Published 10/1/2018
Nina Lightdale-Miric, MD

Joy in Practice Impacts Patient Safety

Loss of joy in practice—often referred to more pessimistically as “burnout”—is characterized by feelings of exhaustion, depersonalization or detachment, and perceived personal failure. Although orthopaedic surgeons have relatively high job satisfaction and reimbursement compared to other clinicians, trends suggest that—consistent with medicine in general—joy in orthopaedic practice is declining. Nearly 50 percent of residents and 25 percent to 50 percent of practicing orthopaedic surgeons have elevated scores on validated measures of burnout. The question is of impact: If orthopaedic surgeons experience reduced meaning, purpose, and fulfillment in their daily practice, might those factors contribute to more errors?

Obstacles to job satisfaction may be personal or inherent to certain specialties or academic positions. The significant cognitive workload and challenges to achieving work-life balance affect orthopaedic surgeons, similar to physicians in other specialties but more so than the general population. Among surgeons, the measured incidence of low job satisfaction categorized as “burnout” is nearly 15 percent higher than among the general U.S. population.

A study by Saleh et al., published in Clinical Orthopaedics and Related Research reported that the nature of joy in practice or engagement varied among orthopaedic surgeons by training level, years in practice, and management position. Department chairs and residency directors had a notable prevalence of emotional exhaustion but maintained their sense of personal accomplishment. Residents and surgeons with less than 10 years of practice reported emotional exhaustion and higher depersonalization scores, as well as feeling like a cog in a machine.

Training program curricula and leadership courses may offer opportunities to model improved working conditions, thereby improving patient safety.

Both individual and organizational systems affect joy in practice. Effective office, operating room, administrative, and residency cultures should encourage open discussion, as well as identify opportunities for improvement and mutual support. Sleep, leisure time, and a social support network decrease burnout. Mindful teamwork and communication among surgeons, staff, and patients can limit harm from errors and adverse events, improve adherence and outcomes, foster better stewardship of resources, and help providers enjoy their work.

Since the first description of burnout in 1970, evidence has mounted that loss of joy in medical practice increases the risk of errors and adverse outcomes. A growing field of research is working to standardize the definitions, validate instruments, report trends, and drive successful intervention and prevention of burnout. It is estimated that each point of increase in depersonalization and exhaustion on a burnout inventory scale is associated with 11 percent and 5 percent increases, respectively, in medical errors reported by surgeons. In addition, physicians with perceived personal failure due to major medical errors have higher rates of depression, reduced empathy, depersonalization, emotional exhaustion, and a lower sense of overall personal accomplishment.

Over the past decade, awareness of the impact of limited joy in orthopaedic practice has increased. Recognizing changes in quality standards due to burnout is now a critical component of every orthopaedic surgeon’s training and longitudinal career. Residency directors, department chairs, and hospital and practice leadership are educated, monitored, and accountable for the individual needs of their trainees, staff, and partners. Continued engagement, education, and incorporation of prevention and early intervention efforts are needed to combat physician burnout in the orthopaedic surgery community.

Physician burnout is also a pressing patient-safety issue, as it is associated with lower patient satisfaction and longer post-discharge recovery time. Efforts to prevent, address, and confront burnout, as well as support surgeons who demonstrate signs of it, directly benefit patients and decrease associated morbidity. The AAOS Patient Safety Committee identifies loss of joy in practice as a patient-safety issue associated with medical errors and supports surgeons to address sources of disengagement and depersonalization to restore meaning and purpose in practice.

You can help guide AAOS efforts to keep patients safe by recognizing the signs of physician burnout. Ask yourself the following questions: Do you feel exhausted, disengaged, underappreciated, or undervalued as an orthopaedic surgeon? If so, do you know where to find help and support? What changes in orthopaedic surgery might stimulate a culture of increased engagement and joy in practice?

Creating and maintaining joy in practice are important. Doing so not only reduces physician burnout but also prevents patient harm and lowers healthcare costs.

Nina Lightdale-Miric, MD, is the Leadership Fellows Program member of the AAOS Patient Safety Committee. She can be reached at NLightdale@chla.usc.edu.


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