Monday, September 12, 2016

Surgeons are burned out in, of all places, France

More than half of French gastrointestinal surgeons in training are burned out says a paper published ahead of print in the American Journal of Surgery.

Five hundred gastrointestinal surgery trainees were surveyed, and 65.6% responded. Of those responding, 52% had indications of burnout syndrome—emotional exhaustion, depersonalization of relationships, and lack of self-fulfillment at work—on the well-validated Maslach Burnout Inventory.

Other notable findings were 67% had insomnia, and 12% had thoughts of suicide.

On multivariate analysis, the significant factors associated with burnout syndrome included being confronted with aggression from patients, lack of gratitude from senior colleagues, trainees feeling they had too much responsibility, and not participating in extracurricular activities.

The average age of the responding trainees was 29.5 years old, and women comprised 42.5%. A surprising 39% of those responding were smokers, but only 7.6% took anxiolytics, and 6.9% were on antidepressants.

The European Working Time Directive [EWTD], a law enacted in 1998, established a maximum work week of 48 hours for workers in all European Union countries. Gastrointestinal surgery trainees in France admitted to working an average of 75.6 hours per week which the authors noted is 1.6 times the legal limit.

A 2014 paper published in BMC Medical Education looked at resident duty hours in Europe, Australia, and North America. The author felt that Sweden and Germany were complying well with the EWTD but wrote "There is anecdotal evidence that many doctors in Spain, Ireland, Greece, and France are working more than the regulation 48-hour week, often without additional pay."

Two years ago I blogged about an email exchange I had with a Swedish surgical resident who said his country was noncompliant with work hours restrictions. I have heard similar comments from trainees in the United Kingdom's National Health Service.

Concerning France, we can now say the evidence is no longer anecdotal.

It takes 13 years to become a gastrointestinal surgeon in France—6 years of medical school (starting immediately after high school), 5 years of residency in digestive surgery, and 2 years as a fellow.

The authors wrote, "This training is notoriously difficult and medical students choose this path less and less often leading to a veritable demographic crisis for the specialty in France."

They recommended "implementation of prevention strategies and screening for burnout syndrome, a better organization of work and training, and rewarding of [trainees'] status." Other than screening for burnout, their plan seems a bit vague.

A 2009 survey of more than 7900 US attending surgeons found 40% were burned out, and only 36% thought they had enough time for personal/family life.

Its authors concluded "Additional research is needed to identify individual, organizational, and societal interventions that preserve and promote the mental health of American surgeons." After seven years, those interventions have not been identified.

I hate papers that end with "Additional research is needed...”


Anonymous said...

What's funny is that as a surgical resident in the USA I dream of weeks with only a 76 hour week. I've been lying on the Surveys since day 1 (I report my program and it loses accreditation and then what do I have to show for it but I digress) I think a lot of what contributes to burnout is expectations

artiger said...

Go back 20 or 30 years ago, or more...a 76 hour work week was called a vacation.

Skeptical Scalpel said...

Anon, I agree. Four years ago, I said that a 4 or 6 week rotation on surgery in med school does not adequately prepare students for a surgery residency. That's especially true if the students are coddled. See

Artiger, 76 hours would have sounded OK to me too.

William Reichert said...

An intervention that I discovered to counter burn out is called
retirement. It is remarkably effective. The need for further research on this topic is no longer needed. Let's get the word out .

Skeptical Scalpel said...

William, good observation. Retirement worked for me too.

artiger said...

Scalpel, Reichert, don't rub it in.

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