American Surgical Association

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Distress parameters among 14 Surgical Specialties, comparing academic and private practice setting
Charles M Balch, MD1, Tait D. Shanafelt, MD*2, Jeffrey A. Sloan, MD*2, Daniel Satele, MD*1, Julie A. Freischlag, MD1
1Johns Hopkins Medical Institutions, Baltimore, MD;2Mayo Clinic, Rochester, MN

OBJECTIVE(S): We compared distress parameters and career satisfaction from survey results of surgeons in an academic versus private practice environment.
METHODS: The 2008 American College of Surgeons survey evaluated demographic variables, practice characteristics, career satisfaction, and distress parameters using validated instruments.
RESULTS: Characteristics are shown in the Table. The practice setting (academic vs. private practice) was independently associated with burnout in a multivariate (MV) analysis (OR 1.172, p=0.02). For academic surgeons, the most significant positive associations with burnout were: 1) trauma surgery (OR 1.513,p=0.0059), 2) nights on call (OR 1.062, p=0.0123) and 3) hours worked (OR 1.019,p<0.0001), while the negative associations were: 1) having older children (>22 years) (OR 0.529, p<0.0001), 2) pediatric surgery (OR 0.583, p=0.0053), 3) cardiothoracic surgery (OR 0.626, p=0.0117), and 4) being male (OR 0.787, p=0.0491). In a private practice setting, the most significant positive associations with burnout were: 1) urologic surgery (OR 1.497, p=0.0086), 2) having 31-50% time for non-clinical activities (OR 1.404, p=0.0409), 3) incentive based pay (OR 1.344, p<0.0001), 4) nights on call (OR 1.045, p=0.0029) and 5) hours worked (OR 1.015, p<0.0001), while the negative associations were; 1) older children (OR 0.677,p=0.0001), 2) physician spouse (OR 0.753, p=0.0093),and 3) older age (OR 0.989, p=0.0158).
CONCLUSIONS: Factors associated with burnout were distinct for academic and private practice surgeons.Distress parameters were lower and career satisfaction higher for academic surgeons.
Comparison of Academic versus Private Surgical Practice
CharacteristicAcademic Practice (N= 2272)Private Practice (N=4240)p value
work > 70 hrs/week41.6%28.1%<0.0001
nightcall/week2.23.0<0.0001
salaried86.5%29.8%<0.0001
> 20% nonpt care61%17.2%<0.0001
burnout37.0%43.1%<0.0001
screen+ depression27.6%33.0%<0.0001
suicide ideation4.7%7.4%<0.0001
become surgeon again77.4%64.9%<0.0001
recommend child become MD61.3%43.7%<0.0001


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