Stress-Induced Burnout Observed Among Cataract Surgeons

A nationwide study in the United Kingdom evaluated the prevalence of stress-induced burnout among cataract surgeons, noting that a better understanding of the various factors involved could help solve the underreported problem.

The findings suggest the overall prevalence of stress-induced burnout by cataract surgery appeared low, but significant in a minority of surgeons, as data show a significant reduction in the feeling of personal achievement within the profession.¹

“A significant proportion of ophthalmologists appear to be willing to give up surgical responsibilities, influenced by varying degrees of burnout,” wrote the investigator team.¹ “More must be done to further evaluate the impact of burnout on the specialty across clinical and surgical responsibilities with the inevitable increased burden on services.”

Despite having no consensus on the optimal measurement of burnout, the Maslach Burnout Inventory (MBI) is the most commonly used instrument with three dimensions of burnout: emotional exhaustion, depersonalization, and personal accomplishment. Led by Abdus Samad Ansari, Singleton Eye Unit, investigators performed the nationwide survey via the Royal College of Ophthalmologists (RCOphth) between December 2019 and February 2020.

The survey invited all consultants, trainees, specialty doctors, and associate specialists to participate. The first part of the survey assembled demographic details, including current position and the number of cataract operations performed. The second survey employed the MBI questionnaire, calculating total burnout through scores recording a high-level burnout in sections A and/or B.

Investigators used logistic regression modeling for factors associated with high-level burnout in certain domains. A total of 406 respondents completed the survey, of which 121 were trainees (30%), and 285 were consultants, associate specialists, or other ophthalmologists (70%), for an overall crude response rate of 18%. The highest cohort of respondents were consultants practicing for more than 15 years (n = 92), consisting of 23% of the total respondent population.

The estimated total prevalence of cataract surgery-related high-level burnout was 3.45% in the analysis. Approximately 96% (n = 135) of consultants practicing for more than 15 years or less than 2 years were either moderately or highly burnout, according to the findings. Section C of the MBI explored personal achievement and identified the incidence of high-level burnout as considerably higher in this domain, with 40% of respondents exhibiting high burnout and 19.7% exhibiting moderate burnout.

Results after multivariate logistic regression indicate multiple factors were associated with an increased risk of burnout within the personal achievement domain. These factors included age over 61 years (odds ratio [OR], 2.99; 95% confidence interval [CI], 1.02 - 8.78; P = .05) and the number of cataract operations completed over 3000 (OR, 2.98; 95% CI, 1.03 - 8.64; P = .04).

The survey additionally suggested burnout risk was associated with increasing lists and subsequently the number of cataract lists undertaken each week, reporting data from 2 cataract lists (OR, 2.99; 95% CI, 1.38 - 6.47; P <.01) to 3 or more lists (OR, 2.64; 95% CI, 1.07 - 6.54; P = .04).

Moreover, a significant proportion of respondents (17%) indicated that they would be willing to give up their surgical duties if they made the same salary. Further information on training grades noted that this population predominately consisted of new consultants or consultants with more than 15 years of experience.

“Development of a workforce which includes ophthalmologists who do not undertake cataract surgery and those who undertake high volume cataract surgery to suit the needs of the population needs may promote the well-being of the ophthalmologists of the future,” investigators wrote.¹ “With this increase in ‘super specialists’, we hope would reduce the burden on current clinicians solely specializing in cataract surgery.”

References

1. Ansari AS, Tung ASW, Wright DM, Watts P, Williams GS. Stress and cataract surgery: A nationwide study evaluating surgeon burnout. European Journal of Ophthalmology. 2023;0(0). doi:10.1177/11206721231154611