Electronic Health Record Burnout in Surgery and Strategies to Improve Burnout: A Narrative Review

Physician burnout is a prevalent occupational syndrome characterized by emotional exhaustion, depersonalization, and diminished professional efficacy. Use of electronic health records (EHRs; also termed EMRs) has been associated with provider burnout in multiple settings. This review characterizes the most frequently reported EHR‑related contributors to burnout among U.S. surgeons across the following four domains: documentation burden, time demands (including after‑hours work), electronic messaging/in‑basket load, and usability. We searched PubMed for English-language, U.S. articles published from January 2004 to April 2024. Two reviewers independently screened and domain‑coded with consensus resolution. We report domain frequencies as n (%) with 95% confidence intervals (CIs) (Wilson) and summarize study‑level magnitudes where available (e.g., hours/day in EHR, after‑hours share, message volume, odds ratios). Of the 207 screened records, 25 were included across general, vascular, orthopedics, otolaryngology, surgical oncology, and the surgical intensive care unit. Domain frequencies: documentation, 15/25 = 60.0% (95% CI = 40.7-76.6); time demands, 17/25 = 68.0% (95% CI = 48.4-82.8); electronic messaging, 8/25 = 32.0% (95% CI = 17.2-51.6); and usability, 4/25 = 16.0% (95% CI = 6.4-34.7). None of the included studies explicitly assessed medicolegal contributors. Examples of magnitudes included EHR hours/day and remote/after‑hours EHR use, message volumes and timing, and fatigue/efficiency markers. In U.S. surgical literature, EHR‑related burnout is most frequently reported in association with documentation burden and time demands, with additional contributions from electronic messaging and usability. Practical mitigation includes surgeon‑facing efficiency tactics (templates, dictation, team inbox protocols) alongside system‑level usability improvements and policy reforms. Further prospective and interventional evaluations are needed.