Education and Career DevelopmentSurgical Resident Burnout and Job Satisfaction: The Role of Workplace Climate and Perceived Support
Introduction
Healthcare systems and national medical education groups are expanding their focus from the Triple Aim to the Quadruple Aim in the United States,1 adding provider well-being as a core component to improving patient care. Despite this increased attention, research on surgical resident well-being is often limited to coping strategies or attempts to increase provider resilience, which limits interventions to address the symptoms—not the cause—of poor work environments. However, organizational science may offer a complementary perspective on provider well-being by introducing empirical evidence on how the clinical learning environment may affect surgical residents' well-being.
Systematic review finds that surgical residents report a lower quality of life and are at a greater risk for burnout compared to attending physicians.2 A 2016 national study of U.S. general surgery residents indicated that 69% of respondents met the criteria for burnout on at least one of the three subscales, and nearly half of respondents desired to drop out of training and reported, in retrospect, they would not choose a career in general surgery.3 Despite these troubling findings, on aggregate, surgical resident job satisfaction has been found to correlate positively with several workplace climate factors such as effective ancillary staff/services, empathetic nursing, and attending engagement in teaching, appreciation, and openness to suggestions.4 Such findings suggest that antecedents to burnout and job satisfaction may include organizational factors including the provision of resources and support to meet the external demands of the environment.
The Job Demands-Resources Model offers one perspective to understand organizational factors that affect well-being. Job Demands-Resources Model research suggests job demands, such as workload, time pressures, and physical environment, are associated with exhaustion, while resources (e.g., feedback, rewards, autonomy, meaningful participation, and leadership support) are associated with engagement.5 To prevent strain on an individual, organizations provide resources to mitigate the demands created by the environment to maintain organizational commitment and member well-being.6 Individuals tend to personify organizations so actions of organizational agents (e.g., leadership) are interpreted to be actions of the organization.7 As a result, individuals develop affective relationships based on perceptions whether their organization cares for, supports, and appreciates its members.8 Members desire to reciprocate feelings of support back to the organization based on positive affective relationships, leading to increased organizational commitment, better individual performance, and higher job satisfaction.9
Our study tested a mediation model to understand how workplace climate positively predicts job satisfaction directly and indirectly through perceived organizational support and burnout for general surgery trainees (Fig. 1). Such relationships have often been studied and supported in nonhealthcare settings, but research with resident populations is limited.
Section snippets
Materials and methods
Residency program directors (n = 344) from general surgery, neurosurgery, otolaryngology, plastics and reconstructive surgery, orthopedic surgery, and urology across the South Atlantic, Mid-Atlantic, and East South Central regions were asked via email to provide 15 minutes during a resident-specific meeting to distribute paper surveys or forward an electronic Qualtrics survey link (Qualtrics, Provo, UT) onto all current residents. Recruitment for our institutional review board–approved study
Results
One hundred sixty general surgery residents (out of 557; 29% response rate) across 19 general surgery residency programs completed our survey. Response rates by program ranged from 4% to 79%; the nine programs that allowed paper survey data collection had higher program response rates compared to programs that participated through the electronic survey method. An independent samples t-test found no statistical difference between responses collected through paper and electronic format. The
Discussion
Our results suggest that features of workplace climate—autonomy, workload, and collegiality—affect job satisfaction for surgical trainees. Furthermore, this relation exists through perceptions of organizational support and subsequent burnout. Because environmental demands for surgical residents continue to cause strain, it is the duty of residency programs to mitigate negative outcomes such as burnout. One potential solution would be to provide further support and resources, as well as build
Conclusions
Through the Quadruple Aim, there is hope for increased effort to improve the clinical learning environment. With the emergent concern surrounding provider well-being, the institutions of medicine require workplace innovation to address the concerns of a modern provider workforce by building positive and reciprocal relationships between provider and organization. Initiatives increasing perceptions of organizational support may be one area of focus to sustain the resident wellness needed in
Acknowledgment
The authors extend their appreciation to the program directors, program coordinators, and surgical residents who engaged in their research study, and to the researchers who developed the survey instruments used in their study.
Authors' contributions: N.P.A. contributed to study design, data collection, data management, analysis, interpretation, and article development. N.L. contributed to study design, data collection, analysis, interpretation, and article development. M.A., K.D., and B.K.
References (32)
- et al.
National survey of burnout among US general surgery residents
J Am Coll Surg
(2016) - et al.
Surgery resident working conditions and job satisfaction
Surgery
(2008) - et al.
The causal links between stress and burnout in a longitudinal study of UK doctors
Lancet
(2002) - et al.
Improving resident well-being and clinical learning environment through academic initiatives
J Surg Res
(2017) Interventions to improve physicians’ well-being and patient care
Soc Sci Med
(2001)- et al.
From triple to quadruple aim: care of the patient requires care of the provider
Ann Fam Med
(2014) - et al.
Quality of life and burnout rates across surgical specialties: a systematic review
JAMA Surg
(2016) - et al.
Job demands, job resources, and their relationship with burnout and engagement: a multi-sample study
J Organ Behav
(2004) - et al.
The job demands-resources model: a three-year cross-lagged study of burnout, depression, commitment, and work engagement
Work Stress
(2008) Reciprocation: the relationship between man and organization
Adm Sci Q
(1965)