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Copyright # 2007 John Wiley & Sons, Ltd. Psycho-Oncology 17: 570–576 (2008)
DOI: 10.1002/pon
572 A. Sharma et al.
Copyright # 2007 John Wiley & Sons, Ltd. Psycho-Oncology 17: 570–576 (2008)
DOI: 10.1002/pon
Stress and burnout in surgeons 573
Table 2. Comparison of the presence or absence of psychiatric morbidity and burnout in colorectal and vascular surgeons
Colorectal surgeons (%) Vascular surgeons (%) p value
GHQ. Using the MBI, 154 (31.7%) had high EE, (p50.005) in response to stress. Surgeons with
103 (21.2%) had high levels of DP and 140 (28.8%) normal GHQ scores and low burnout scores
had feelings of low PA on the MBI (Table 2). reported greater job satisfaction (p50.005) and
Vascular surgeons were found to have significantly indicated that they were less likely to retire before
higher levels of DP (w2 ¼ 4:06; p ¼ 0:04); there retirement age (p50.005) or achieving affordability
were no significant differences in psychiatric (p50.005). Surgeons with low burnout and/or
morbidity, PA or EE levels. normal GHQ scores considered their training in
Three hundred and eighty-three surgeons (76.9% management skills to have been adequate, whereas
of colorectal surgeons and 77.9% of vascular those with high burnout and/or psychiatric mor-
surgeons, p ¼ 0:8) stated that they intended to bidity considered their training to have been
retire before the statutory retirement age and 343 inadequate (p50.005). Surgeons reporting low
(64.7% of colorectal surgeons and 73.7% of PA and high DP considered their training in
vascular surgeons, p ¼ 0:06) said they would retire communication to have been inadequate
as soon as they could afford to. (p50.005).
One hundred and fifty-eight (32.3%) consultants Logistic regression analysis showed that several
thought they had not received adequate training in factors independently predicted the presence or
communication skills, and 226 (43.5%) indicated absence of psychiatric morbidity and burnout. Low
that they had insufficient training in management job satisfaction was identified as most predictive of
skills. No significant difference was found between psychiatric morbidity and all aspects of burnout.
vascular and colorectal surgeons. In terms of Intention to retire early was an independent
coping with work-induced stress, no significant predictor of high psychiatric morbidity, low PA
differences were found between the two groups of and high EE. Living with a partner was shown to
surgeons. be protective against psychiatric morbidity. Eating
Younger respondents had higher DP scores less or more and poor social coping were also
(U ¼ 16796; p ¼ 0:02) and surgeons who were independent predictors of psychiatric morbidity
married or living with partners had lower levels and burnout (Tables 3–6).
of psychiatric morbidity (w2 ¼ 5:9; p ¼ 0:01) and
DP (w2 ¼ 0:68; p ¼ 0:04).
In terms of coping with self-perceived work- Discussion
related stress, surgeons with psychiatric morbidity
and a high score on any of the three MBI scales This national study set out to investigate the
coped by changing their food consumption (by prevalence of psychiatric morbidity and burnout
eating more or less, p50.005), increasing their in colorectal and vascular surgeons and to examine
alcohol consumption (p50.005), tending to take the influence of demographic factors and coping
work home (p50.005), keeping things to them- strategies.
selves (p50.005), taking stress out on family or Five hundred and one colorectal and vascular
friends (p50.005), engaging less in sports surgeons returned the study booklet. This repre-
(p50.005) and recreation (p50.005) and mixing sents 56% of the colorectal surgeons and 62% of
less with friends (p50.005) in response to an the vascular surgeons who were identified by their
increase in work-related stress. On the other hand, professional societies.
surgeons who scored in the normal range of the Overall, 33% of the surgeons (30% colorectal
GHQ and low on the burnout scales reported that and 36% vascular surgeons) scored 4 or above in
they coped by taking things easier (p50.005), the GHQ, which suggests that they were currently
talking things over with family (p50.005), increas- experiencing clinically significant psychiatric mor-
ing level of sports (p ¼ 0.02) and recreation bidity. Ramirez et al. reported GHQ-12 caseness
(p50.005) and mixing more with friends (GHQ score 54) of 22% in surgical oncologists in
Copyright # 2007 John Wiley & Sons, Ltd. Psycho-Oncology 17: 570–576 (2008)
DOI: 10.1002/pon
574 A. Sharma et al.
Table 3. Logistic regression analysis showing independent related to impaired work performance, more days
predictors of psychiatric morbidity of missed work and poorer physical health in
Independent Coefficient (B) Significance (p) military personnel [17]. In addition to their own
covariates suffering, high psychiatric morbidity can have wide
ranging implications on families and friends. The
Marital status 1.527 0.01
Eat less 0.493 0.03
other concern is the high rate of suicide among
Take work home 0.679 0.01 doctors in the UK. Ramirez et al. [10] quote
Mix less with friends 0.715 0.003 reports from the BMA in which suicide stands out
Satisfaction with work 1.285 50.005 as a prominent cause of death among medical
Intention to retire before the 1.087 0.01 practitioners.
statutory retirement age In terms of burnout, 31% scored in the
‘significant range’ for EE, 21% for DP and 29%
for PA. The proportions of surgeons in the two
specialties were similar for EE and PA, but the
Table 4. Logistic regression analysis showing independent
predictors of burnout (personal accomplishment) proportion of vascular surgeons scoring higher on
DP was significantly higher (17 vs 25%). There are
Independent Coefficient (B) Significance (p) differences in the level of burnout found in Ramirez
covariates
study and this study; Ramirez et al. used the EE
Keep things to myself 0.470 0.02 component of burnout in the 2002 results. The level
Satisfaction with work 0.727 50.005 of EE increased from 27 to 41% between 1994 and
Intention to retire before the 0.945 0.01 2002 in their study. In this study, however, the level
statutory retirement age of EE was significantly lower, being 31.1% in
Training in communication 0.186 0.02
colorectal and 32.2% in vascular surgeons
(w2 ¼ 6:9; p ¼ 0:03).
According to Maslach et al. [12], burnout is
Table 5. Logistic regression analysis showing independent associated with long-term job-related stress: ‘what
predictors of burnout (emotional exhaustion) started out as important, meaningful and challen-
Independent Coefficient (B) Significance (p) ging work becomes unpleasant, unfulfilling and
covariates meaningless. Energy turns into exhaustion, invol-
vement turns into cynicism and efficacy turns into
Eat less 0.532 0.02
Take things easier 0.513 0.03
ineffectiveness’. Burnout is thought to be specific to
Keep things to myself 0.513 0.04 work context and is situation specific rather than
Talk with professional 0.403 0.05 general depression. The symptoms are also present
Take sleeping tablets 1.787 0.02 in normal persons who did not suffer from
Mix less with friends 0.665 0.007 psychopathology before and the emphasis is on
Satisfaction with work 1.123 50.005 the mental and behavioural symptoms rather than
Intention to retire before the 0.818 0.05 on physical ones.
statutory retirement age
Training in management skills 0.194 0.02
Burnout is associated with stress-related ill-
nesses, lower productivity and intention to retire
early, all of which have significant adverse man-
power implications for the NHS [12,18]. Burnout
has also been shown to be associated with
Table 6. Logistic regression analysis showing independent
predictors of burnout (depersonalisation) substance misuse and interpersonal difficulties,
both of which have significant implications for
Independent covariates Coefficient (B) Significance (p) safety in the workplace for colleagues and patients
Eat more 0.571 0.008 [19,20].
Take it out on family 0.941 50.005 The notion that working with cancer per se
Talk with family 0.869 50.005 confers high risk of stress and burnout is not
Mix less with friends 0.555 0.01 supported by the present study. Neither psychiatric
Satisfaction with work 0.600 0.005 morbidity nor burnout levels were higher in
surgeons with a higher cancer workload.
Three-fourth of surgeons wanted to retire early
1994 increasing to 33% in 2002. Their 2002 result is and a similar number said they would retire as soon
similar to this study (w2 ¼ 1:69; p ¼ 0:43; Graph- as they could afford to. If this stated intention is
pad, InStat software. This picture is less than translated into the actual behaviour it is likely that
satisfactory with significant ramifications for the the NHS is going to lose the most experienced
quality of care that these individuals can deliver. group of surgeons prematurely. To offset this to a
Stress at work has been shown to be related to high degree it does appear that those likely to say that
burnout levels in health-care professionals [2]; they are most likely to retire early also have
work stress has also been shown to be significantly significant psychiatric morbidity and are burnt out.
Copyright # 2007 John Wiley & Sons, Ltd. Psycho-Oncology 17: 570–576 (2008)
DOI: 10.1002/pon
Stress and burnout in surgeons 575
Multivariate analysis indicated that job dissatis- and vascular surgeons and are likely to impact
faction was an independent predictor of psychiatric adversely on patient satisfaction and service
morbidity and burnout. However, given the cross- quality.
sectional design of the present study, it is not There are several implications for the work force
possible to say what is the cause and what is the planning of NHS which are highlighted in this
effect. It could be that because people have study. A significant number of surgeons with
psychiatric morbidity they are not satisfied, or psychiatric morbidity, high levels of burnout and
alternatively, because of their dissatisfaction they intention to retire early could lead to a future work
develop psychiatric morbidity. Training in com- force crisis.
munication and management was also predictive of
burnout. There is evidence in medical literature to
suggest that communication skills training can Notes
improve attitude of clinicians towards patients,
thus reducing DP [21]. 1. Royal College of Surgeons of England, 35-43 Lincoln’s
Several coping strategies were found to be Inn Fields, London, WC2A 3PE.
independent predictors of psychiatric morbidity 2. Kendata Peripherals Limited, Nutsey Lane, Totton,
and burnout. People with poor social strategies Southampton, SO40 3N.
(taking work home, mixing less with friends) had
higher stress and burnout levels. All these re-
sponses can increase adverse consequences domes-
tically and in turn lead to reduction of social
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Copyright # 2007 John Wiley & Sons, Ltd. Psycho-Oncology 17: 570–576 (2008)
DOI: 10.1002/pon
576 A. Sharma et al.
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Copyright # 2007 John Wiley & Sons, Ltd. Psycho-Oncology 17: 570–576 (2008)
DOI: 10.1002/pon