Ryan J. Ellis, MD MS General Surgery Resident Surgical Outcomes and Quality Improvement Center (SOQIC) Northwestern Medicine 

Workplace Mistreatment During Surgical Training Linked to Physician Burnout

MedicalResearch.com Interview with:

Ryan J. Ellis, MD MS General Surgery Resident Surgical Outcomes and Quality Improvement Center (SOQIC) Northwestern Medicine 

Dr. Ellis

Ryan J. Ellis, MD MS
General Surgery Resident
Surgical Outcomes and Quality Improvement Center (SOQIC)
Northwestern Medicine 

MedicalResearch.com: What is the background for this study?

Response: Burnout has emerged as a significant problem affecting the entire healthcare workforce and it has been likely to myriad downstream problems such as increases in medical errors, alcoholism, and depression. Despite the attention on clinician burnout, there are significant gaps in our understanding of how the workplace environment may lead to burnout. Moreover, there are particular concerns about the workplace environment in training, specifically with regards to abuse, discrimination, and harassment.

We had the opportunity to survey all U.S. general surgery residents to comprehensively define the frequency of workplace mistreatment and its relationship with burnout and suicidal thoughts among surgical residents.

MedicalResearch.com: What are the main findings?

Response: This study, buoyed by a 99% survey response rate, comprehensively defines the frequency of mistreatment, burnout, and suicidal thoughts among general surgery trainees. Nearly 50% of residents report some amount of workplace mistreatment, with 19% reporting mistreatment a few times a month or more. These numbers are even higher among female residents, with more than 70% reporting abuse, discrimination, or sexual harassment and more than 30% reporting these exposures a few times per month or more. Those reporting workplace mistreatment were significantly more likely to report both burnout and suicidal thoughts. Importantly, while women had higher rates of burnout overall, they were no more likely to report burnout when adjusting for the higher rate of mistreatment they report in the workplace.

MedicalResearch.com: Doesn’t surgical life get even harder after residency?

Response: Yes and no. There is certainly a higher level of direct responsibility for patient care after residency, but many other stresses improve significantly. For example, trainees have very little control over their own time, and as this study shows are subject to a workplace environment that can be particularly challenging to manage. I would also add that this study is not meant to imply that surgical residents have it worse than practicing surgeons or physicians in other specialties. While not directly demonstrated in our research, I believe the observed association between workplace mistreatment and poor wellness likely applies across all of healthcare and should be a call to action regardless specialty or seniority.

MedicalResearch.com: What should readers take away from your report?

Response: This study both defines the extent of workplace mistreatment in surgical training and establishes a potential link between workplace mistreatment and poor wellness outcomes. It also implies that higher rates of burnout observed in women – which has been shown in previous studies – may be driven by their differential exposure to things like gender discrimination and sexual harassment. Reducing the rate of workplace mistreatment may improve trainee wellness.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: This study has directly informed the upcoming Surgical Education Culture Optimization through targeted interventions based on National Comparative Data (SECOND) trial. This national study is open to all general surgery residency programs. It involves developing and testing a multi-pronged intervention including robust data feedback, a wellness improvement toolkit, and support for implementing interventions aimed at improving trainee wellness.


Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training

Yue-Yung Hu, M.D., M.P.H., Ryan J. Ellis, M.D., M.S.C.I., D. Brock Hewitt, M.D., M.P.H., Anthony D. Yang, M.D., Elaine Ooi Cheung, Ph.D., Judith T. Moskowitz, Ph.D., M.P.H., John R. Potts, III, M.D., Jo Buyske, M.D., David B. Hoyt, M.D., Thomas R. Nasca, M.D., and Karl Y. Bilimoria, M.D., M.S.C.I.

October 31, 2019
N Engl J Med 2019; 381:1741-1752
DOI: 10.1056/NEJMsa1903759

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Last Updated on October 31, 2019 by Marie Benz MD FAAD