19.04 Gender Differences in Burnout during Surgical Training: A Multi-Institutional Survey.

L. C. Elmore1, D. B. Jeffe2, L. Jin1, M. M. Awad1, I. R. Turnbull1 1Washington University School Of Medicine,Department Of Surgery,Saint Louis, MO, USA 2Washington University School Of Medicine,Division Of Health Behavior Research, Department Of Medicine,Saint Louis, MO, USA

Introduction: Burnout has been shown to have deleterious effects on career satisfaction, the quality of healthcare delivery, individual productivity, personal health and interpersonal relationships. Previous studies report high rates of burnout amongst all-comers to medical residency and surgical subspecialties, but there is limited data on burnout in general surgery trainees and systematic differences based on gender in this group. We report results of a survey of residents, examining the effect of gender on burnout during general surgery training.

Methods: Following IRB approval, from April-December, 2014, we asked program directors of all ACGME-accredited general surgery programs to email their general surgery residents inviting them to complete an anonymous, online survey. We measured demographics and program characteristics. Burnout was assessed with Maslach’s Burnout Inventory (MBI); we calculated scores for Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA). Higher scores on EE and DP and lower scores on PA indicate greater burnout. Chi-square tests were used to analyze categorical data. Analysis of covariance (ANCOVA) was used to measure differences by gender, personal relationship status, and career plans, adjusting for confounders, including number of children, age, and work hours; two-tailed p-values <0.05 were considered significant.

Results: Of 753 respondents, 588 residents engaged in clinical training had complete data for analysis. The average age of the study sample was 30 years old; 56% of respondents were male and 44% were female. Overall, 67% of residents reported being burned out, scoring in the highest tertile of EE or DP, or in the lowest tertile of PA (based on data from Maslach’s normative sample). Women were significantly more likely than men to report burnout as defined above (73.4% vs. 63.2%, p<0.05). A greater proportion of women than men scored in the highest tertile of EE (66.8% vs. 48.9%) and lowest tertile of PA (51.7% vs. 39.8%, each p<0.05). Women also were more likely to have considered dropping out of residency (51.9% vs. 37.2%, p<0.001). ANCOVA demonstrated a significant interaction between gender and relationship status for EE and DP (each p<0.05). Men who were married or in a committed relationship reported lower levels of EE and DP compared to single men, while women who were married or in a committed relationship reported higher levels of EE and DP compared to single women.

Conclusion: General surgery residents reported high levels of burnout irrespective of gender and women are more burned out than men. While relationships were protective in men, they appeared to exacerbate burnout in women. The observed gender differences in burnout and the gender-by-relationship status interaction suggest that a catch-all approach to interventions to mitigate burnout may be insufficient and efforts may need to account for specific challenges that differ by gender.