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Physician burnout in ophthalmology: U.S. survey

Sedhom, Jessica A. MS; Patnaik, Jennifer L. PhD; McCourt, Emily A. MD; Liao, Sophie MD; Subramanian, Prem S. MD, PhD; Davidson, Richard S. MD; Palestine, Alan G. MD; Kahook, Malik Y. MD; Seibold, Leonard K. MD

Author Information
Journal of Cataract & Refractive Surgery: June 2022 - Volume 48 - Issue 6 - p 723-729
doi: 10.1097/j.jcrs.0000000000000837
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The term burnout was first coined in 1974 by psychiatrist Herbert J. Freudenberger. He observed how his patients were so listless that they would light cigarettes and forget to smoke them, letting them literally burnout.1 Burnout syndrome is now defined as a work-related disorder characterized by depersonalization, stress, and emotional exhaustion. Recently, in May 2019, the World Health Organization added burnout to the 11th revision of the International Classification of Diseases, thus inaugurating the term as a diagnosable condition.2

Burnout symptoms are well classified for their association with higher risk for alcohol abuse, depression, and suicide.3,4 The literature indicates physician burnout is significantly associated with increased medical errors, decreased patient satisfaction, and overall suboptimal patient care. 5–7 Furthermore, burnout needs to be addressed because of economic concerns. Burnout is associated with reduced physician productivity, increased physician turnover, and increased malpractice suits.8–10 In addition, the cost of recruiting, hiring, and training doctors and ancillary staff and the increased patient workload in the interim financially incentivizes large healthcare systems to address widespread burnout.11

Although the prevalence of physician burnout in general has been well described, to our knowledge, study data focusing on ophthalmology specifically have been limited. According to a recent online survey in 2020, ophthalmology was among the least burned out specialties (30%); however, this remains considerably high compared with nonphysicians.12 A study of ophthalmology residents in the United States found burnout symptoms in as many as 63% of respondents.13 A survey in India found burnout in approximately 1 in 4 physicians, with higher rates among female ophthalmologists.14 Despite the notion that ophthalmologists generally garner high patient satisfaction and a more favorable lifestyle, the objectively high incidence of burnout testifies to the unsettling normalization of this condition.

To the authors’ knowledge, a targeted, comprehensive study quantifying burnout among practicing ophthalmologists in the United States has not been performed. The aim of this study was to determine the prevalence of physician burnout among ophthalmologists in the United States and identify characteristics that place physicians at a higher risk for experiencing such symptoms.

METHODS

In accordance with ethical guidelines, approval for this study was obtained prior to survey distribution from the Colorado Multiple Institutional Review Board (Submission ID #APP001-1; June 10, 2019). This research was compliant with the Health Insurance Portability and Accountability Act and adhered to the tenets of the Declaration of Helsinki. All participants provided informed consent.

Participants completed a modified Mini Z burnout survey, a 10-item questionnaire measured in 5-point Likert scales that assesses the outcomes and drivers of burnout. The survey included all 10 of the original questions of the Mini Z survey; however, the final open-ended question “Please tell us about your stressors and potential solutions” was omitted. In addition to this, several questions regarding physician demographics, clinical practice, and lifestyle were added (See Supplemental Table 1, https://links.lww.com/JRS/A488). The survey was distributed by email using the respective listservs of the following ophthalmic organizations: American Society of Cataract and Refractive Surgery (∼6800 members), American Glaucoma Society (∼1470 members), American Association for Pediatric Ophthalmology and Strabismus (∼1400 members), American Society of Ophthalmic Plastic and Reconstructive Surgery (∼800 members), American Uveitis Society (∼230 members), North American Neuro-Ophthalmology Society (∼800 members), and the CEDARS/ASPENS society (∼83 members). Data were collected anonymously through surveymonkey.com (San Mateo, California). A total of 2 reminder emails were sent before the survey was closed for a total survey duration of 25 days (January 24, 2020 through February 17, 2020).

Historically, the Maslach Burnout Inventory (MBI), a 22-item survey, has been commonly used as a research tool to assess 3 components of burnout syndrome: emotional exhaustion, depersonalization, and reduced personal accomplishment. Despite the widespread use of this inventory, the goal of this particular study was to not only quantify burnout but emphasize the potential drivers of this condition. For this reason, the Mini Z Burnout Survey was chosen over other surveys such as MBI. The Mini Z was designed to assess 3 outcomes: stress, burnout, and job satisfaction, in addition to the 7 drivers of burnout (control, chaos, time pressure, teamwork, electronic health record [EHR] use at home, EHR proficiency, and values alignment).15 Furthermore, the single-item burnout measure (item 3) has been externally validated with the emotional exhaustion item of MBI.16 Because the Mini Z survey relies on each respondent to use their own definition of burnout in item 3, survey results are limited by subjective bias. The Mini Z is the standard burnout survey used by the American Medical Association.

The inclusion criterion was any self-identified ophthalmologist by training. Neuro-ophthalmologists identified as neurologists were excluded from this study. Participants who did not complete the demographic portion of the survey are noted as missing for these characteristics in the tables. Of note, the American Association for Pediatric Ophthalmology and Strabismus contains some international members and may not fully represent the state of burnout among American physicians alone.

Self-reported burnout was defined and classified as reporting the following answers to Question 3 on the survey: “C–I am definitely burning out and have one or more symptoms of burnout, for example, emotional exhaustion” (mild), “D–The symptoms of burnout that I am experiencing won't go away. I think about work frustrations a lot” (moderate), and “E–I feel completely burned out. I am at the point where I may need to seek help” (severe).

Basic frequencies and percentages are presented for self-reported burnout and other survey questions that are categorical. Means and SDs are reported for continuous variables and Likert scale items. Univariate and multivariate logistic regression models were used with odds ratios and 95% confidence limits to compare prevalence of self-reported burnout by demographic and practice characteristics. Likert scale items were compared between participants who self-reported burnout with those who did not with means, 95% confidence limits, and the Wilcoxon rank-sum test.

RESULTS

A total of 592 ophthalmologists responded to the survey. Most of the respondents were men (63.3% [343]), White (76.5%, 411), and married (88.3%, 483). Complete demographic characteristics for all participants and those reporting burnout are listed in Table 1. In total, 224 respondents (37.8%; 95% CI: 33.9%-41.7%) self-reported symptoms of burnout. Among those reporting burnout, most were categorized as mild (65.2%, 146/224), followed by moderate (29.5%, 66/224) and severe (5.4%, 12/224). Female ophthalmologists reported significantly higher rates of burnout compared with men (46.2% vs 31.2%, 92/199 vs 107/343, respectively). Several other demographic factors, including race/ethnicity, marital status, healthcare occupation of spouse, number of children, average annual salary, and population of practice location were analyzed for their possible associations with burnout symptoms; however, none of these were significantly associated with prevalence of burnout (Table 1).

Table 1. - Demographic Characteristics and Rate of Self-Reported Burnout.
Respondent characteristic n (%) Burnout, n (%) OR (95% CI) P value
Total 592 224 (37.8)
Sex
 F 199 (36.7) 92 (46.2) 1.9 (1.3, 2.7) .0005
 M 343 (63.3) 107 (31.2) Ref
 Missing 50 25 (50.0)
Race/ethnicity
 White 411 (76.5) 147 (35.8) Ref
 African American 10 (1.9) 4 (40.0) 1.2 (0.3, 4.3) .783
 Hispanic 23 (4.3) 6 (26.1) 0.6 (0.2, 1.6) .348
 Asian 93 (17.3) 37 (39.8) 1.2 (0.7, 1.9) .468
 Missing 55 30 (54.6)
Marital status
 Single 36 (6.6) 15 (41.7) 1.2 (0.6, 02.5) .531
 Married 483 (88.3) 176 (36.4) Ref
 Other a 28 (5.1) 11 (39.3) 1.1 (0.5, 2.5) .761
 Missing 45 22 (48.9)
Spouse also in healthcare
 Yes 196 (40.2) 73 (37.2) 1.1 (0.7, 1.6) .657
 No 292 (59.8) 103 (35.3) Ref
 Missing 104 48 (46.2)
Children, n
 Mean (SD) 2.1 (1.2) 2.0 (1.3) 0.9 (0.8, 1.1) .369
 Missing 69 32
Avge annual salary, k
 $50, $100 25 (4.7) 11 (44.0) 1.6 (0.7, 3.8) .297
 $100, $200 59 (11.1) 22 (37.3) 1.2 (0.6, 2.3) .573
 $200, $300 154 (29.0) 62 (40.3) 1.4 (0.8, 2.2) .215
 $300, $400 110 (20.7) 36 (32.7) 1.0 (0.6, 1.7) .955
 $400, $500 57 (10.7) 24 (42.1) 1.5 (0.8, 2.8) .238
 +$500 127 (23.9) 42 (33.1) Ref
 Missing 60 27 (45.0)
Population size, k b
 <50 21 (3.8) 7 (33.3) 0.7 (0.3, 1.9) .536
 50, 200 100 (18.2) 35 (35.0) 0.8 (0.5, 1.3) .358
 200, 800 142 (25.9) 45 (31.7) 0.7 (0.5, 1.1) .087
 >800 286 (52.1) 115 (40.2) Ref
 Missing 43 22 (51.2)
OR = odds ratio; Ref = reference
aIncluded 22 divorced, 3 widowed, 3 civil union
bOf city where pracatice located

Among ophthalmology subspecialties, burnout rates ranged from a low of 30.8% (12/39) for vitreoretinal specialists to a high of 45.4% (30/66) for uveitis specialists. The self-reported burnout rates by specialty are shown in Figure 1. The only subspecialty not reporting burnout was ophthalmic pathology; however, there were only 5 respondents in this group. General ophthalmologists were not specifically identified in this study; however, participants who did not select a fellowship training (n = 89) had a burnout rate (44.9%, 40/89) that was similar to respondents reporting specialties (Table 2). The analysis indicated no single subspecialty as significantly associated with burnout (Table 2).

F1
Figure 1.:
Self-reported burnout rates by subspecialty in ophthalmology. No statistically significant difference of burnout rates was detected between subspecialties.
Table 2. - Characteristics of Practice and Rate of Self-Reported Burnout.
Respondent characteristic n (%) Burnout, n (%) OR (95% CI) P value
Fellowship trained in
 Vitreoretinal 39 (7.8) 12 (30.8) 0.8 (0.4, 1.5) .434
 Glaucoma 121 (24.1) 44 (36.4) 1.0 (0.6, 1.5) .955
 Pediatric 162 (32.2) 60 (37.0) 1.0 (0.7, 1.5) .883
 Cornea/refractive 47 (9.3) 15 (31.9) 0.8 (0.4, 1.5) .486
 Neuro-ophthalmology 68 (13.5) 29 (42.6) 1.3 (0.8, 2.3) .265
 Uveitis 66 (13.1) 30 (45.4) 1.5 (0.9, 2.6) .110
 Oculoplastics/orbital 66 (13.1) 27 (40.9) 1.2 (0.7, 2.1) .434
 Pathology 5 (1.0) 0 (0)
 Missing 89 40 (44.9)
Practice type
 Academic 190 (32.1) 81 (42.6) 2.0 (1.2, 3.2) .007
 Hospital based 59 (10.0) 28 (47.5) 2.4 (1.3, 4.6) .008
 Solo 64 (10.8) 18 (28.1) 1.0 (0.5, 2.0) .918
 Small private group 113 (19.1) 41 (36.3) 1.5 (0.9, 2.6) .144
 Large private group 124 (21.0) 34 (27.4) Reference
 Missing 42 22 (52.4)
Employed or owner
 Employed 315 (53.2) 127 (40.3) 1.4 (1.0, 2.1) .044
 Owner 235 (39.7) 75 (31.9) Reference
 Missing 42 22
Surgeries performed/wk, n
 None 58 21 1.0 (0.5, 1.9) .964
 0-5 170 61 Reference
 5-10 154 63 1.2 (0.8, 1.9) .353
 10-15 88 31 1.0 (0.6, 1.7) .917
 15-20 38 14 1.0 (0.5, 2.2) .911
 20+ 43 12 0.7 (0.3, 1.4) .327
 Missing 41 22 (53.7)
Years in current role 14.2 (11.0) 14.1 (10.1) 1.0 (1.0, 1.0) .855
Days in clinic/wk 4.2 (4.5) 4.3 (5.1) 1.0 (1.0, 1.0) .594
OR = odds ratio

The mean scores of all Likert scale items of the Mini Z burnout survey are displayed in Figure 2. Participants self-reporting burnout showed significant associations with all Likert scale items of the Mini Z burnout survey (P < .0001) with the exception of proficiency with EHR (P = .564). Respondents experiencing burnout reported less/worse job satisfaction, control over workload, time for documentation, team efficiency, and alignment of professional values to department leaders and a more hectic work atmosphere, greater stress because of their job, and more time spent on EHR at home.

F2
Figure 2.:
Mean Likert scale of potential drivers of burnout according to the presence of self-reported burnout. Items 1—10 indicate the individual Mini Z survey questions with item 3 (the single-item burnout measure) excluded from this figure.

Sex was associated with self-reported burnout. Although a relatively smaller proportion of female ophthalmologists responded to our survey compared with men (n = 199 compared with n = 343, respectively), women reported higher rates of burnout symptoms. Women had nearly twice the odds of reporting burnout (OR = 1.9 [95% CI: 1.3-2.7); P = 0.0005; Table 1). As noted in Table 3, women were more likely to report increased symptoms of burnout, overall stress, and misalignment with departmental leaders and decreased job satisfaction, control over workload, time for documentation, workplace stability, and healthcare team efficiency, when compared with men. Indeed, there was a significant sex disparity in the first 7 items of the Mini Z burnout survey (Table 3); however, there were no statistically significant differences across sex relative to EHR time and proficiency (items 9 and 10). Women were more likely to report practicing in academic (43.2%, 86/199 of women vs 29.2%, 100/343 of men) and hospital-based settings (15.6%, 31/199 of women vs 7.9%, 27/343 of men); however, these clinic settings remained significant predictors of burnout even after adjustment for sex (P = .020 and P = .019, respectively).

Table 3. - Reporting of Categorized Likert Scale Items by Sex.
Item number Total
N = 592
Women
n = 199
Men
n = 342
Chi-square P value
n (%)
1. Overall, I am satisfied with my current job (strongly agree, agree) 440 (74.4%) 139 (69.8%) 264 (77.2%) .059
2. I feel a great deal of stress because of my job (strongly agree, agree) 320 (54.2%) 125 (62.8%) 168 (49.1%) .002
3. Symptoms of burnout (completely, Won’t go away, definitely) 224 (37.8%) 92 (46.2%) 107 (31.2%) .0005
4. My control over my workload (poor, marginal) 190 (32.2%) 76 (38.2%) 91 (26.6%) .005
5. Sufficiency of time for documentation (poor, marginal)  321 (54.2%) 119 (59.8%) 173 (50.4%) .035
6. Which number best describes the atmosphere in your primary work area (hectic/chaotic) 112 (19.0%) 47 (23.7%) 54 (15.7%) .022
7. My professional values are well aligned with those of my department leaders (strongly agree, agree) 390 (65.9%) 121 (60.8%) 242 (70.6%) .020
8. The degree to which my care team works efficient together (optimal, good, satisfactory) 503 (85.0%) 161 (80.9%) 304 (88.6%) .013
9. The amount of time I spend on the EHR at home (excessive, high, moderate) 252 (47.6%) 84 (47.5%) 141 (46.2%) .794
10. My proficiency with EHR use (optimal, good, satisfactory) 495 (85.0%) 170 (86.3%) 282 (83.9%) .463
EHR = electronic health record; OR = odds ratio

Practice characteristics of all respondents and those reporting burnout are listed in Table 2. Most of the respondents were employed (ie, not an owner) (53.2%, 315/592) and in an academic practice (32.1%, 190/592) or large private group (21.0%, 124/592). Physicians employed in academic (OR = 2.0 [95% CI: 1.3.2]; P = .007) or hospital-based facilities (OR = 2.4 [95% CI: 1.3-4.6]; P = .008) reported higher rates of burnout compared with large private groups. Similarly, employed physicians reported higher rates of burnout (40.3%, 127/315) when compared with physicians who owned their practices (31.9%, 75/235) (OR = 1.4 [95% CI: 1.0-2.1]; P = .044).

These data indicated that EHR plays a variable role in contributing to physician burnout among ophthalmologists. The final item of the Mini Z survey (item 9 in Supplemental Table 1, https://links.lww.com/JRS/A488) regarding proficiency with EHR was the only item not significantly associated with self-reported burnout (P = .164); however, increased use of EHR at home was significantly associated with burnout (P < .0001; Figure 2). Furthermore, doctors who use scribes reported a lower rate of burnout compared with physicians who did not, but this difference was not statistically significant (P = .062; Table 2).

DISCUSSION

Our study confirms the significant rates of burnout prevalent among ophthalmologists in the United States. Among the 37.8% of ophthalmologists self-reporting burnout, most were classified as mild, with approximately one third being moderate or severe. Specifically, female physicians and employed nonowner physicians practicing in academic or hospital-based facilities were at the highest risk for reporting burnout. Factors such as poor job satisfaction, high stress, increased time burdens for documentation, and lack of control over workload were significantly associated with self-reported burnout. To the authors’ knowledge, this study is the first to comprehensively quantify burnout among the U.S. ophthalmologists and identify the aforementioned risk factors.

The high prevalence of physician burnout is in accordance with other surveys to-date. According to a Medscape 2019 survey, more than 40% of ophthalmologists were reporting burnout; however, only 23% report seeking professional help for it.12 In a study of burnout in ophthalmologists in India, 25.2% reported being affected.14 In that same study, 68.4% of female ophthalmologists reported sex-based inequalities.14 Previously, a meta-analysis of 9 total studies reported significant rates of burnout in ophthalmology (effective size = 0.41; CI [0.26-0.56]), with a high prevalence of emotional exhaustion, depersonalization, and low sense of personal accomplishment among 1408 subjects.17 Of the 9 included studies, 5 were from the United States, including 3 regarding resident physicians only and 1 regarding academic chairs only. Although this meta-analysis is in overall agreement with the results of our investigation, comparison of methods and demographics are limited because of study heterogeneity.

Our data indicated autonomy and workplace control as major factors driving burnout. Studies suggest that burnout symptoms begin as early as when in the medical school. One study of medical students found approximately 50% experience burnout and 11% reported suicidal ideation within the past year.18 This phenomenon continues in residency and persists into everyday practice.19,20 In a study of burnout among ophthalmology residents in Saudi Arabia, 41% of ophthalmology residents scored a positive burnout result on the common subscales of either emotional exhaustion and/or depersonalization.21 Further analysis of this group revealed work hours and on-call duty were associated with higher rates of burnout. Similar results were concluded among the U.S. ophthalmology residents where 63.3% reported at least 1 symptom of burnout.13 In a prospective cohort study where physicians were surveyed in medical school and then again during year 2 of residency, ophthalmology residents were at a higher relative risk for reporting burnout symptoms compared with other clinical specialties with a burnout prevalence of 55.8%.17,22 In a survey of the U.States. ophthalmic residents, only 26.7% of respondents reported a formal resident wellness program despite the fact 68.4% reported depression, burnout, or suicide. These alarmingly high rates are in contrast to those of academic department chairs in ophthalmology, where only 9% reported experiencing burnout based on their MBI surveys.23 Together, these data suggest that burnout in ophthalmology may be most pervasive earlier in careers and decrease with increasing autonomy and control over time. For this reason, burnout symptoms should be addressed early on in medical education with a greater emphasis on resident wellness programs.

Female ophthalmologists are nearly twice as likely to self-report burnout compared with men. This finding among the U.S. ophthalmologists is in accordance with the previously reported higher incidence of burnout among female ophthalmologists in India.14 The increased prevalence of burnout among women is not unique to country or specialty with widespread sex disparities well quantified.24–27 The reason behind this may lie in the gendered nuances of reporting itself. In a recent meta-analysis of the relationship between sex and burnout, results indicate that women are more likely to report emotional exhaustion, whereas men are more likely to report depersonalization.28 Several studies indicate gender expectations in the physician–patient relationship may also be contributing to the difference. One such study indicated female physicians spent, on average, more time counseling patients, resulting in increased time pressure, decreased workflow, and increased physician stress.29 Other studies indicate female doctors are more likely to experience discrimination and sexual harassment compared with men, which may be further contributing to a stressful work atmosphere.30 A global meta-analysis concluded that physicians were at 1.44 times greater risk for committing suicide compared with nonphysicians, with women more than twice as likely to commit suicide compared with their nonmedical, female counterparts.4 Ultimately, it is likely a myriad of factors such as work-life integration, sexual harassment and discrimination, gendered expectations, and reporting bias that all contribute variable degrees to the higher rates of self-reported female physician burnout. The precise reasons that burnout is disproportionately affecting female ophthalmologists warrant further research. As of 2015, women made up 22.7% of all ophthalmologists in the United States.31 In this survey, 36.7% of total respondents were women, suggesting our results may be prone to selection bias. Of note, other demographic factors including race/ethnicity, annual salary, city of practice, number of children, and marital status were not significantly associated with self-reported burnout. It is difficult to draw conclusions regarding race given the small number of African American and Hispanic participants, and more targeted research is warranted. Most of the respondents in this study identified as White (76.5%), which slightly overestimates the 72.7% of White practicing ophthalmologists in the United States as of 2015.

Our data indicated that ophthalmologists practicing in hospital-based and academic institutions were associated with higher rates of self-reported burnout when compared with those in private practice. Other studies indicate hospital-owned practice is positively associated with burnout even after controlling for personal characteristics and practice organization.32 This relationship is particularly concerning given the current movement in medicine away from private practice entirely. In a single year (2012 to 2013), solo practitioners decreased from 21% to just 15% of the total physician workforce, which was accompanied by an increase of hospital-based physicians from 20% to 26%.9 In the latest Physician Practice Benchmark survey from the American Medical Association, the trend continues with 34.7% of doctors working for a hospital or a practice partly owned by a hospital, a stark increase from the 29% reported in 2012.33

As the physician pool continues to trend away from private practice, the disproportionately higher burnout rates among employed and hospital-based ophthalmologists will become even more pertinent. Ultimately, because burnout syndrome is a specifically work-related condition, systemic response from the hospital systems and academic institutions that directly employ these individuals would be beneficial.

The specific underlying cause of greater burnout in ophthalmologists who are employed or part of a hospital-based practice is unclear. The lower rates of burnout among ophthalmologists in private practice suggests that physician autonomy may be key in reducing burnout symptoms. Furthermore, a poor work control, chaotic work environment, and inefficient care team were significantly associated with self-reported burnout. Combined, these data suggest that it may not be so much the workload itself but a perceived lack of control over that work among hospital-based ophthalmologists. Increased bureaucratic demands, misalignment with hospital administrators, and lack of choice over patient scheduling and ancillary staff may be at the root of this relationship. Among academic institutions particularly, the time constraint of educating medical students, residents, and fellows should be evaluated for its effect on stress, workflow, and documentation. Altogether, more research is necessary to validate the exact causes of the burnout disparity among practice types and employment status. In addition, it would be interesting to explore the role of se, specifically within academic and hospital-based facilities.

Among other factors, our results indicate that an inability to work efficiently with a healthcare team, lack of time for documentation, and amount of time spent on EHR are significant drivers of self-reported burnout among ophthalmologists. The emphasis of interpersonal communication between physicians, administrators, and allied ophthalmic personnel, including technicians and scribes, is essential to mitigating the effects of burnout.34 In a study conducted by the Association of Technical Personnel in Ophthalmology, poor management was cited as the number one cause of ophthalmic technicians leaving a practice.35 Greater efforts to invest, retain, and support ancillary staff may help mitigate the effects of self-reported burnout among ophthalmologists. Physicians who employed scribes reported slightly lower rates of burnout, although this difference did not reach statistical significance (P = .06). These data suggest that the use of scribes may help in alleviating EHR burden, which is a known driver of burnout. More research with larger sample sizes is warranted to further characterize the effect medical scribes may play in burnout prevention, particularly investigating scribes in private practice vs hospital settings using items 8 and 9 of the Mini Z Burnout survey.

Regarding subspecialty, rates of burnout were similar between all groups. A notable limitation of the study is that general ophthalmologists were not specifically identified in this study. However, respondents that did not indicate fellowship training had a similar burnout rate to other subspecialties, indicating the condition can equally affect ophthalmologists in all fields.

The importance of quantifying burnout and its drivers is further relevant in the context of the COVID-19 global pandemic. Factors such as increased use of telehealth, decreased elective surgery, healthcare uncertainty, and impracticality conducting eye examinations under telehealth protocols may be further exacerbating symptoms of burnout. Of note, our survey data are limited to before the onset of the major effects of the pandemic in the United States with the last response submitted on February 17, 2020. Therefore, survey responses were completed nearly 1 month before the World Health Organization declared COVID-19 a global pandemic on March 11, 2020.36 Future studies assessing the effect of the pandemic on burnout would be worthwhile.

WHAT WAS KNOWN

  • Historically, ophthalmology is considered a relatively high-satisfaction and favorable lifestyle specialty within medicine.
  • To the authors’ knowledge, a targeted study to quantify self-reported burnout among ophthalmologists in the United States has not been performed.

WHAT THIS PAPER ADDS

  • Approximately 37.8% of ophthalmologists surveyed reported symptoms of burnout in the United States.
  • Female ophthalmologists are nearly twice as likely to report symptoms of burnout.
  • Participants working in academic and hospital-based facilities reported higher rates of burnout compared with those working in private practices.

Acknowledgments

Dr. Mark Linzer and colleagues at Hennepin County Medical Center for their design of the original Mini Z survey.

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