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The Prevalence of Burnout Among US Neurosurgery Residents
Abstract
BACKGROUND
Burnout is a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment. Its prevalence among US physicians exceeds 50% and is higher among residents/fellows. This is important to the practice of neurosurgery, as burnout is associated with adverse physical health, increased risk of substance abuse, and increased medical errors. To date, no study has specifically addressed the prevalence of burnout among neurosurgery residents.
OBJECTIVE
To determine and compare the prevalence of burnout among US neurosurgery residents with published rates for residents/fellows and practicing physicians from other specialties.
METHODS
We surveyed 106 US neurosurgery residency training programs to perform a descriptive analysis of the prevalence of burnout among residents. Data on burnout among control groups were used to perform a cross-sectional analysis. Nonparametric tests assessed differences in burnout scores among neurosurgery residents, and the 2-tailed Fisher's exact test assessed burnout between neurosurgery residents and control populations.
RESULTS
Of approximately 1200 US neurosurgery residents, 255 (21.3%) responded. The prevalence of burnout was 36.5% (95% confidence interval: 30.6%-42.7%). There was no significant difference in median burnout scores between gender (P = .836), age (P = .183), or postgraduate year (P = .963) among neurosurgery residents. Neurosurgery residents had a significantly lower prevalence of burnout (36.5%) than other residents/fellows (60.0%; P < .001), early career physicians (51.3%; P < .001), and practicing physicians (53.5%; P < .001).
CONCLUSION
Neurosurgery residents have a significantly lower prevalence of burnout than other residents/fellows and practicing physicians. The underlying causes for these findings were not assessed and are likely multifactorial. Future studies should address possible causes of these findings.
Journal Article
Do no harm : stories of life, death and brain surgery
What is it really like to be a brain surgeon, to hold someone's life in your hands, to drill down into the stuff that creates thought, feeling and reason? How do you live with the consequences of performing a potentially life-saving operation when it all goes wrong? In this powerful, gripping and brutally honest account, one of the country's top neurosurgeons reveals what it is to play god in the face of the life-and-death situations he encounters daily. Henry Marsh gives a rare insight into the intense drama of the operating theatre, the chaos and confusion of a modern hospital, the exquisite complexity of the human brain, and the blunt instrument that is surgeon's knife by comparison.
BOOK
From indication to initiation of invasive intracranial pressure monitoring time differences between neurosurgeons and intensive care physicians: can intracranial hypertension dose be reduced? TIMING-ICP, a multicenter, observational, prospective study
Background
The duration of episodes of intracranial hypertension is related to poor outcome, hence the need for prompt diagnosis. Numerous issues can lead to delays in the implementation of invasive intracranial pressure (ICP) monitoring, thereby increasing the dose of intracranial hypertension to which the patient is exposed. The aim of this prospective, observational, multicenter study was to assess the magnitude of this delay, evaluating the time required for initiation of invasive ICP monitoring, from indication (T1) to initiation of the maneuver (T2) when performed by neurosurgeons compared to intensive care physicians.
Methods
We evaluated the impact of the operator performing the maneuver (neurosurgeon vs. intensivist) on the T2-T1 time interval, where T1 represents the time at which indication for invasive ICP monitoring is declared, and T2 the time at which the maneuver starts, defined as the skin incision. The effect of the operator performing the maneuver was evaluated through a parametric survival model. Both intraparenchymal catheters (IPCs) and external ventricular drains (EVDs) were considered as invasive ICP monitoring devices. Invasive monitoring could be performed in intensive care unit (ICU) or in operating room (OR).
Results
A total of 112 patients were included into the final analysis; 39 IPCs were placed by intensivists within the ICU, and a total of 73 IPCs and EVDs by neurosurgeons both within the ICU and OR settings. The mean difference in T2-T1 time for IPCs placement in the ICU was 69 min (CI 50.1–94.8) in the intensivist group and 145 min (CI 103.4–202.9) in neurosurgeon group. The mean difference between these groups, 76 min, was found to be statistically significant (
p-value
= 0.0021). In the group treated by neurosurgeons, no statistically significant differences were found in timing between the ICU and the OR.
Conclusions
Invasive ICP monitoring performed with IPCs in ICU begins earlier when performed by intensivists rather than neurosurgeons. This finding suggests the possibility to obtain a prompt diagnosis of intracranial hypertension when intensivists intervein directly at patient’s bedside. Further studies are needed to confirm these findings and investigate their effect on outcome.
Journal Article
Admissions : a life in brain surgery
Henry Marsh has spent four decades operating on the human brain. In this searing and provocative memoir, following his retirement from the NHS, he reflects on the experiences that have shaped his career and life, gaining a deeper understanding of what matters to us all in the end.
Pride, prejudice, and other flavors : a novel
\"A new series about the Rajes, an immigrant Indian family descended from royalty, who have built their lives in San Francisco\"-- Provided by publisher.
BOOK
Differences in intervention for patients with acute stroke according to the manpower of neurosurgeons
Stroke, a leading global cause of death, poses a substantial health burden. The incidence of stroke is high in an aging society. Appropriate healthcare resources are crucial for providing prompt interventions to patients with stroke. We investigated the factors associated with the choice between conservative and interventional treatments, including an analysis of the number of neurosurgeons required for interventional care, for patients with acute stroke.
We utilized health insurance claims data from hospitals submitted to the Health Insurance Review and Assessment Service in 2018 and 2021. The data covered 60,661 patients with acute stroke admitted to the emergency room in tertiary or general hospitals. The number of hospital neurosurgeons was the key variable of interest; conservative and interventional treatments were the independent variables. Using a multi-level analysis, we identified the individual- and hospital-level factors associated with interventional treatment by constructing four models.
The odds of patients with hemorrhage and ischemic stroke receiving intervention were 0.60 [95% confidence interval (CI), 0.31-0.52] and 0.51 [95% CI, 0.39-0.65] times lower, respectively, in the group with fewer neurosurgeons. We categorized the number of neurosurgeons and indicated an association between a minimum of three neurosurgeons and stroke treatment.
We demonstrated an association between individual- and hospital-level factors and the intervention for patients with different types of stroke. We predicted the number of neurosurgeons needed for intervention. These findings can be used for the efficient distribution and utilization of healthcare resources to improve public health.
Journal Article