High-intensity jobs can cause physical and mental exhaustion in workers. Health care workers in particular face a variety of stressors1 that can cause work-related burnout, defined as “exhaustion of physical or emotional strength as a result of prolonged stress or frustration.”2 Anesthesiology can be especially exhausting given factors such as noisy environment, poorly-defined work spaces, long work hours, fatigue, demanding interpersonal relations, unpredictability, work overload, fear of litigation, unskilled supervisors and the need for constant vigilance.3,4 Given its prevalence, researchers have begun to investigate the causes and results of work-related exhaustion in anesthesiology.
The causes of burnout in anesthesiology are apparent from the beginning of training.5 For example, Gandhi et al. found that anesthesiology residents faced high workload and undefined working hours, with 80 percent feeling that they were overloaded with work.6 Abut et al. also found that inexperienced trainees in anesthesiology are especially vulnerable to stress and job burnout, likely due to undeveloped coping mechanisms.7 Additionally, anesthesiology trainees’ environments, personalities and demographics may affect work-related exhaustion. In Abut et al.’s study, gender and number of children affected scores on personal accomplishment, depersonalization and emotional exhaustion. Women showed higher personal accomplishment and lower depersonalization scores than men, and people with multiple children showed lower depersonalization and emotional exhaustion than people with no children.7 A different study found that being a “night person” versus a “morning person” caused variations in anesthesiology trainees’ salivary amylase, which may reflect work-related stress.8 In their 2013 paper, de Oliveira et al. showed that burnout and depression risk in trainees was linked to working more than 70 hours per week, drinking more than 5 drinks per week and being female,9 and that smoking could also affect depression risk.9 A 2011 study by de Oliveira et al. showed that burnout factors extend late into anesthesiology careers, with residency program directors facing variable risk based on compliance issues, self-assessment of effectiveness, family support, perceived impact of stressful factors and current job satisfaction.10 Finally, a recent meta-analysis found that strained working patterns, younger age and having children was associated with more burnout.11 Clearly, various factors can affect burnout risk among anesthesiology trainees and superiors, with studies showing some conflicting results.
With many causes for work-related exhaustion and burnout among anesthesiologists, the emotional and physical effects can be severe. Per Abut et al., perceived stress was very high in the early years of training, with younger anesthesiology trainees experiencing more emotional exhaustion and depersonalization and less personal accomplishment than their older peers.7 The 2013 study by de Oliveira et al. found high burnout risk in 41 percent of anesthesia resident respondents, with 56 percent at high risk for depression or burnout.9 In terms of patient care, 33 percent of respondents with high burnout and depression risk reported multiple medication errors in the past year, as opposed to 0.7 percent of lower-risk responders.9 Median best practice scores were also lower for residents at high risk of burnout and depression than for those at lower risk.9 Of the 100 program directors who responded to de Oliveira et al.’s 2011 survey, 20 were at high burnout risk and an additional 30 were at risk for developing burnout. Those at high burnout risk were more likely to report lower job satisfaction and an increased likelihood of stepping down in the next couple of years.10 Finally, the meta-analysis by Sanfilippo et al. showed that some studies found up to 59 percent of moderate burnout risk among anesthesiologists.11 Anesthesiologists face widespread work-related exhaustion and burnout, which may be related to their own poor physical and mental health as well as lower-quality patient care.
Given the various job-related stressors in anesthesiology and the high prevalence of exhaustion among anesthesiology professionals, future research should approach potential solutions to these issues. Comfortable work environments, regulations on working hours, support from superiors and better work predictability might be effective in preventing work-related exhaustion in anesthesiology trainees and attendings. Researchers should assess programs that implement these changes to work toward a resolution.
1. Portoghese I, Galletta M, Coppola RC, Finco G, Campagna M. Burnout and Workload Among Health Care Workers: The Moderating Role of Job Control. Safety and Health at Work. 2014;5(3):152–157.
2. Felton JS. Burnout as a clinical entity—its importance in health care workers. Occupational Medicine. 1998;48(4):237–250.
3. Riad W, Mansour A, Moussa A. Anesthesiologists work-related exhaustion: A comparison study with other hospital employees. Saudi Journal of Anaesthesia. 2011;5(3):244–247.
4. Jackson SH. The role of stress in anaesthetists’ health and well-being. Acta Anaesthesiologica Scandinavica. 1999;43(6):583–602.
5. Larsson J, Rosenqvist U, Holmstrom I. Being a young and inexperienced trainee anesthetist: A phenomenological study on tough working conditions. Acta Anaesthesiologica Scandinavica. 2006;50(6):653–658.
6. Gandhi K, Sahni N, Padhy SK, Mathew PJ. Comparison of stress and burnout among anesthesia and surgical residents in a tertiary care teaching hospital in North India. J Postgrad Med. 2018;64(3):145–149.
7. Abut YC, Kitapcioglu D, Erkalp K, et al. Job burnout in 159 anesthesiology trainees. Saudi Journal of Anaesthesia. 2012;6(1):46–51.
8. Yamakage M, Hayase T, Satoh J-I, Namiki A. Work stress in medical anaesthesiology trainees. European Journal of Anaesthesiology. 2007;24(9):809–811.
9. de Oliveira GS, Chang R, Fitzgerald PC, et al. The prevalence of burnout and depression and their association with adherence to safety and practice standards: A survey of United States anesthesiology trainees. Anesthesia & Analgesia. 2013;117(1):182–193.
10. de Oliveira GS, Almeida MD, Ahmad S, Fitzgerald PC, McCarthy RJ. Anesthesiology residency program director burnout. Journal of Clinical Anesthesia. 2011;23(3):176–182.
11. Sanfilippo F, Noto A, Foresta G, et al. Incidence and Factors Associated with Burnout in Anesthesiology: A Systematic Review. BioMed Research International. 2017;2017:10.