Global disparities in surgeons' workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

Abstract

The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS^® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI.

Keywords: Global research; Human Development Index; On-call; Surgeon’s well-being; Surgeon’s workload.

Fig. 1

Global distribution of survey respondents by Human Development Index (HDI) categories. This map illustrates the geographic dispersion of participants in our survey, categorized by the HDI of their respective countries. Areas are color-coded to represent different levels of development: very high (dark green), high (light green), medium (orange), low (red), and regions with no data (grey)

Fig. 2

Distribution of clinical and academic responsibilities across continents (Consultant/Professor Left, Trainee Right). This heatmap illustrates the comparison of clinical and academic tasks undertaken by medical trainees and consultants across five continents. Color intensity correlates with the frequency of each activity, ranging from private practice to on-call duties, with darker shades indicating higher prevalence

Fig. 3

Distribution of clinical and academic responsibilities by Human Development Index (HDI) (Consultant/Professor Left, Trainee Right). This heatmap displays the variance in clinical and academic responsibilities among medical trainees and consultants/professors across countries with different HDI levels. Color intensity correlates with the frequency of each activity, ranging from private practice to on-call duties, with darker shades indicating higher prevalence

Fig. 4

Professional activity profiles by continent and role. This radar chart compares the distribution of clinical and academic tasks among medical trainees and consultants/professors across four different continents: Europe, North America, South America, and Asia. Each colored shape represents the composite profile for trainees (blue) and consultants/professors (red) within each continent, across activities like teaching, research activities, private practice and clinical duties. The extent of each axis reflects the level of engagement in the corresponding activity

Fig. 5

Independent predictors of a day-off following on-call duties—Multivariable Analysis. General population of responders (A); Subgroup analysis of responders who perform > 12 h on-calls (B)