Professional Burnout in US Plastic Surgery Residents: Is It a Legitimate Concern? (2019)

PURPOSE: The rate of burnout in medicine is double that in other professions and remains intimately associated with the desire to leave an institution, increased fiscal loses, substance abuse, depression, suicidal ideation, medical errors, and lower patient satisfaction scores. Unfortunately, no study, until now, has sought to examine burnout and its relationship to medical errors and program-related factors, by directly sampling all US Plastic & Reconstructive Surgery residents. METHODS: Cross-sectional study of data collected from current US Plastic & Reconstructive surgery residents (Integrated and Independent) at ACGME-accredited programs during the 2018–2019 academic year and from participants in the 2018 ACAPS Plastic Surgery Boot Camps using the Stanford Professional Fulfillment Index, Maslach Burnout Index, Short Form-12 survey, alcohol use disorder identification test, and depression screening from the Personal Health Questionnaire. Additional data collected included demographics, relationship status, call schedule, perceived impact within one’s program, and admission of medical errors. RESULTS: One hundred ninety-five subjects responded. Residents from each post-graduate year in the first 6 years were well represented. No relationship was found between burnout and age, gender, race, relationship status, or PGY level. Residents who reported that they do not feel like they matched into the right program would not recommend their program to medical students, and do not feel involved in program decisions had a significantly higher incidence of burnout; P = 0.014, 0.001, and 0.013, respectively. There was a significant association between burnout and increasing hours worked in the week prior (P = 0.031; odds ratio [OR], 1.03). Residents who reported feeling that they were taking too much call had significantly higher incidence of burnout, as opposed to residents who felt they took an appropriate amount of call or too little call (P < 0.001). Residents were more likely to be professionally fulfilled if they would recommend their program to medical students (P = 0.02), felt involved in program decisions (P = 0.008), and felt like they had matched into the right program (P = 0.001). There was a significant increase in emotional exhaustion with increasing average weekly work hours (P = 0.002; OR, 1.04) and calls taken the month prior (p = 0.03; OR, 1.11). There was a significant increase in interpersonal disengagement with increasing average weekly work hours (P = 0.002; OR, 1.05) and calls taken the month prior (P = 0.03; OR, 1.12). A significant association exists between burnout and a major medical error that could have resulted in patient harm (P = 0.014). A significant association between burnout and laboratory errors (P = 0.035) with a trending association between burnout and medication errors (P = 0.078) was also observed. CONCLUSION: This study represents the first and largest direct examination of burnout, self-reported medical errors, and program suitability in US Plastic & Reconstructive residents using a validated scale and suggests that burnout and some medical errors may be related to program-specific, modifiable factors. Additionally, we propose a novel screening instrument for burnout among plastic surgery residents (SMOkE/R questionnaire) based on the data, and outline future studies in this 3-part series to help optimize training within our specialty, facilitate curriculum development, and develop resources for residents burdened with burnout.