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A National Assessment of Well-Being and Mistreatment Among General Surgery Faculty
*Kellie A. Brue
1, *Sarah Huber
1, *Joshua S. Eng
1, *Daniela Amortequi
1, *Natalia Mackiewicz
1, *Yue-Yung Hu
1,2, Karl Bilimoria
1,
*Amy L. Holmstrom11Surgical Education Numbered Trials (SENT), Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana; 2Surgical Education Numbered Trials (SENT), Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
ObjectiveWhile research has recently been done to improve surgical trainee well-being and mistreatment, there has not been a comparable large-scale, national assessment of surgical faculty well-being. Our objectives were (1) to assess the prevalence of poor faculty well-being, (2) to identify sources of faculty mistreatment (bullying, discrimination, and sexual harassment), and (3) to investigate the factors that impact surgeon well-being.
MethodsAn anonymous, national cross-sectional survey was sent to all general surgery faculty through the ACGME in 2024 to assess faculty well-being and mistreatment. Burnout was evaluated using the modified Maslach Burnout Inventory. Multivariable logistic regression models evaluated the association of individual and department characteristics on thoughts of attrition (i.e., leaving their current job) and weekly burnout symptoms.
ResultsResponses from 3,253 (30% response rate) surgical faculty from 349 general surgery programs were analyzed. Overall, 66% (N= 2,141) of faculty (including 89% of 873 women) reported experiencing mistreatment, specifically, bullying (54%), discrimination (46%), and sexual harassment (13%). Among faculty who experienced bullying, the main source of bullying was other faculty (56%). Women who faced discrimination reported patients as the main source (90%); however, men identified administration as the main source of discrimination (58%). About a third of faculty experienced burnout (35%, N=1,127) and thoughts of attrition (30%, N=976). Faculty were more likely to consider leaving their current job if Non-White (32.8%, OR 1.31, 95% CI 1.07-1.60), childless (35.3%, OR 1.32, 95% CI 1.03-1.69), working at university-affiliated programs (30.6%, OR 1.38, 95% CI 1.09-1.75), or > 70 hours/week on average (35.8%, OR 1.53, 95% CI 1.15-2.04). Faculty were more likely to experience burnout if female (42.7%, OR 1.36, 95% CI 1.10-1.69), childless (OR 1.29, 95% CI 1.02-1.63), midcareer (i.e., 5-10 years into practice; OR 1.85, 95% CI 1.46-2.36), working in the largest departments (OR 1.44, 95% CI 1.06-1.96), >70 hours/week on average (OR 2.23, 95% CI 1.73-2.87), or ≥7.5 nights on call/month on average (OR 1.68, 95% CI 1.39-2.04). Notably, compensation was not associated with burnout or thoughts of attrition. After adjusting for mistreatment, the higher risk of burnout for women was eliminated (aOR 1.00, 95% CI 0.80-1.25) and they were significantly less likely than men to have thoughts of attrition (aOR 0.74, 95% CI 0.58-0.94).
ConclusionsBurnout and mistreatment are common among surgical faculty, especially female surgeons. Long work hours and frequent call contribute to poor well-being. Gendered disparities in well-being may be attributable to mistreatment. These results provide potential modifiable targets to improve the well-being of surgeons.
Sources of Mistreatment among U.S. Surgical Faculty
| Mistreatment Type | Source | Overall; N=1,760 | Male; N= 970 | Female; N=570 |
| Bullying | Administration | 958 (54%) | 567 (58%) | 268 (47%) |
| | Colleagues | 982 (56%) | 494 (51%) | 369 (65%) |
| | Nurses/Support Staff | 481 (27%) | 260 (27%) | 156 (27%) |
| | Patients | 697 (40%) | 369 (38%) | 246 (43%) |
| | Trainees | 379 (22%) | 199 (21%) | 137 (24%) |
| Discrimination | Source | Overall; N=1,499 | Male; N=558 | Female; N=745 |
| | Administration | 784 (52%) | 325 (58%) | 348 (47%) |
| | Colleagues | 818 (55%) | 263 (47%) | 450 (60%) |
| | Nurses/Support Staff | 647 (43%) | 129 (23%) | 432 (58%) |
| | Patients | 1,028 (69%) | 230 (41%) | 674 (90%) |
| | Trainees | 268 (18%) | 58 (10%) | 171 (23%) |
| Sexual Harassment | Source | Overall; N=425 | Male; N=172 | Female; N=207 |
| | Administration | 33 (7.8%) | 14 (8.1%) | 13 (6.3%) |
| | Colleagues | 190 (45%) | 73 (42%) | 96 (46%) |
| | Nurses/Support Staff | 112 (26%) | 64 (37%) | 39 (19%) |
| | Patients | 234 (55%) | 77 (45%) | 132 (64%) |
| | Trainees | 45 (11%) | 21 (12%) | 16 (7.7%) |
Rows with missing data for gender (N=220 for bullying, N=196 for discrimination, and N=46 for sexual harassment) not included in the table.
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