Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina.
Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill.
JAMA Surg. 2020 Aug 1;155(8):742-750. doi: 10.1001/jamasurg.2020.1332.
Burnout among US surgeons is alarmingly high, particularly among women, and work-life integration conflicts contribute to career dissatisfaction.
To evaluate associations between surgical career satisfaction and personal life factors such as time requirements for outside interests, household chores, and parenting responsibilities and to explore similarities and differences between men and women.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey study of practicing US surgeons was conducted between June 4 and August 1, 2018. The 257-item online survey was sent to 25 748 fellows of the American College of Surgeons. A 31-item subanalysis was performed from August 13 to November 4, 2019.
Degree of career satisfaction was measured on a 5-point Likert scale. Professional and personal life factors associated with career satisfaction were evaluated with gender-stratified multivariable proportional odds models.
Among 3807 respondents, 3166 self-identified as male (83%) and 639 (17%) as female. Fewer women reported career satisfaction (483 [77%] vs 2514 [82%]) and relatively more women reported problematic interruption of personal life owing to work (315 [50%] vs 1381 [45%]). A higher proportion of women reported being primarily responsible for meal preparation (282 [46%] vs 355 [12%]) and housekeeping (149 [24%] vs 161 [5%]). On multivariable analyses, factors independently associated with career satisfaction were generally similar between genders. Stronger collegial support of work-life integration efforts was significantly associated with higher career satisfaction for both genders (P < .001), although the odds ratio (OR) for women was higher than for men (OR, 4.52; 95% CI, 2.60-7.87 vs OR, 2.45; 95% CI, 1.88-3.21). For men and women, increasing age was significantly associated with higher career satisfaction (men: OR, 1.04; 95% CI, 1.03-1.05; P < .001; women: OR, 1.04; 95% CI, 1.02-1.06; P = .001), and insufficient time for family owing to work was associated with lower satisfaction (men: OR, 0.66; 95% CI, 0.49-0.90; P = 009; women: OR, 0.49; 95% CI, 0.30-0.81; P = .006). For women only, there was a significant association between primary responsibility for at least 1 household chore and lower career satisfaction (OR, 0.66; 95% CI, 0.45-0.98; P = .04).
In this study, although women had relatively lower surgical career satisfaction than men, the associations between career satisfaction and personal life factors were largely similar. Collegial support of work-life integration efforts appeared to be the most influential factor, particularly for women. Optimization of work-life integration may not only decrease physician burnout but also promote gender equity in surgery.
重要性：美国外科医生的倦怠现象令人震惊地高，尤其是女性，工作与生活的冲突导致职业满意度下降。
目的：评估外科医生职业满意度与个人生活因素（如业余爱好、家务和育儿责任的时间要求）之间的关系，并探讨男性和女性之间的相似点和不同点。
设计、地点和参与者：这是一项针对美国外科医生的横断面调查研究，于 2018 年 6 月 4 日至 8 月 1 日期间进行。研究人员向美国外科医生学院的 25748 名研究员发送了一份 257 项的在线调查问卷。2019 年 8 月 13 日至 11 月 4 日进行了 31 项的子分析。
主要结果和测量：职业满意度的程度通过 5 点李克特量表进行测量。采用性别分层多变量比例优势模型评估与职业满意度相关的专业和个人生活因素。
结果：在 3807 名受访者中，3166 名自认为是男性（83%），639 名（17%）是女性。报告职业满意度较低的女性比例（483[77%]比 2514[82%]）相对较高，因工作而导致个人生活中断的比例也较高（315[50%]比 1381[45%]）。报告主要负责准备饭菜的女性比例较高（282[46%]比 355[12%]）和家务（149[24%]比 161[5%]）。在多变量分析中，性别之间与职业满意度相关的因素总体上相似。更强的工作-生活整合努力的同事支持与男性和女性的职业满意度显著相关（P < .001），尽管女性的优势比（OR）高于男性（OR，4.52；95%CI，2.60-7.87 vs OR，2.45；95%CI，1.88-3.21）。对于男性和女性来说，年龄的增长与更高的职业满意度显著相关（男性：OR，1.04；95%CI，1.03-1.05；P < .001；女性：OR，1.04；95%CI，1.02-1.06；P = .001），而工作导致家庭时间不足与满意度降低相关（男性：OR，0.66；95%CI，0.49-0.90；P = 0.09；女性：OR，0.49；95%CI，0.30-0.81；P = .006）。仅对女性而言，至少一项家务的主要责任与较低的职业满意度之间存在显著关联（OR，0.66；95%CI，0.45-0.98；P = .04）。
结论和相关性：在这项研究中，尽管女性的外科职业满意度相对男性较低，但职业满意度与个人生活因素之间的关联在很大程度上是相似的。工作-生活整合努力的同事支持似乎是最有影响力的因素，尤其是对女性而言。优化工作-生活整合不仅可以减少医生的倦怠，还可以促进外科领域的性别平等。
