Survey: Surgeons bemoan reimbursement, work hours

San Francisco-Surgeons are generally happy with their chosen profession, but there is significant dissatisfaction when it comes to hours worked and reimbursement. Those who are unhappy with their reimbursement are nearly six times more likely to be unhappy with their career, and surgeons who work in a non-university setting are three times more likely to be unhappy with their career than surgeons who work in a university or Veterans Health Administration setting are.

These results are part of the national Lifestyles in Surgery Today (LIST) survey conducted by researchers at the University of California Davis Medical Center, Sacramento, and the American College of Surgeons. LIST is designed to study surgeons' current levels of satisfaction with their career and lifestyle and identify risk factors for dissatisfaction and an inability to balance work and life.

Kathrin Troppmann, MD, associate professor of surgery at UC Davis, discussed the study results at the American College of Surgeons Clinical Congress here.

The supply of surgeons has dropped in recent years, she noted. Factors contributing to the shortfall include declining interest in surgery among medical students due to lifestyle concerns, as well as burnout, career changes, and early retirement. The average retirement age for surgeons is only 57, she noted.

On the demand side, all indicators point upward. The U.S. population is projected to increase by approximately 25 million per decade through the middle of the century. The number of adults age 65 and older will nearly double from 38 million today to 78 million by 2030, and will account for the greatest consumption of medical resources, including surgery, Dr. Troppmann said.

The challenge for the American College of Surgeons is to maximize recruitment of medical students into surgery and maximize retention among surgeons already in practice.

In the LIST initiative, researchers mailed a survey to all surgeons who were certified by the American Board of Surgery in 1988, 1992, 1996, 2000, and 2004. Covariates for the multivariate analysis for career dissatisfaction and work-life balance included such demographic factors as gender, marital status, having or not having children, and ABS certification vintage as a surrogate for generation: 1988 to 1996 for baby boomers versus 2000 to 2004 for Generation Xers. Other covariates included specialization, practice setting, practice location, and satisfaction with reimbursement.

Chequered satisfaction

Among respondents, mean age was 46 years, and 80% practiced in a non-university or non-VA setting, and 45% were general surgeons.

While 85% of respondents said they were satisfied with their career as surgeons, dissatisfaction with specific career aspects was rampant. Respondents reported working a mean of 64 hours weekly compared to an ideal load of 50 hours. More than two-thirds were satisfied with the 20 weekly hours spent with family and friends, but 60% were dissatisfied with the 4 hours spent on hobbies or recreation.

When it came to reimbursement, nearly three-fourths were dissatisfied with the total hours worked, the irregularity of their working schedule, and the responsibility.

"Most surgeons are satisfied, and that's good to point out to students considering surgery," Dr. Troppmann said. "But only 50% of surgeons would work more hours. They don't want to cut even more deeply into their private lives."

The survey also showed that dissatisfaction with reimbursement and working outside a university or VA setting were the only significant risk factors for career dissatisfaction. Surgeons who were dissatisfied with reimbursement were almost six times more likely to be dissatisfied with their career, while those who practiced in a non-university setting were three times more likely to be dissatisfied with their career.