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Special Article
April 20, 2009

Stress and Burnout Among Surgeons: Understanding and Managing the Syndrome and Avoiding the Adverse Consequences

Author Affiliations

Author Affiliations: Department of Surgery, Johns Hopkins Medical Institution, Baltimore, Maryland (Drs Balch and Freischlag); and Department of Medicine, Mayo Clinic, Rochester, Minnesota (Dr Shanafelt).

Arch Surg. 2009;144(4):371-376. doi:10.1001/archsurg.2008.575

Training for and practicing surgery are stressful endeavors.1-4 Studies5-11 involving national samples of surgeons from surgical subspecialty societies and graduates of surgical training programs suggest that burnout rates among surgeons range from 30% to 38%. These statistics indicate that a substantial number of our colleagues are struggling with personal and professional distress at a level that should be of concern to all surgeons.

Surgeons work hard, work long hours, deal regularly with life-and-death situations with their patients, and make substantial personal sacrifices to practice in their field. These attributes of surgical practice, along with the rigors and length of training for this profession, attract individuals of a particular character and determination. These individuals share an unwritten but understood code of rules, norms, and expectations. This code includes coming in early and staying late, working nights and weekends, performing a high volume of procedures, meeting multiple simultaneous deadlines, never complaining, and keeping emotions or personal problems from interfering with work. These are hallmarks of dedicated professionals that should be celebrated and rewarded. However, there is a fine line separating dedication from overwork; if unchecked, overwork could lead to counterproductive, unhealthy, or even self-destructive behavior that may affect patient care. Studies5-11 show that a substantial proportion of surgeons experience distress or burnout, conditions that can have negative repercussions for themselves, their families, their colleagues, and their patients.