U.S. Attending Anesthesiologist Burnout in the Postpandemic Era
Anesthesiologists are experiencing unprecedented levels of workplace stress and staffing shortages. This analysis aims to assess how U.S. attending anesthesiologist burnout changed since the onset of the COVID-19 pandemic and target well-being efforts.
Burnout is an occupational phenomenon pervasive in medicine characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment.1–4 The presence of burnout in physicians has detrimental effects on physician health and quality of life, provided quality of care, and the number of medical errors.5–8 Addressing burnout is both a healthcare worker and patient safety issue.
Burnout was endemic in anesthesiology even before the COVID-19 pandemic. The first large-scale study on burnout among U.S. American Society of Anesthesiologists (ASA; Schaumburg, Illinois) member attending anesthesiologists occurred in March 2020, immediately preceding the escalation of COVID-19. The analysis found that 59.2% of respondents reported at least one symptom of burnout syndrome, while 13.8% reported all three symptoms.9 Since this initial study, the healthcare landscape has experienced a pandemic with myriad downstream effects. Throughout the pandemic, anesthesiologists were part of the front line of care for COVID-19 patients.10 These unprecedented demands on the field were instrumental in caring for patients but placed profound stressors on anesthesiologists.11,12 Evidence suggests the pandemic may have led to increased burnout prevalence in anesthesiologists as well as other mental health conditions such as posttraumatic stress disorder, anxiety, and depression.13,14
Burnout is an occupational phenomenon pervasive in medicine characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment.1–4 The presence of burnout in physicians has detrimental effects on physician health and quality of life, provided quality of care, and the number of medical errors.5–8 Addressing burnout is both a healthcare worker and patient safety issue.
Burnout is an occupational phenomenon pervasive in medicine characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment.1–4 The presence of burnout in physicians has detrimental effects on physician health and quality of life, provided quality of care, and the number of medical errors.5–8 Addressing burnout is both a healthcare worker and patient safety issue.
There was a relative shortage of U.S. attending anesthesiologists before the COVID-19 pandemic, partially due to increased demand from the aging baby boomer generation,15 which was previously associated with burnout in anesthesiologists.9 As the COVID-19 pandemic has likely worsened anesthesiologist and anesthesia team member shortages, the impact that insufficient staffing has had on the field remains unclear.
This study aimed to quantify and assess changes in U.S. ASA member attending anesthesiologist burnout since the onset of the COVID-19 pandemic, to identify risk factors associated with workplace burnout, and to identify interventions respondents perceived as most beneficial to address burnout. Our hypothesis was that the prevalence of burnout had increased since our last study conducted in March 2020.
Our team conducted a nationwide study of U.S. ASA member attending anesthesiologists. The survey was endorsed by the ASA Committee on Physician Well-Being and approved by the ASA Executive Committee before distribution. Both committees gave feedback on the study design, but neither was directly involved in the analysis, except for two authors currently serving as chair and vice chair of the ASA Committee on Physician Well-Being.
Results
Response Rate
Of the 24,680 U.S. attending anesthesiologists who received the email invitation, 2,933 (11.9%) opened the survey link and were considered to have participated. Of those who opened the link, 2,698 (92.0%) completed the survey and were included in the statistical analysis (effective 10.9% response rate). Among the sample size of n = 2,698 survey respondents, the following are the number of respondents who availed themselves of the opportunity to provide demographics data: gender identity (n = 2,543), age (n = 2,599), and identify as underrepresented on the basis of race; religion; lesbian, gay, bisexual, queer/questioning, intersex, and asexual status; or speaking English as a second language (n = 2,445).
Physician Characteristics
Participant characteristics are presented in table 1. While limited, basic information on ASA U.S. attending anesthesiologist members was provided to the authors for comparison to the study cohort. The geographic location of participants matched the ASA population closely with few differences, namely a slightly lower proportion of participants from the mid-Atlantic (difference, –2.2%; 95% CI, –3.5 to –0.9%) and West South Central (difference, –2.2%; 95% CI, –3.4 to –1.0%) geographic regions as compared to the ASA population. The median age of participants was 50 yr (interquartile range, 42 to 59 yr), compared with 48 (interquartile range, 41 to 58 yr) for the ASA population (difference, 2 yr; 95% CI, 1.4 to 2.6 yr). Of the respondents, 33.2% identified as female, compared to 29.6% of the ASA population (difference, 3.6%; 95% CI, 1.7 to 5.5%). Due to editorial and reviewer concerns regarding the question on practice environment, particularly the reporting accuracy and overlap of possible responses, we have post hoc considered this question flawed and removed its analysis from this report. The most prevalent subspecialties of practice were general (58.9%), pediatric (11.9%), and cardiothoracic (10.5%) anesthesiology. The median time since completion of training was 17 yr (interquartile range, 10 to 27 yr). Of the participants, 86.2% worked at least 40h per week, 78.4% experienced recent perceived staffing shortages, 52.2% felt little to no support in their work life, 22.9% felt little to no support in their home life, and 71.0% had caregiving responsibilities. Numerous participants identified as underrepresented based on race (10.8%), religion (4.5%), lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual status (3.5%), and English as a second language (5.5%).
Workplace-related perspectives of U.S. attending anesthesiologists are shown in table 2. Of the respondents, 37.9% (1,022 of 2,698) acknowledged that the pandemic had accelerated their retirement plans, 36.0% (970 of 2,698) were likely or very likely to leave their current position within the next 2 yr, and 24.7% (666 of 2,698) have reduced their weekly hours since the pandemic or planned to do so in the next year.
