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INDIAN WELLS, CALIF. -- Forty percent of surgeons met criteria for burnout, and 30% screened positive for depression in a survey of 7,905 members of the American College of Surgeons.

The 61-question survey, conducted for the ACS by the Mayo Clinic Survey Research Center, is the largest survey of burnout among physicians so far. The findings were published in the April issue of Archives of Surgery (2009;144:371-6).

The unusually high response rate--32% of 24,922 surgeons who were contacted--shows how important surgeons consider this topic, Dr. Charles M. Balch said at the annual meeting of the American Surgical Association.

Among respondents, 32% had high emotional exhaustion scores and 26% had high depersonalization scores (with some overlap), both of which are criteria for burnout, Dr. Balch and his associates reported.

In addition, 28% of respondents had a mental quality of life score that was more than half a standard deviation below the population norm, and 11% had a physical quality of life score more than half a standard deviation below the population norm. "These are both clinically and statistically significant in the quality of life field," said Dr. Balch of the Johns Hopkins Medical Institutions, Baltimore.

Previous data on the validity of depression screening suggests that if the 30% of surgeons who screened positive for depression on the survey underwent a full psychological evaluation, 10%-15% of all respondents would be diagnosed with depression, he added.

"All of us are subject to stresses and strains in our career," he said. "If there's any one message here, it's that we should be proactive about this to avoid that small but significant percentage of surgeons who get into real trouble with addictive behavior, with early retirement, with suicide, with adverse events" because of burnout.

Slightly more than half of respondents said they would recommend a career as a surgeon to their children. Burned-out surgeons were significantly less likely to recommend their career to their children (32%) than were those who did not feel burned out (62%).

Only 36% felt that their work schedule leaves enough time for personal and family life. Among burned-out surgeons, 18% reported sufficient personal/family time, compared with 49% of their counterparts--a significant difference.

Generally, 74% of surgeons said they would become surgeons if they could do it all over again, but responses to this question differed significantly between surgeons who were burned out (only 52% would choose surgery again) and those who weren't (83% would repeat).

The median workload was 60 hours per week, but 30% of respondents reported working 70 hours per week or more. The investigators were surprised, however, that the number of hours worked was not significantly associated with either burnout or with satisfaction in choice of career and specialty.

The choice of subspecialty led the list of factors independently associated with burnout in a multivariate logistic analysis. Trauma surgery was associated with a 57% higher risk of burnout, compared with respondents as a whole. Urologic surgery was associated with a 46% higher risk, otolaryngology with a 38% higher risk, vascular surgery with a 36% higher risk, and general surgery with a 21% higher risk.

Other significant risk factors for burnout included having a youngest child between age 5 and 21 years (35%-41% increased risk), receiving compensation based entirely on billing (32% higher risk), and having a spouse who also works in health care (32% higher risk). The number of nights spent on call per week was associated with a 6% increased risk for burnout. Each additional year in practice was associated with a 3% increase in risk, but each additional year in age was protective, associated with a 5% decrease in risk for burnout.

Factors significantly associated with satisfaction in career and specialty were led by the "absence of burnout" and included subspecialty choice, higher academic ranking, older age, number of hours per week in the operating room, and having fewer nights on call. The subspecialists most likely to report job and career satisfaction were those practicing in otolaryngology, transplant surgery, plastic surgery, ophthalmology, orthopedic surgery, pediatrics, urology, trauma surgery, neurology, and oncology.

The survey used the Maslach Burnout Inventory to assess burnout, the Primary Care Evaluation of Mental Disorders (PRIME MD) screening tool to assess depression, and the Medical Outcomes Study (SF-12) to assess quality of life.

Respondents had been in practice for 18 years on average and had a median age of 51 years. They averaged 16 hours per week in the OR and 2 nights per week on call. Their demographics were similar to those of all American College of Physicians members; 10% were young surgeons including residents.

Subanalyses of responses from the 1,043 female surgeons and other subgroups are being conducted.

Dr. Balch and his associates will present data later this year showing that burnout is associated with suboptimal patient care and adverse patient events, he said.

Previous studies include a 582-person survey of Michigan surgeons, a 549-person survey of surgical oncologists, and 1,393-person survey of European family physicians. "I hope that other specialty organizations will conduct similar surveys of their memberships so that we can begin to understand the various causes of extreme burnout" and differentiate factors related to a medical career in general compared with a specific specialty, Dr. Balch said.