S.F. Tan1, H. Siddiqui2, B. Paur2, K. Tetreault3, G. Chen3, D.M. Elfenbein1, R.J. Davidson4,5, S.B. Goldberg5,6 1University of Wisconsin School of Medicine and Public Health, Department Of Surgery, Madison, WI, USA 2University of Wisconsin School of Medicine and Public Health, Madison, WI, USA 3University of Wisconsin School of Medicine and Public Health, Department Of Biostatistics And Medical Informatics, Madison, WI, USA 4University of Wisconsin-Madison, Department Of Psychiatry, Madison, WI, USA 5University of Wisconsin-Madison, The Center For Healthy Minds, Madison, WI, USA 6University of Wisconsin-Madison, Department Of Counselling Psychology, Madison, WI, USA
Introduction:
Burnout is prevalent among residents, especially in surgery and frontline specialties. Identifying factors that contribute to or mitigate burnout is crucial for effective interventions. The impact of work hours on burnout and well-being remains unclear, particularly post-pandemic, with no nationwide studies across specialties. We hypothesized that higher levels of meaning and purpose would moderate the relationship between work hours and burnout.
Methods:
A nationwide cross-sectional survey was conducted as part of a randomized clinical trial evaluating a mental skills training intervention among residents in high-burnout specialties (surgery, obstetrics and gynecology, family medicine, internal medicine, and emergency medicine). The survey assessed burnout and well-being outcomes. Differences across specialties were analyzed using chi-square and ANOVA. Ordinal logistic regression examined the associations between work hours, burnout, and well-being, controlling for demographic variables, with model selection based on the Akaike information criterion (AIC).
Results:
A total of 512 residents responded, with 242 (47%) in a surgical specialty. Surgical residents had significantly higher burnout in the depersonalization scale with 76% reporting moderate or high burnout compared to 66% in non-surgical residents (p<0.001). Despite working longer hours (p<0.001), surgical residents did not show significant differences in perceived stress, emotional exhaustion, flourishing, or sleep disturbance and had higher resilience (p<0.001) compared to non-surgical residents. Longer work hours was associated with perceived stress when controlling for sex, specialty, post-graduate level, relationship status, and geographic location (p<0.05). However, there was no association between average work hours and burnout in depersonalization and emotional exhaustion. Furthermore, longer average work hours were associated with less burnout in the personal accomplishment scale (p<0.01). Mindfulness was the only study variable that significantly moderated the relationship between work hours and burnout (p < 0.01).
Conclusion:
This study reveals higher burnout, especially in depersonalization, among surgical residents compared to non-surgical peers. Despite longer hours, surgical residents showed greater resilience, with no significant differences in other well-being measures. Notably, longer work hours were associated with reduced burnout in personal accomplishment, indicating that work hours alone do not explain burnout levels. These results highlight the complexity of factors contributing to burnout and well-being and challenge the notion that further restriction of work hours is a solution to burnout in residents. Future interventions could address factors such as mindfulness to better support resident well-being. Limitations include the self-report bias and the selection bias of the study population, which may affect generalizability.