|Year : 2020 | Volume
| Issue : 5 | Page : 2442-2447
Burnout syndrome among southern region orthopedic surgeons, Saudi Arabia
Mohammed Lafi Shaher Al-Otaibi1, Sultan Abdulrahman Alyali2, Turki Khalid Alshehri2, Abdullah Khalid Alshehri2, Abdulrahman Abdulelah Alshahrani2, Abdualaziz Ghazi Banah2, Rishi K Bharti3
1 Department of Surgery, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
2 College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
3 Family and Community Medicine Department, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
|Date of Submission||25-Jan-2020|
|Date of Decision||13-Mar-2020|
|Date of Acceptance||07-Apr-2020|
|Date of Web Publication||31-May-2020|
Dr. Mohammed Lafi Shaher Al-Otaibi
Department of Surgery, College of Medicine, King Khalid University, P.O. Box 641, Abha
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Background: Burnout is known as result of long term exposing to stress. There are some factors that may cause stress in physicians: nature of work, their training, their public image, their families and themselves. The person who has burnout syndrome (BOS) seems like to have tiredness, low energy, nervousness, and mentally unstable. The aim of the study is to assess the pattern and magnitude of burnout among orthopedic surgeons in southern region, Saudi Arabia. Methodology: A descriptive cross-sectional survey was applied targeting all orthopedic surgeons in 12 hospitals all southern region, Saudi Arabia during the period from December 2018 to April 2019. Data were collected using self-administered questionnaire that was developed by the researchers. The questionnaire included personal data. Burnout was assessed using Maslach Burnout Inventory Scale. Results: A total sample of 107 orthopedic surgeons were included with their ages ranged from 25 to 65 years old with mean age of 38.1 ± 8.9 years. About 94% of the surgeons were males and 43.9% were Saudi. Generally, the surgeons recorded mean score for emotional exhaustion of 18.9 points out of 54 with mean score% of 35.1%. Regarding depersonalization, the surgeons had mean score % of 30.7% and had a score of 39.6% for personal accomplishment. Conclusions: The study revealed that all included physicians had moderate levels of burnout. Personal accomplishment was the highest level of burnout recorded. Health education sessions and periodic training is required to improve surgeons coping strategies to overcome burnout.
Keywords: Burnout, burnout scale, occupations stress, self-destruction, surgeons, work stress
|How to cite this article:|
Shaher Al-Otaibi ML, Alyali SA, Alshehri TK, Alshehri AK, Alshahrani AA, Banah AG, Bharti RK. Burnout syndrome among southern region orthopedic surgeons, Saudi Arabia. J Family Med Prim Care 2020;9:2442-7
|How to cite this URL:|
Shaher Al-Otaibi ML, Alyali SA, Alshehri TK, Alshehri AK, Alshahrani AA, Banah AG, Bharti RK. Burnout syndrome among southern region orthopedic surgeons, Saudi Arabia. J Family Med Prim Care [serial online] 2020 [cited 2020 Sep 23];9:2442-7. Available from: http://www.jfmpc.com/text.asp?2020/9/5/2442/285074
| Background|| |
Health-related behavior in early life influences later risks for lifestyle-related disorders. It is therefore important to investigate health behaviors among young people. University students represent a major segment of the young adult population.
Occupational burnout is thought to result from long-term, unresolvable, job stress. In 1974, Herbert Freudenberg became the first researcher to publish in a psychology-related journal, a paper that used the term burnout. The paper was based on his observations of the volunteer staff (including himself) at a free clinic for drug addicts: burnout by a set of symptoms that includes exhaustion resulting from work's excessive demands as well as physical symptoms such as headaches and sleeplessness, “quickness to anger,” and closed thinking., It has been defined by Maslach and Jackson as “a syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment that can occur among individuals who do ‘people work’ of some kind.”
Burnout is known as result of long term exposing to stress. Its more likely to be common in medical care workers. There are some factors that may cause stress in physicians: nature of work, their training, their public image, their families and themselves. The person who has burnout syndrome (BOS) seems like to have tiredness, low energy, nervousness, and mentally unstable. BOS is associated with: medical errors, dissatisfaction of job, low productivity, and discomfort ability of medical staff working with this person. Particularly, surgeons are frequently overworked with the demands of taking care of patients with fewer organizational resources. Burnout may include sleep troubles, moodiness, marital distress, alcohol and smoking abuse, tiredness, and also cardiovascular problems. Burnout gradually expands overtime and it is hard to be cured. Increase susceptibility of burnout with long hours of working and difficulties in balancing between home and work. Lack of quality in medical facilities and low income have important rule as well. Workshops were established to decrease burnout at organizational and individual levels but it gave unclear results. Prevention and treatment of burnout is a hard issue that faces the medical community. In US, the prevalence of burnout and satisfaction with work-life balance among physicians increased between 2011 and 2014.
In this study, authors aimed to assess the exact prevalence of BOS among orthopedic surgeons in southern region of Saudi Arabia, which is known of its difficult landscape and high incidence of road traffic accidents and lack of resources equivalent to other region in Kingdom of Saudi Arabia among Southern Region Orthopedic Surgeons.
| Methodology|| |
A descriptive cross-sectional survey was applied targeting all orthopedic surgeons in 12 hospitals all southern region, Saudi Arabia during the period from December 2018 to April 2019. All accessible orthopedic surgeons in the included hospitals were invited to participate in the survey after explaining the target and having oral consent. Data were collected using self-administered questionnaire that was developed by the researchers. The questionnaire included personal data for surgeons like their ages, gender, residence region, work data, and personal habits. Burnout was assessed using Maslach Burnout Inventory Scale. The scale consists of 22 items pertaining to occupational burnout. The nine-item emotional exhaustion (EE) scale measures feelings of being emotionally overextended and exhausted at one's work. Higher scores correspond to greater experienced burnout. The five-item depersonalization (DP) scale measures an unfeeling and impersonal response toward recipients of one's service, care, treatment, or instruction. Higher scores correspond to greater degrees of experienced burnout. The eight-item personal accomplishment (PA) scale measures feelings of competence and successful achievement in one's work with people. Lower scores correspond to greater experienced burnout.
The Research Ethics Committee of College of Medicine, King Khalid University, Abha, Saudi Arabia approved this research activity on October 23, 2018 (REC#2018-05-36.
After data were collected it was revised, coded, and fed to statistical software IBM SPSS version 20. All statistical analysis was done using two tailed tests and alpha error of 0.05. P value less than or equal to 0.05 was considered to be statistically significant. The discrete scores for each type of burn out were summed together to have the overall for each domain. Frequency and percent were used to describe the frequency distribution of each category for surgeons’ data while mean with standard deviation described burnout type's scores. Cross tables were used to describe burnout distribution according to surgeons’ personal data.
| Results|| |
A total sample of 107 orthopedic surgeons were included with their ages ranged from 25 to 65 years old with mean age of 38.1 ± 8.9 years. About 94% of the surgeons were males and 43.9% were Saudi. Exact 41.1% of the surgeons had experience years up to 5 years and 33.6% were of experience exceeded 10 years. Residents constituted 34.6% of the surgeons while 31.8% were consultants. Regarding children they had, 60.5% had more than three children. Smoking was recorded among 24.3% of the surgeons while 69.2% were nonsmokers and only three surgeons use alcoholic beverages [Table 1].
|Table 1: Personal data of Southern Region Orthopedic Surgeons, Saudi Arabia|
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As for burnout, [Table 2] demonstrates burnout details among surgeons. Considering emotional exhaustion, 73.8% of the surgeons felt emotionally drained from work, 88.8% felt that they were used up at the end of the workday. Frustration from job was recorded by some degree among 87.6% of the surgeons and 79.4% of them felt fatigued when they get up in the morning and have to face another day on the job. Considering depersonalization, 82.2% of the surgeons felt they were burned out from their work and 79.4% of them felt exhilarated after working closely with patients. Patient blame for some services was recorded by 84.1% of the surgeons while 91.1% can deal very effectively with the problems of patients. With regard to personal accomplishment, 93.3% of surgeons feel that they perform very hard job and 69.2% of the surgeons recorded that working with people all day is really a strain for them. About 61% of the surgeons feel like they are at the end of their rope and 48.6% of them treat some patients as if they were impersonal objects. Generally, the surgeons recorded mean score for emotional exhaustion of 18.9 points out of 54 with mean score% of 35.1% which is moderate value. Regarding depersonalization, the surgeons had mean score % of 30.7% (9.2 out of 21 points) which is also considered moderate level and had a score of 39.6% for personal accomplishment (19.1 out of 48 points) [Table 3].
|Table 2: Burnout among Southern Region Orthopedic Surgeons, Saudi Arabia|
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|Table 3: Overall burnout among Southern Region Orthopedic Surgeons, Saudi Arabia|
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Finally, on relating burnout level with surgeons’ characteristics [Table 4], it was clear that there were discrepancy among surgeons according to their job title as residents had mean score of 21.6 for emotional exhaustion compared to 16.1 for consultants. Also residents had mean score for depersonalization of 10.3 compared to 8.4 for consultant and mean score for personal accomplishment of 20.6 compared to 18.5 for consultants. Also experience years were considerable determinate for burnout as those who had experience for less than 5 years recorded higher burnout scores than those who had long experience years of 10 years or more (20.7 vs. 15.6, 9.5 vs. 7.9 for EE and DP, respectively). EE was higher among divorced surgeons than single (28 and 19.8 points, respectively). Surgeons who use alcoholic beverages recorded mean score of 23 points for EE compared to 18.7 for those who did not and had mean score of 13.7 for DP compared to 9.1 for others who did not. Also they had mean score of 20.3 for PA compared to 19 pints for those who did not.
|Table 4: Distribution of different burnout scores according to orthopedics personal data, Saudi Arabia|
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| Discussion|| |
Recently the medical field in general, and specially surgery, is faced with a problem that is severely affecting both trainees and practicing physicians. Surgeons work and training are stressful endeavors. Surgeons’ duties are hard and for long duration. They deal regularly with life-and-death situations daily, and make substantial personal sacrifices to as their job description. These circumstances of surgical field, besides 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.,,,
The current study aimed to assess the magnitude of burnout among orthopedic surgeons in southern region of Saudi Arabia which is a very big and wide region serving millions of Saudi population. Also the researchers aimed to identify the pattern of burnout recorded among surveyed surgeons. The current study included all grades of surgeons as residents with the highest work load due to on-call duties in ER with specialists and consultants.
The study revealed that about one-third of the surveyed physicians had burnout and personal accomplishment was the highest followed with emotional exhaustion and depersonalization. These findings give an indicator regarding the area of burnout which is mainly focused in coping to deal with patients and emotional well-being of the surveyed staff. More than two-thirds of the physicians can deal very effectively with the problems of my patients and can easily understand how patients feel about things which on the expense of their psychological tolerance making them usually under stress. Also more than half of the physicians feel working too hard in their job which another stress area is ending with high burnout to fulfill patients’ expectations. On asking directly about burnout, about 19% of the physicians recorded they were burned out daily and 17% deal hardly with their patients. Regarding frustration from job, one-third of the physicians recorded high rate of frustration and one quarter feel that that this job is hardening them emotionally.
Positive findings were that more than two-thirds of the physicians can deal very effectively with the problems of their patients. Also more than 60% of the surgeons recorded their ability to positively influencing other people's lives through work. Also about half of the sampled surgeons recorded that they accomplished many worthwhile things in this job. Burnout was recorded higher among female residents of Saudi nationality and low experience. Also smokers were more burned out than others and also those who use alcoholic beverages.
These findings were concordant with studies involving samples of surgeons from surgical subspecialties and graduates of surgical training programs which recorded that burnout rates among surgeons range from 30% to 38%. These findings revealed that a substantial number of colleagues are struggling with personal and professional distress at a level that should be of concern to all surgeons.,, Another study was done by Hamdan et al. 2017 on Palestinian health care workers in emergency department. The study revealed that high levels of burnout among EDs workers; 64.0% suffered from high emotional exhaustion, 38.1% from high depersonalization, and 34.6% from low personal accomplishment. In addition, high levels of emotional exhaustion (72.3%). In Saudi Arabia, Alwaleed Alyamani et al. 2018 conducted a study to assess burnout among medical and surgical residents at King Abdulaziz Medical City. The study findings were total 51% of the participants showed high depersonalization, 31.50% exhibited low personal achievements, and 12.50% with high emotional exhaustion.
The recorded considerable level of burnout among the study surgeons is flag sign for further problems and errors. Efforts to identify at-risk population were warranted and interventions to prevent burnout like counseling and social skills training were encouraged.
| Conclusions and Recommendations|| |
In conclusion, the study revealed that all included physicians had moderate levels of different types of burnout especially residents, young aged surgeons, females, and divorced staff. Personal accomplishment was the highest level of burnout recorded followed with emotional exhaustion which is more related to physicians’ mental wellbeing. Health education sessions and periodic training is required to improve surgeons coping strategies to overcome burnout and reduce its destructive consequences.
The research was approved by the Ethics and Research Committee of the College of Medicine of King Khalid University.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Freudenberger, HJ. Staff burnout. J Soc Issues 1974;30:159-65.
Ruotsalainen JH, Verbeek JH, Mariné A, Serra, C. Preventing occupational stress in healthcare workers. Cochrane Database Syst Rev 2015:CD002892. doi: 10.1002/14651858.CD002892.pub5.
Arora M, Asha S, Chinnappa J, Diwan AD. Review article: Burnout in emergency medicine physicians. Emerg Med Australas 2013;25:491-5.
Campbell DA, Sonnad SS, Eckhauser FE, Campbell KK, Greenfield LJ. Burnout among American surgeons. Surgery 2001;130:696-705.
Sadat-Ali M, Al-Habdan IM, Al-Dakheel DA, Shriyan D. Are orthopedic surgeons prone to burnout? Saudi Med J 2005;26:1180-2.
Christie-Seely J. Marriage and medicine: The physician as partner, parent, and person. Can Fam Physician 1986;32:360-8.
Saleh KJ, Quick JC, Conaway M, Sime WE, Martin W, Einhorn TAM. The prevalence and severity of burnout among academic orthopaedic departmental leaders. J Bone Joint Surg Am 2007;89:896-903.
McCray LW, Cronholm PF, Bogner HR, Gallo JJ, Neill MRA. Resident physician burnout: Is there hope? Fam Med 2008;40:626-32.
American Medical Association. JAMA. American Medical Association; 1960 [cited 2018 May 18].
Dimou FM, Eckelbarger D, Riall TS. Surgeon burnout: A systematic review. J Am Coll Surg 2016;222:1230-9.
Coker AO, Adewole OA, Shoga MO, Uzodimma CC. Burnout syndrome among orthopaedic surgeons in Lagos, Nigeria. East Cent Afr J Surg 2018;17.
Daniels AH, DePasse JM, Kamal RN. Orthopaedic surgeon burnout. J Am Acad Orthop Surg 2016;24:213-9.
Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, et al
. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc 2015;90:1600-13.
Harms BA, Heise CP, Gould JC, Starling JR. A 25-year single institution analysis of health, practice, and fate of general surgeons. Ann Surg 2005;242:520-9.
Kuerer HM, Eberlein TJ, Pollock RE, Huschka M, Baile WF, Morrow M, et al
. Career satisfaction, practice patterns and burnout among surgical oncologists: Report on the quality of life of members of the society of surgical oncology. Ann Surg Oncol 2007;14:3043-53.
Dyrbye LN, Shanafelt TD. Protecting and promoting the well-being of surgeons. Timbros J Timbros-Kemper TCM basics of surgery. Maarssen, Germany Elsevier Gezondheidzorg; 2007. p. 177-84.
Green A, Duthie HL, Young HL, Peters TJ. Stress in surgeons. Br J Surg 1990;77:1154-8.
Kent GGJohnson AG. Conflicting demands in surgical practice. Ann R Coll Surg Engl 1995;77(Suppl):235-8.
Sharma A1 Sharp DM, Walker LG, Monson JR. Stress and burnout in colorectal and vascular surgical consultants working in the UK national health service. Psychooncology 2008;17:570-6.
Hamdan M. Burnout among workers in emergency departments in Palestinian hospitals: Prevalence and associated factors. BMC Health Ser Res 2017;17:407.
Alyamani A, Alyamani L, Altheneyan F, Aldhali S, Albaker K, Alshaalan A, et al
. Prevalence of burnout among residents at King Abdulaziz Medical City in Riyadh, Saudi Arabia. Int J Med Res Health Sci 2018;7:37-40.
[Table 1], [Table 2], [Table 3], [Table 4]