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Workload and Perceived Burden From a National Survey of Surgeons
Saffanat Sumra1, Anirudh S Margasahayam2, Thomas M Li3
1School of Medicine, University of California, San Francisco.
Importance:
Surgeon workload is substantial, but data characterizing perceived burden are scarce, limiting workforce planning, surgeon well-being, and patient safety.
Objective:
To characterize surgeon workload and factors associated with perceived burden.
Design, Setting, And Participants:
This was a national, anonymous, cross-sectional survey distributed to US surgeon members of the American College of Surgeons (ACS) between September and November 2024 through the ACS listserv. The study included clinically active US surgeon associates and/or fellows on the ACS email distribution list.
Exposures:
Cumulative workload across clinical and nonclinical domains during scheduled and unscheduled work hours.
Main Outcomes And Measures:
Scheduled and unscheduled workload, and perceived burden (not enough, just right, or too much). Multivariable ordinal logistic regression and conditional inference classification tree analyses were used.
Results:
Of 24 937 surgeons who opened the survey, 5329 responded (21.2%). Most respondents were male (2140 [65.6%]) or female (1002 [30.7%]), with more than half (1741 [52.4%]) in practice for 20 or more years. The largest specialties were critical care, trauma, and/or acute care surgery (571 [17.2%]) and general surgery (509 [15.3%]). Median (IQR) scheduled workload was 68.1 (68.1-94.8) hours per week; respondents also worked outside scheduled hours a median (IQR) of 5.0 (2-7) days per week. Overall, of the participants reporting perceived work burden, 712 (58.3%) reported workload as too much and 447 (36.6%) as just right. Perceived burden was independently associated with cumulative workload, years in practice (6-10 years: odds ratio [OR], 1.85; 95% CI, 1.12-3.07; 20-29 years: OR, 1.96; 95% CI, 1.22-3.14; P < .001), female gender (OR, 1.8; 95% CI, 1.33-2.45; P < .001), and select subspecialties such as pediatric surgery (OR, 5.19; 95% CI, 1.95-13.80) and urology (OR, 3.85; 95% CI, 1.43-10.40). Conditional inference tree analysis identified years in practice as the root node, or primary predictor, of perceived burden, followed by workload thresholds (66.0 and 46.2 hours/week) and, respectively, subspecialty and gender among surgeons with 29 years or less and greater than 30 years in practice.
Conclusions And Relevance:
Results suggest that surgical workload was high, heterogeneous, and predominantly reported as excessive. Time (in years) spent in practice was the strongest predictor of perceived burden, followed by workload, subspecialty, and gender. These findings provide potential empirical benchmarks for targeted workforce planning and surgeon well-being efforts.
