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.
| Characteristic | Academic Practice (N= 2272) | Private Practice (N=4240) | p value |
| work > 70 hrs/week | 41.6% | 28.1% | <0.0001 |
| nightcall/week | 2.2 | 3.0 | <0.0001 |
| salaried | 86.5% | 29.8% | <0.0001 |
| > 20% nonpt care | 61% | 17.2% | <0.0001 |
| burnout | 37.0% | 43.1% | <0.0001 |
| screen+ depression | 27.6% | 33.0% | <0.0001 |
| suicide ideation | 4.7% | 7.4% | <0.0001 |
| become surgeon again | 77.4% | 64.9% | <0.0001 |
| recommend child become MD | 61.3% | 43.7% | <0.0001 |
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