High burnout among the South African orthopaedic community: a cross-sectional study
Keywords:burnout, orthopaedic, South Africa, professional fulfilment, Stanford Professional Fulfilment Index, moral injury, compassion fatiue, imposter phenomenon, second-victim syndrome, approval addiction
Background: Burnout is epidemic among physicians, with the orthopaedic speciality displaying one of the highest rates of burnout in international studies. The burnout rate of the South African orthopaedic community is unknown. This study aimed to determine the prevalence and causes of burnout, as well as the coping mechanisms and associations with burnout, in South African orthopaedic surgeons and trainees.
Methods: We conducted a cross-sectional, secure, online survey of members of the South African Orthopaedic Association. The survey assessed demographic characteristics, workload, professional fulfilment and burnout (utilising the Stanford Professional Fulfilment Index), associated workplace distress conditions, causes of and coping strategies for burnout. A response was not compulsory for any question. Statistical analysis was performed to assess for independent associations with burnout.
Results: One hundred and fifty-six respondents, with a median age of 46.5 years (interquartile range [IQR] 37–58) participated. Ninety per cent (139 of 155) of respondents were male. Registrary accounted for 17% (27 of 155), while 83% (128 of 155) were qualified specialists. Respondents were in orthopaedic practice for a median of 17 years (IQR 9–28). Sixty per cent (76 of 127) practise in private, 17% (22 of 127) in public and 23% (29 of 127) in both sectors. The overall burnout rate was 72% (113 of 156). Burnout was associated with being the parent of young children and having fewer hours of sleep on call. Registrars were more likely to have burnout than consultants (OR 5.68, 95% CI 1.3–25.2). Gender, practice setting and subspeciality were not associated with burnout. Self-reported causes of burnout that were found to be associated with actual burnout were: ‘hours at work’, ‘lack of free time’ and ‘work–life imbalance’. No selfreported coping mechanisms were found to be protective in this cohort, but the use of alcohol as a coping mechanism was associated with an increased likelihood of burnout (OR 3.9, 95% CI 1.4–10.7). Respondents felt that the concurrent experience of the COVID pandemic at the time of running the survey reduced their experience of burnout.
Conclusion: The burnout rate in the South African orthopaedic community is 72%. Trainees were found to be particularly vulnerable. There appears to be a need to develop, assess and implement effective system-related initiatives aimed at reducing the burnout rate among orthopaedic surgeons and trainees in South Africa.
Level of evidence: Level 4