Contemporary Evaluation of Work-Life Integration and Well-Being in US Surgical Residents: A National Mixed-Methods...

The demands of surgical training present challenges for work-life integration (WLI). We sought to identify factors associated with work-life conflicts and to understand how programs support WLI.

A cross-sectional national survey conducted after the 2020 American Board of Surgery In-Training Examination queried 4 WLI items. Multivariable regression models evaluated factors associated with (1) work-life conflicts and (2) well-being (career dissatisfaction, burnout, thoughts of attrition, and suicidality). Semistructured interviews conducted with faculty and residents from 15 general surgery programs were analyzed to identify strategies for supporting WLI.

Of 7,233 residents (85.5% response rate), 5,133 had data available on work-life conflicts. A total of 44.3% reported completing noneducational task work at home, 37.6% were dissatisfied with time for personal life (eg hobbies), 51.6% with maintaining healthy habits (eg exercise), and 48.0% with performing routine health maintenance (eg dentist). In multivariable analysis, parents and female residents were more likely to report work-life conflicts (all p < 0.05). After adjusting for other risk factors (eg duty-hour violations and mistreatment), residents with work-life conflicts remained at increased risk for career dissatisfaction, burnout, thoughts of attrition, and suicidality (all p < 0.05). Qualitative analysis revealed interventions for supporting WLI including (1) protecting time for health maintenance (eg therapy), (2) explicitly supporting life outside of work (eg prioritizing time with family), and (3) allowing meaningful autonomy in scheduling (eg planning for major life events).

Work-life conflicts are common among surgical residents and are associated with poor resident well-being. Well-designed program-level interventions have the potential to support WLI in surgical residency.