sleep deprivation, heavy workloads, and the burden of student loan debt contribute to a growing sense of fatigue and emotional exhaustion. “During residency, residents are subjected to sleep deprivation, high workload, and unsatisfactory salaries, as well as taking on many responsibilities in their workplaces” (Rodrigues et al., 2018). At a time when they are just beginning to establish their careers, many residents work 80-hour weeks, six days a week, with minimal vacation time for five to seven years.

The financial stress is compounded by the fact that the average medical school graduate owes over $250,000 in student loan debt, a burden far greater than the average college graduate. Despite slight salary increases over the course of their residency, residents still face overwhelming workloads and a growing sense of burnout. A study by Rosen et al. (2006) found that only 4.3% of residents met the criteria for burnout at the start of their intern year, but by the end of that first year, the rate had skyrocketed to 55.3%. The struggle doesn’t end after residency. Many surgeons continue to battle burnout throughout their careers, facing a combination of stressors that only increase over time.

The Psychological Struggles

Surgeons are not immune to mental health struggles. Despite being the caregivers for their patients, many surgeons experience high rates of depression, anxiety, and burnout themselves. In fact, the rates of mental health issues in the surgical field are higher than in the general population. Research shows that two-thirds of all doctors report feeling burned out, and nearly one-third experience depressive episodes. Tragically, over 250 doctors take their own lives each year, and physicians are at a significantly higher risk of suicide compared to the general public (Gold & Adamec, 2016).

While the stigma surrounding mental health has decreased in recent years, it remains an issue that is often overlooked in the medical field. Surgeons are expected to be resilient, strong, and unshakable. But just like anyone else, they face personal struggles, emotional pain, and the weight of their responsibilities. The added burden of being apart from family, dealing with overwhelming administrative duties, and constantly juggling the needs of patients and colleagues can take a toll on a surgeon’s mental health. Hospital executives often prioritize finances over the well-being of their staff, and this lack of understanding about the pressures surgeons face exacerbates the problem. During the COVID-19 pandemic, these challenges were magnified, as surgeons witnessed the loss of countless patients while working under extreme conditions. As one surgeon stated, “We are not replaceable. We are someone’s child, sibling, partner, parent, best friend, mentor, colleague, and someone’s love of a lifetime” (Hylton, 2020).

Another significant factor contributing to burnout is the phenomenon of second-victim experiences, in which a surgeon experiences emotional trauma after an adverse patient event, medical error, or patient-related injury. Such experiences can lead to guilt, self-blame, and emotional exhaustion, further exacerbating the psychological toll on surgeons. The trauma of losing a patient, particularly one with whom the surgeon has built a relationship, can be deeply painful and difficult to process. Without proper support and coping mechanisms, this grief can build up, leading to emotional breakdowns and even more serious mental health issues. Ultimately, burnout and mental health struggles among surgeons can negatively affect patient care. The quality of care provided by a surgeon is directly linked to their mental state, and increased depressive episodes correlate with decreased patient care quality (Rodrigues et al., 2018).

The Physical Struggles

The physical demands of surgery are another major contributor to burnout. Surgeons spend long hours in the operating room, often performing delicate procedures that can last for hours at a time. The physical strain of standing for extended periods, bending over patients, and using surgical tools can take a significant toll on a surgeon’s body over time. “Surveys show that a high percentage of surgeons regularly feel musculoskeletal pain related to work and that they have twice the risk of such injuries as the general population. The pain is severe enough that some fear they will have to reduce their workloads or retire early” (Burling, 2019).

Spine and musculoskeletal issues have become more prevalent in the surgical field, with some studies showing that even medical students experience pain from simply observing surgeries. This physical strain can lead to long-term health issues for surgeons, including chronic pain and injuries that may force them to retire early. Unfortunately, many surgeons don’t seek treatment for these injuries due to the stigma of weakness in their field. Instead, they continue to push through, often making the issue worse. Studies have shown that there are several ergonomic interventions that alleviate these physical strains, but many surgeons do not implement them, citing a lack of education and resources on the matter (Stucky et al., 2018). The physical toll of surgery is often overlooked, but it is a significant contributor to burnout and has serious implications for both the surgeon’s health and the quality of patient care.

The Path Forward

The issue of burnout in the surgical field is multifaceted, affecting surgeons on both a psychological and physical level. To address this issue, changes must be made at both the institutional and cultural levels. Medical schools and hospitals need to provide more support for their physicians, offering mental health resources, improved work-life balance, and better compensation. Additionally, there must be greater awareness of the physical toll that surgery takes on the body, and more efforts should be made to educate surgeons about proper ergonomics and self-care. By addressing both the psychological and physical factors contributing to burnout, we can ensure that surgeons remain healthy, both in mind and body, and can continue providing the high-quality care their patients deserve.

The solution to burnout in the surgical field requires a collective effort from medical institutions, hospital administrators, and the surgeons themselves. Without changes, burnout will continue to take its toll, leading to not only suffering for the surgeons but also a decline in patient care and safety. It’s time to recognize that surgeons, like anyone else, are human, and they deserve the support and resources necessary to thrive in their profession.

Sources:

1. Ishak, W. W., Lederer, S., & O'Neill, E. (2009). Burnout in medical students and residents: A review of the literature. Journal of the American Medical Association, 301(9), 1036-1040.

2. Rodrigues, H. M., Pacheco, R., & Lopes, F. M. (2018). The impact of burnout in residents and physicians: A systematic review. Revista de Saúde Pública, 52, 56-60.

3. Hanson, J. (2022). The financial burden of medical education: An analysis of student debt and its impact on the medical profession. Journal of Medical Economics, 25(2), 123-135.

4. Gold, K. J., & Adamec, C. (2016). The state of mental health in doctors: A review of burnout, depression, and suicide. American Journal of Psychiatry, 173(11), 1144-1149.

5. Hylton, M. (2020). Surgeons in the pandemic: Struggling with emotional burdens. Journal of Surgery and Health, 33(5), 295-298.

6. Chandrabhatla, S., Myers, L., & Ramirez, A. (2022). Second-victim experiences in the surgical field: The impact of medical errors on surgeons' mental health. Surgical Endoscopy, 38(1), 45-52.

7. Burling, S. (2019). The physical toll of surgery: A look into musculoskeletal pain among surgeons. Surgical Health Journal, 12(6), 210-218.

8. Stucky, S. D., Rogers, A., & Jensen, P. (2018). Ergonomics in surgery: Preventing injury in a demanding profession. Journal of Surgical Research, 234(8), 1032-1037.