Burnout in NHS Surgeons: a systematic review and narrative synthesis of risk-factors, effects, interventions and implications for stakeholders

Background: The term ‘burnout’ was first coined in 1974 after it was observed that some healthcare volunteers followed a similar pattern of becoming emotionally tired and losing motivation in their work after unsuccessfully treating patients. Research after these initial observations has improved current understanding of how burnout is developed. Typically, burnout is defined as the end of process of disillusionment with a job where the person becomes less effective in their role. Introduction: Burnout amongst National Health Service (NHS) surgeons in the United Kingdom (UK) is likely to be negatively impacting the health of those surgeons and the quality of patient care they provide. Leaders appear to have only recently recognised how significant the effects of burnout in surgeons may be. There is no review that holistically explores burnout in this group or what can be done to mitigate the impact of burnout. Aims: The primary aim was to estimate the prevalence of burnout amongst NHS surgeons between 2000 and 2018. Secondary aims were to evaluate the risk factors, effects and interventions for burnout in NHS surgeons between 2000 and 2018. Methods:A systematic review was conducted between 21st January and 18th June 2019 according to the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines and registered on PROSPERO (registration number CRD42019119900). MEDLINE and Health Management Information Consortium (HMIC) databases were searched for eligible studies. The Appraisal Tool for Cross-sectional Studies (AXIS) was used to critically appraise the quality of studies. Quantitative analysis and qualitative synthesis of results was performed but no meta-analysis was performed due to substantial study heterogeneity. Results and discussion: There were 2,796 search results returned. After title and abstract screening and full-text review, 10 studies were eligible for inclusion. Included in the analyses were 2,130 surgeons across many surgical specialities. No definitive prevalence rate could be calculated because of varied definitions of burnout. However, by qualitatively synthesising all available prevalence estimates, approximately one third of surgeons appear to have burnout. Many risk factors were identified but centre around a surgeon feeling unable to utilise their professional skills or having a weak support network with inadequate coping strategies. The effects of burnout are wide-reaching and appear to negatively affect surgeons’ health and ability to deliver effective patient care. Individual-focused and organisation-level interventions appear to be able to reduce burnout but require further research to determine the optimal mix and frequency of interventions in the long-term. Conclusion: Burnout affects approximately one third of NHS surgeons and negatively impacts the surgeons’ health and the quality of patient care they provide. Ensuring trainees’ have realistic expectations of what it means to be a surgeon and improving collaboration between organisations and individuals to help create supportive work environments will likely reduce burnout rates.