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Researchers seeking to quantify the impact of physician burnout have their work cut out for them. In this ASA Member Spotlight, Anoushka Afonso, MD, FASA, shares how she and her colleagues went about conducting the first large-scale study of physician burnout among anesthesiologists – and helps put her team’s important findings in much-needed perspective.

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You helped author the landmark study on physician burnout published in Anesthesiology this past May. Before we get to the findings, what first got you interested in researching this topic and how did you become involved in the project?

As a dual-trained physician in Internal Medicine and Anesthesiology, perioperative care of the oncology patient and building enhanced recovery programs are in my lane. Physician burnout was not even on my radar. However, in the last decade I have personally known three physicians who took their own lives. That is three too many. Burnout is a fatal disorder. But it doesn’t happen overnight. There is a “slow burn” as many of us have become so accustomed to the stress, that we just don’t realize it until too late. I asked myself what is being done to address this and how is our specialty at risk?

Upon further research, there was a paucity of data, specifically in our field of Anesthesiology, examining this topic. This was one study that had to be done immediately. To make sure that this study would be done with an expert in the field, I connected with Dr. Amy Vinson, Boston Children’s Hospital & Harvard Medical School, who is ASA Chair of the Wellness Committee. We partnered together and assembled a team that would give this topic justice and make an impact. Due to COVID we have never actually met in person, but we both looked forward to our frequent zoom calls and virtual brainstorming sessions that helped us push the envelope on this important topic.

 

This was the first large-scale study to focus specifically on burnout among practicing anesthesiologists. The idea of physician burnout has been around for years – why do you think we’re just now seeking to understand the dynamics of burnout as it relates to anesthesiology as a specialty?

The concept of physician burnout is certainly not new.  The term burnout has been used in literature for more than 50 years to describe many of the negative emotional and physical consequences that physicians face. We have also known for many years that burnout among physicians is far more common than in the general population. We have also seen an increase in demand of anesthesiologists in general, and hospital working on narrow margins trying to stay competitive in the current health care environment. We are struggling with retention and anesthesiologist shortages across the country. The anesthesiologist workforce is often stretched thin, with little control over scheduling issues such as working hours and calls. All this, while at the same time trying to maintain a healthy work-life balance including much needed attention to family and personal health.  

To maintain and even grow the anesthesia workforce, we cannot ignore burnout anymore. If we want to take care of ourselves and our colleagues, we need to address this problem that has become endemic to anesthesiologists. We must find ways to identify those at risk and how to effectively prevent and alleviate burnout in anesthesiologists. Our study is a major milestone in understanding prevalence and risk factors, and a first step in finding targeted solutions to produce sustained change.

What aspects of the research findings really jumped out at you? Did anything surprise you?

Two findings really stood out and were not appreciated as well prior to our study. First, the prevalence of burnout among anesthesiologists seems to be higher than what had been estimated.

Before our study, we knew that burnout among physicians was high and more prevalent than in the general population.  Anesthesiologists had some of the highest rates of burnout among physicians with a prevalence close to 50%.  But our study, which included almost 4,000 US anesthesiologists, shows that the burnout rate among anesthesiologists is even higher than had been suggested in the past, and is closer to 60%. Our survey was sent out without us being aware of the impending and long-lasting effects of the COVID-19 pandemic. Our results are, therefore, more reflective of the pre-COVID era. Fast forward, we are now in an even worse position than before. The toll this pandemic has taken on our profession is immeasurable. It will take many years to fully understand what impact the COVID pandemic had on physician well -being.

The other major study goal was to identify factors associated with burnout. We found that perceived lack of support at work was the strongest risk factor associated with burnout syndrome. This finding suggests that creating a healthy work environment is one of the key strategies in addressing burnout among anesthesiologists, rather than only focusing on individual characteristics of anesthesiologists.  Meaningful changes that we can make to lessen burnout are likely at the organizational and institutional level. It is time to rethink how we approach burnout. 

In your work you also focus a lot on developing the medical student pipeline, particularly among underrepresented groups. What do you believe is at stake when it comes to diversity in medicine, and how are you going about “casting a wider net”?

In high school, I participated at a program at the National Institutes of Health (NIH). I am where I am today because of that program which opened many doors for me. Many students do not have the opportunities that most of us take for granted. Programs like these are essential as they can alter the trajectory of our future generation.

One of my passions in medicine is to mentor and develop career-enhancing opportunities for medical students.  I currently serve as the Faculty Director for the Summer Pipeline Program at Memorial Sloan Kettering Cancer Center (MSK).  Through this program we select a group of talented and accomplished Underrepresented in Medicine (UiM) medical students from across the United States and pair them with research mentors.  We ensure that these students have access to world-class scientists and physicians with whom they can work on research projects in this 8-week program. Additionally, the Summer Exposure Program for High School students (SEP) is a mentorship program for underrepresented minority and under-resourced high school students. These students learn about aspects of clinical cancer care, explore the interplay between research and clinical practice and are paired with a clinical/research mentor for the summer. We hope to expand this program to middle-school and beyond with additional program support for earlier exposure.

There are many health disparities in the US among different racial/ethnic groups that can no longer be neglected.  If we want to effectively address those health inequalities, we need to also start by physicians representing the communities that they serve. As institutions we must strive to provide the best medical care possible for our patients.  Additionally, not having a diverse qualified physician workforce will prevent us from truly addressing the significant health inequalities that we see across the United States.

Is there anything you’d like to add here that we haven’t yet touched on?

As we look at our social interactions beyond the COVID pandemic, we should make a conscious effort to connect with our colleagues, friends, and family. Social isolation is a significant issue for all age groups that can adversely affect health and wellbeing. The need for socialization and personal interactions cannot be underestimated. I encourage all of us to make that extra step to reach out to someone.

Many paved the road before me. I am deeply gracious to all those who mentored and sponsored me. I only hope to pay it forwards.

Lastly, I would like to thank my husband for all his unwavering support through my career and my three young kids for helping me live in the moment.

 Anoushka Afonso, MD, FASA, is Associate Professor of Anesthesiology at Memorial Sloan Kettering Cancer Center (MSK), where she is Director of the Enhanced Recovery Programs (ERP), and Faculty Director of the MSK Pipeline Programs in the Office of Health Equity. She currently serves on the Board of the American Society of Enhanced Recovery (ASER) and previously on the ASA Educational Track Subcommittees on Perioperative Medicine, Ambulatory Anesthesia and Fundamentals.