How Vascular Surgeons Can Address High Rates of Burnout

Dr. Kristen Fuller loved her patients, took pride in her work and found joy in helping people.

“But it was all overshadowed by the dark side of the ‘business of medicine,’” she wrote. “It turns out that I’m not alone in these feelings…arguments with insurance companies, lack of physician autonomy, treading through the bureaucratic red tape of medicine, hostile and angry patients, lack of support from hospital administration, and not being able to practice the art of bedside medicine all have made us unable to function.”

That’s burnout, and it’s endemic in healthcare. Physician burnout has been linked to medical errors, decreased patient satisfaction, and decreased career longevity. And vascular surgery is not immune.

Compared with 13 other surgical specialties, vascular surgeons reported the second highest rate of burnout (44.1%), lower mental quality of life and lowest level of career satisfaction. Vascular surgeons were the most likely (36%) to suggest they “would not become a surgeon again” in comparison with general surgeons (32%), orthopedic surgeons (20%), and pediatric surgeons (15.6%).

The most recent projections by the U.S. Department of Health and Human Services indicates that there will be a 520 full-time equivalent deficit of vascular surgeons by 2025. And vascular surgeons are in increasing demand. One Level I trauma center saw a 529% increase in vascular surgery consultations between 2002 and 2017.

Given the increasing prevalence of cardiovascular disease, do we have enough vascular surgeons and how might burnout affect the supply?

Survey Shows High Vascular Surgeon Burnout Even Before COVID-19

In 2018, the Society for Vascular Surgery’s Wellness Taskforce surveyed its 2,905 active members and received responses from 889 members. The responses were analyzed for symptoms emotional exhaustion (EE) and depersonalization (DP) as dimensions of burnout on the Maslach Burnout Inventory. Surgeons with a high score on the DP and/or EE Maslach subscales were considered to have at least one manifestation of professional burnout.

The results, published in 2021, showed that:

• • 41% of respondents had at least one symptom of job burnout
  • 37% had symptoms of depression in the past month
  • 8% said they had considered suicide in the last 12 months

In a typical week, those with high EE/DP scores:

• • Worked more hours
  • Covered more night calls
  • Spent more time after hours on the electronic medical record
  • Spent more time after hours on administrative and scholarly work

Notably, 59.3% of members reported experiencing a conflict between work and personal responsibilities in the past 3 weeks. Surgeons who displayed traits of burnout were more likely to resolve the conflict in favor of work, while those who didn’t display burnout symptoms were more likely to resolve conflict to meet both work and personal responsibilities.

How to Combat Burnout

Dr. Gilbert Upchurch, Jr. is a vascular surgeon who suggests that the specialty should offer resilience training to improve “grit” (unyielding courage in the face of hardship or danger). In the UK, researchers found that attending surgeons had higher grit scores, lower burnout scores, lower disengagement and less exhaustion compared with trainees.

So what’s the solution to combatting job burnout and keeping needed vascular surgeons in practice, while also helping them find joy in both their work and personal life?

Here are some suggestions:

• • Surgical coaching. One study found less emotional exhaustion and overall burnout, coupled with improved quality of life and resilience, through surgical coaching— a 1-hour professional coaching session followed by five 30-minute sessions.
  • Dr. Margo Shoup, a general surgeon and president of the Orlando Health Cancer Institute, says surgeons who take the time to engage in daily activities they find personally rewarding will bolster their resilience both at work and at home.
  • The Journal of the American Medical Association recommends the following, broken down by tactics in both the personal and professional arenas:
    • • Personal
        • • Influence happiness through personal values and choices
          • Spend time with family and friends
          • Become involved with religious or spiritual activity
          • Practice self-care (e.g. nutrition, exercise)
          • Adopt a healthy philosophical outlook
          • Have a supportive spouse or partner
      • Work
        • • Exert control over environment and workload
          • Find meaning in work and set limits
          • Have a mentor
          • Ensure adequate administrative support systems

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