Surgeon distress as calibrated by hours worked and nights on call

J Am Coll Surg. 2010 Nov;211(5):609-19. doi: 10.1016/j.jamcollsurg.2010.06.393. Epub 2010 Sep 20.


Background: The relationships of working hours and nights on call per week with various parameters of distress among practicing surgeons have not been previously examined in detail.

Study design: More than 7,900 members of the American College of Surgeons responded to an anonymous, cross-sectional survey. The survey included self-assessment of their practice setting, a validated depression screening tool, and standardized assessments of burnout and quality of life.

Results: There was a clear gradient between hours and burnout, with the prevalence of burnout ranging from 30% for surgeons working <60 hours/week, 44% for 60 to 80 hours/week, and 50% for those working >80 hours/week (p < 0.001). When correlated with number of nights on call, burnout exhibited a threshold effect at ≥2 nights on call/week (≤1 nights on call/week, 30%; ≥2 nights on call/week, 44% to 46%; p < 0.0001). Screening positive for depression rate also correlated strongly with hours and nights on call (both p < 0.0001). Those who worked >80 hours/week reported a higher rate of medical errors compared with those who worked <60 hours/week (10.7% versus 6.9%; p < 0.001), and were twice as likely to attribute the error to burnout (20.1% versus 8.9%; p = 0.001). Not surprisingly, work and home conflicts were higher among surgeons who worked longer hours or had ≥2 nights on call. A significantly higher proportion of surgeons who worked >80 hours/week or had >2 nights on call/week would not become a surgeon again (p < 0.0001).

Conclusions: Number of hours worked and nights on call per week appear to have a substantial impact on surgeons, both professionally and personally. These factors are strongly related to burnout, depression, career satisfaction, and work and home conflicts.

MeSH terms

  • Adult
  • After-Hours Care
  • Burnout, Professional / epidemiology*
  • Cohort Studies
  • Female
  • General Surgery / classification
  • General Surgery / organization & administration*
  • General Surgery / statistics & numerical data*
  • Health Planning Guidelines
  • Humans
  • Incidence
  • Job Satisfaction
  • Male
  • Medical Errors / statistics & numerical data
  • Middle Aged
  • Night Care
  • Population Surveillance
  • United States / epidemiology
  • Workload / statistics & numerical data*