Burnout in Military Orthopedic Surgeons: A Multicenter, Cross-Sectional Study

Abstract

Background: High rates of burnout are prevalent in U.S. physicians with evidence that the rates are increasing. Military orthopedic surgeons experience unique circumstances including deployments, relocations, and collateral duties that may place them at an even higher risk for burnout. The purpose of this study was to identify the prevalence and risk factors for burnout in active duty U.S. military orthopedic surgeons.

Materials and methods: We distributed a voluntary, anonymous, 64-question survey (SurveyMonkey) to the Society of Military Orthopaedic Surgeons listserv, an orthopedic specialty society that includes a large proportion of active duty, reserve, and retired military surgeons. The survey included questions about basic demographics, education and training, work environment, and military-specific variables, including number of deployments, relocations (Permanent Changes of Station), and perceived support from leadership. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used to measure burnout. The primary outcome was burnout, defined as high emotional exhaustion or high depersonalization scores as measured on the MBI-HSS. Low personal accomplishment was included as a secondary outcome. A multivariate analysis was performed for each primary domain of the MBS-HSS to determine risk factors for burnout.

Results: A total of 191 active duty orthopedic surgeons (138 attendings and 53 residents) completed a survey. Males comprised 82% of respondents while 18% were female. Of all the respondents, 33% (63/191) met criteria for burnout. Military residents reported higher rates of burnout than attending physicians (49% vs. 26%, respectively, P = .002). Age, gender, race, relationship status, military branch, and level of training were not independently associated with burnout. Analysis of the diagnostic domains of burnout showed that a longer remaining active duty service obligation (P = .007) and a rank O5 or higher (P = .04) were associated with high emotional exhaustion. Support of colleagues and leadership (P = .01), a manageable workload (P < .001), and attending a service academy (P = .03) were protective. Residents had higher depersonalization scores than attendings (P < .001). A manageable workload (P < .001), a general practice (no fellowship training) (P = .01), and the rank of O4 (P = .006) were protective against depersonalization. However, being a generalist was associated with low personal achievement scores (P = .04) while fellowship training was protective (P = .05). Only 50% of attendings and 70% of residents indicated that they would join the military again, while 93% of attendings and 86% of residents would choose to enter orthopedics again.

Conclusions: Despite several specific additional stressors, the prevalence of burnout in military orthpaedic surgeons is similar to previously reported rates in all orthopedic surgeons. Military-specific challenges such as deployments and relocations unique to military orthopedic surgeons were not associated with increased burnout.