Fewer than 10 percent of surgeons who specialize in limb lengthening and reconstruction utilize wellness counseling, despite high rates of burnout, according to results of a study presented at the AAOS 2024 Annual Meeting. For AAOS Now, Selina C. Poon, MD, MPH, FAAOS, sat down with study coauthor Christopher Iobst, MD, FAAOS, pediatric orthopaedic surgeon at Nationwide Children’s in Columbus, Ohio, to discuss his study, which looked at how burnout impacts surgeons in this subspecialty across the globe.

Dr. Poon: Can you tell us the reason for pursuing your research project?
Dr. Iobst: I think in the medical world, we are all coming to the concept of burnout and physician wellness. We realize how important it is for us to take care of ourselves, which then makes it better for us to take care of our patients. In our world of limb reconstruction, we live in high-pressure situations. Many of our patients are highly complex. There are a lot of complications that can be involved in these types of surgeries. We often feel pressure that we’re sometimes billed as the last resort or the last hope for these patients. So within the field, there’s this natural tendency for a lot of stress, and I thought that we may be more susceptible to burnout. We wanted to look at this, because it’s never actually been studied.

You surveyed an international group of limb-deformity surgeons, looking specifically at burnout rates. Did you find a difference between the United States and everywhere else?
We purposely wanted to get a global sense of what this burnout phenomenon is like, and what our results showed is that it is something across the board. No matter where you are from, you definitely feel this level of stress which can lead to burnout. But in individual countries and in different parts of the world, I think they feel different types of burnouts. We all sort of are in the same pot of stress, but the elements that create that stress might be different.

In your study, only 6 percent of surgeons use the burnout counseling available to them, but 52 percent reported having it available at work. Why do you think so few surgeons use the resources available to them?
That is an astonishing disparity, right? To think that many of us have resources at our disposal, but we do not choose to use them. I believe that speaks to this underlying code among surgeons, that we’re supposed to be invincible. We do not talk about our problems. We don’t want to burden somebody with our thoughts or concerns. It is hard to break through that barrier and accept that I need help. Even though there are resources to get help, I just don’t feel comfortable asking for them.

Do you think wellness counseling is the answer for burnout amongst surgeons?
I think it’s a multifactorial treatment plan, but certainly that’s one of the important components to it. Sort of just making it more acceptable to talk about these things among ourselves, even with a colleague, can be therapeutic. But certainly, if you speak with a professional—and we can learn to be comfortable with that choice—it will go a long way to hopefully prevent burnout.

How do we increase the usage of wellness counseling? Do you think surgeons would be more willing to use it if it is offered by a professional society like AAOS or the Limb Lengthening and Reconstruction Society instead of their own institution?
That’s a great point, because I think there are certainly subspecialty-specific types of stress where maybe speaking to a colleague who’s familiar with what you’re doing adds a little bit more validity to it. On the other hand, it can also be a bit disconcerting to talk to someone who’s a colleague, because you want to keep this sort of anonymous or private. I can see both sides of it, but I really just think it’s a matter of breaking through and allowing us to feel comfortable to ask for help.

What is the key point from this study that you want our audience to take home?
For limb-reconstruction surgeons to realize that burnout is a global phenomenon. It’s not just in the United States; it’s all over. We need to develop a treatment plan, so having a support group or having some sort of way to allow us to deal with these issues is going to be the next step in moving forward. Now that we’ve identified the problem, it is time for us to come up with solutions.

Selina C. Poon, MD, MPH, FAAOS, is a pediatric orthopaedic surgeon and director of research at Shriners Children’s Southern California in Pasadena, California.