Keywords
burnout syndrome - emotion exhaustion - depersonalization - personal accomplishment - neurosurgeons
Introduction
Burnout syndrome (BOS) is a condition characterized by physical, mental, and emotional exhaustion (EE) resulting from prolonged exposure to emotionally demanding situations.[1] It has serious negative consequences, including deteriorating health, irritability, mood swings, a lack of enthusiasm, and reduced initiative, which can ultimately lead to depression. Burnout in neurosurgeons is an important and increasingly recognized issue in the health care field. Neurosurgeons face unique challenges that contribute to a higher risk of burnout compared with other medical specialties.[2] These challenges include long and irregular working hours, high-stress situations, demanding surgeries, and the pressure of making life-or-death decisions. Additionally, neurosurgeons may experience emotional and psychological strain from dealing with severe patient outcomes,[3]
[4] such as traumatic brain injuries or life-altering neurological conditions. Several factors contribute to burnout in neurosurgeons—workload and time pressure: neurosurgeons often have to manage complex cases and long hours in the operating room, leading to mental and physical exhaustion. Their workday can be unpredictable, and the need to balance surgery, patient consultations, and administrative tasks can create a sense of overload. Emotional stress: neurosurgeons frequently deal with patients in critical conditions, and the emotional toll of seeing patients suffer, or dealing with complications, can lead to feelings of helplessness and burnout. The nature of neurological cases, which often involve significant quality-of-life implications, can also be emotionally draining. High expectations and responsibility: neurosurgeons are often under immense pressure due to the critical nature of their work. They are expected to perform with precision and competence, which can lead to stress. This sense of responsibility can contribute to a feeling of constant pressure, which increases the risk of burnout. Lack of work-life balance: given the intensity and demands of neurosurgery, many neurosurgeons struggle to maintain a healthy work-life balance. This imbalance contributes significantly to burnout, as personal well-being can be sacrificed in favor of professional duties. Limited mental health support: the demanding nature of the profession sometimes makes it difficult for neurosurgeons to seek support for mental health issues. The stigma around seeking help, particularly in a high-stakes field like surgery, can make it harder for individuals to address the early signs of burnout.[5]
[6] The European General Practice Research Network Burnout Study Group, which surveyed 1,400 family physicians across 12 European countries, found that 43% experienced high EE, 40% had high depersonalization (DP), and 30% reported low personal accomplishment (PA), with 12% experiencing burnout across all three dimensions.[7] Additionally, a U.K. study involving over 500 physicians found that at least one-third showed signs of burnout.[8] Despite these widespread findings, there is limited research on BOS specifically among Thai neurosurgeons, who are often tasked with managing complex cases, such as traumatic brain injuries and other neurological surgeries. This study aims to assess the prevalence of BOS among Thai neurosurgeons and identify the contributing factors. The goal is to provide insights that will help prevent burnout and improve the well-being and performance of neurosurgeons in Thailand.
Materials and Methods
Study Design and Population
This study employed a cross-sectional analytic design to assess burnout among Thai neurosurgeons. Data were collected through electronic surveys. Participants were selected using simple random sampling from an email register maintained by the Royal College of Neurosurgeons of Thailand, which included active members from 2011 to 2024. The study followed the ethical guidelines set by the Institutional Review Board of the Royal Thai Army Medical Department's Ethics Committee.
Participants were Thai neurosurgeons working in various medical settings, including medical schools, provincial hospitals, regional hospitals, and large private hospitals. The inclusion criteria required participants to be practicing neurosurgeons, while exclusion criteria included individuals under 18 years of age, those who did not consent to participate, and nonspecialized physicians.
Sample size calculations were based on a previous study,[3] which found a high level of EE at 17.1% among Thai psychiatrists. Given this finding, the minimum sample size was calculated to be 40 participants. The final sample was selected based on the approved criteria, and participants were fully informed about the study's objectives and provided voluntary informed consent.
Data Collection
Data were collected using a self-report questionnaire consisting of four sections: including basic information, this section included eight items that collected general demographic data, including age, sex, marital status, hospital type, position, subspecialty, work experience, and salary. Work characteristics, this section contained 25 items relating to various aspects of the work environment, including hospital bed capacity, patient admission rates, patient care demands, number of health care assistants, and work hours. Personal data, this section contained nine items related to personal background, such as stress-related factors and family situation. Burnout assessment, the Maslach Burnout Inventory-Human Services Survey (MBI-HSS),[9] Thai version, was used to assess burnout. The MBI-HSS contains 22 items, covering three dimensions, EE, DP, and reduced PA. Each item is rated on a 7-point scale, with items in the top third indicating a higher risk of burnout (with PA items being reversed). The Thai version of the MBI-HSS was translated and validated by experts, demonstrating excellent reliability (Cronbach's α: EE = 0.92, DP = 0.66, PA = 0.65). Specific items used to assess each dimension are outlined in [Table 1]. The MBI is one of the most widely used instruments for assessing burnout in various professional settings, including health care. The inventory was developed by Christina Maslach and Susan Jackson in the 1980s and has been validated in many occupational groups, including medical professionals. The MBI is designed to measure burnout across three primary dimensions, EE, this dimension reflects the feelings of being emotionally drained or overwhelmed by one's work. It measures the extent to which individuals feel fatigued, depleted, or overextended in their work roles. DP, this dimension measures the development of negative, detached, or cynical attitudes toward patients or clients. It reflects a sense of detachment from others, including dehumanizing attitudes toward patients. Reduced PA, this dimension captures feelings of incompetence and a reduced sense of accomplishment in one's work. It measures how individuals perceive their effectiveness and achievement in their professional roles. Each dimension in the MBI is assessed using a 7-point Likert scale, where individuals rate their feelings and experiences on the job. The responses range from “never” (0) to “every day” (6), allowing for a detailed understanding of the frequency and intensity of burnout symptoms. EE, higher scores indicate greater EE, suggesting a higher risk of burnout. DP, higher scores suggest greater cynicism and detachment from patients or colleagues. PA, lower scores indicate a lower sense of accomplishment and personal effectiveness. In this study, the Thai version of the MBI-HSS was used to measure burnout among Thai neurosurgeons. The MBI-HSS includes a total of 22 items, and it has been extensively used in medical and health care settings, making it an appropriate tool for assessing burnout in neurosurgeons. The following dimensions were specifically assessed using the corresponding items: EE, items 1, 2, 3, 6, 8, 13, 14, 16, and 20; DP, items 5, 10, 11, 15, and 22; and PA, items 4, 7, 9, 12, and 17 to 21. By using the MBI-HSS, the study was able to measure burnout severity among Thai neurosurgeons and identify factors associated with burnout levels. It provides a reliable and validated means of understanding the extent of burnout in health care professionals and guides interventions to mitigate its impact.
Table 1
The 22-question assessment evaluates and scores the three dimensions of burnout: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA)
|
High
|
Average
|
Low
|
|
Emotional exhaustion (EE)
|
≥ 27
|
17–26
|
< 16
|
|
Depersonalization (DP)
|
≥ 13
|
7–12
|
< 6
|
|
Decreased personal accomplishment (PA)
|
< 31
|
32–38
|
> 39
|
Note: Scores are categorized as low (EE = 0–16, DP = 0–6, PA ≥ 39), moderate (EE = 17–26, DP = 7–12, PA = 32–38), or high (EE ≥ 27, DP ≥ 13, PA = 0–31).
Statistical Analysis
Descriptive statistics (e.g., percentages, means, and standard deviations) were calculated to present basic demographic data, work characteristics, personal information, and burnout levels. The prevalence of BOS was determined based on the presence of severe burnout indicators in at least one of the three dimensions (EE, DP, PA). Factors associated with BOS were analyzed using both univariate and multivariate logistic regression. Variance inflation factors were used to detect multicollinearity to ensure the validity of the regression results. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, with statistical significance set at p < 0.05. Data analysis was conducted using the STATA Program, Version 18. BOS was defined as the presence of at least one of the following three aspects of burnout among Thai neurosurgeons: EE, DP, or reduced PA. To improve the analysis, advanced statistical techniques, such as multivariate analysis, were applied to examine the interactions between various stressors. Factors like work hours, patient load, emotional strain, administrative burden, and institutional support were analyzed for their impact on burnout. Additionally, structural equation modeling was explored to examine the complex relationships between observed variables (e.g., work pressure) and latent variables (e.g., EE). Furthermore, longitudinal analysis could offer insights into how burnout develops and changes over time, providing a deeper understanding of its onset and progression.
Ethics Approval and Consent to Participate
This study received approval from the Thai Clinical Trials Registry Committee (protocol number TCTR20240917005) on September 17, 2024 and from the Ethics Committee of the Institutional Review Board of the Medical Department (protocol number IRBRTA 1816/2560). The study adhered to the Council for International Organizations of Medical Sciences Guidelines 2012 and Good Clinical Practice standards established by the International Conference on Harmonization. As no specific medical interventions were performed and the data were analyzed in an aggregated form without identifying individual participants, written informed consent was obtained from all participants. Data privacy and confidentiality were upheld throughout the study.
Results
Participant Characteristics
Since the establishment of the Royal College of Neurosurgeons of Thailand until 2017, the total number of Thai neurosurgeons available for contact was 333. A sample population was drawn from five hospitals, yielding 266 responses to the electronic survey, resulting in a response rate of 80%. The study included 266 participants, with an average age of 35 ± 7 years; 164 were males (61.65%). The majority were single (122 participants, or 46%), and most worked in medical schools (180 participants, or 68%). In terms of work experience, 106 participants (40%) had between 1 and 5 years of experience. Monthly income for 106 participants (40%) fell within the range of 50,000 to 60,000 Thai Baht. Most patients admitted to the neurological surgery department each month ranged from 41 to 60 cases (48%). On average, patients stayed in the department for 6 to 10 days (50%), with less than 20 patients requiring ventilator support in the intensive care unit (ICU) (44%). Thai neurosurgeons reported an average of 8.17 ± 5.27 overtime shifts per month and 1.42 ± 0.81 rest days per week. Notably, 60% of health care providers felt their weekly rest days were insufficient, and 52% believed their job responsibilities were excessive. Additionally, 64% expressed a desire to stop caring for patients in the ICU within the past year (see [Table 2]).
Table 2
Demographic data of 266 Thai neurosurgeons in this study
|
Demographic data
|
Total (n = 266)
|
|
Sex
|
|
Male
|
164 (61)
|
|
Age
|
|
Mean ± SD
|
35 ± 7
|
|
Status, no. (%)
|
|
Single
|
124 (46.62)
|
|
Divorced
|
82 (30.83)
|
|
Married with childless
|
28 (10.53)
|
|
Married with children
|
37 (14)
|
|
Workplaces, no. (%)
|
|
Medical school
|
180 (68)
|
|
Provincial hospital
|
47 (18)
|
|
Hospital center
|
26 (10)
|
|
Private hospital
|
10 (4)
|
|
Work experience, no. (%)
|
|
< 1 y
|
71 (27)
|
|
1–5 y
|
106 (40)
|
|
6–10 y
|
37 (14)
|
|
11–15 y
|
23 (9)
|
|
16–20 y
|
31 (12)
|
|
Monthly income, no. (%)
|
|
< 50,000 THB
|
55 (21)
|
|
50,001–60,000 THB
|
106 (40)
|
|
60,001–70,000 THB
|
39 (15)
|
|
> 70,000 THB
|
63 (24)
|
|
Average number of patients in service monthly, no. (%)
|
|
< 40
|
79 (30)
|
|
41–60
|
127 (48)
|
|
61–80
|
37 (14)
|
|
81–100
|
10 (4)
|
|
> 100
|
10 (4)
|
|
Average length of stay for a patient in service (d)
|
|
< 5
|
53 (20)
|
|
6–10
|
133 (50)
|
|
11–15
|
58 (22)
|
|
16–20
|
15 (6)
|
|
> 20
|
5 (2)
|
|
Average number of patients requiring ventilator in the ICU monthly, no. (%)
|
|
< 20
|
117 (44)
|
|
21–30
|
58 (22)
|
|
31–40
|
47 (18)
|
|
> 40
|
42 (16)
|
|
Average number of end-of-life care patients monthly, no. (%)
|
|
< 2
|
111 (42)
|
|
2–5
|
95 (36)
|
|
6–10
|
15 (6)
|
|
> 10
|
42 (16)
|
|
Average number of ICU deaths monthly, no. (%)
|
|
< 2
|
106 (40)
|
|
2–5
|
95 (36)
|
|
6–10
|
10 (4)
|
|
> 10
|
53 (20)
|
|
Average number of working hours per day, h (%)
|
|
< 8
|
26 (10)
|
|
8–10
|
34 (13)
|
|
10–12
|
93 (35)
|
|
> 12
|
113 (42)
|
|
Average number of cases operated per day (%)
|
|
< 2
|
98 (37)
|
|
2–5
|
109 (41)
|
|
6–10
|
30 (11)
|
|
> 10
|
29 (11)
|
|
Average number of patients seen in outpatient services per day (%)
|
|
< 20
|
45 (17)
|
|
20–30
|
125 (47)
|
|
30–40
|
55 (21)
|
|
> 40
|
41 (15)
|
|
In 1 month, how many shifts did you have to care for a patient
overtime?, no. (%)
|
8.17 ± 5.27
|
|
Mean
|
|
How many rest days do you receive on average weekly?, no. (%)
|
1.42 ± 0.81
|
|
Mean
|
Abbreviations: ICU, intensive care unit; SD, standard deviation.
Note: Values are presented as mean and mean ± SD. Overall, these demographic characteristics provide insights into the professional background and working conditions of the participating neurosurgeons.
Incidence of BOS
Overall, 138 participants (52%) experienced BOS. Specifically, 111 participants (42%) reported high levels of EE, 101 participants (38%) reported DP, and 122 participants (46%) experienced decreased PA. The distribution of BOS components classified by severity is detailed in [Table 3] and illustrated in [Fig. 1].
Table 3
Secondary outcomes in subgroup analysis of burnout syndrome in Thai neurosurgeons
|
Subgroup analysis of burnout syndrome
|
Mean
|
SD
|
Grading scale in stress related burnout syndrome
|
|
Low
|
Moderate
|
high
|
|
Emotional exhaustion
|
22.72
|
12.63
|
44 (33.59)
|
40 (30.53)
|
47 (35.88)
|
|
Depersonalization
|
5.57
|
5.04
|
89 (67.94)
|
23 (17.56)
|
19 (14.50)
|
|
Decreased personal accomplishment
|
32.57
|
7.79
|
22 (16.79)
|
44 (64.59)
|
65 (49.62)
|
Abbreviation: SD, standard deviation.
Note: Values are presented as mean or n (%).
Fig. 1 Secondary outcomes in components of burnout syndrome in Thai neurosurgeons.
Factors Associated with BOS among Thai Neurosurgeons
Multivariate logistic regression analysis for BOS: factors influencing BOS among Thai neurosurgeons included age > 40 years (adjusted OR = 2.6, p = 0.013), neurological surgery experience < 5 years (adjusted OR = 3.7, p = 0.03), perception of excessive workload (adjusted OR = 4.1, p = 0.04), income < 60,000 Baht (adjusted OR = 2.7, p = 0.03), considering quitting their neurosurgery job in the past year (adjusted OR = 14.6, p = 0.013), needing more than 2 days of vacation per week (adjusted OR = 6.8, p = 0.027), and patient length of stay > 10 days (adjusted OR = 2.3, p = 0.006). These results are summarized in [Table 4]. The subgroup analysis of BOS among Thai neurosurgeons revealed several notable secondary outcomes. Gender differences: male neurosurgeons exhibited higher rates of EE compared with their female counterparts. Workplace setting: those working in medical schools reported greater levels of DP than those in private or regional hospitals. Years of experience: neurosurgeons with less than 5 years of experience showed significantly higher levels of reduced PA compared with those with more experience. Income levels: participants with monthly incomes below 60,000 Baht were more likely to report severe burnout across all three dimensions (EE, DP, PA). Workload perception: neurosurgeons who perceived their workload as excessive had higher incidences of EE and DP. Patient care demands: increased patient admissions correlated with higher levels of burnout, particularly among those managing more than 60 cases monthly. These secondary outcomes provide further insights into the factors influencing BOS and highlight the need for targeted interventions based on specific subgroups within the population of Thai neurosurgeons. The analysis of BOS components among Thai neurosurgeons yielded several significant secondary outcomes. EE: a majority of participants reported high levels of EE, with notable correlations to perceived workload and years of experience. Those with less than 5 years of experience experienced higher EE compared with their more experienced colleagues. DP: participants working in medical schools exhibited elevated levels of DP. Additionally, those who perceived their patient load as excessive were more likely to report feelings of detachment and cynicism toward their patients. Reduced PA: many neurosurgeons expressed feelings of reduced PA, particularly among those considering leaving the profession. This dimension was closely linked to income levels, with those earning less than 60,000 Baht reporting lower feelings of achievement. Overall burnout prevalence: the analysis revealed that 52% of participants experienced at least one component of BOS, indicating a widespread issue within this professional group. These findings highlight the complex nature of BOS among Thai neurosurgeons and emphasize the need to address each component to enhance overall well-being and job satisfaction.
Table 4
Multivariate logistic regression analysis for Thai neurosurgeons in this study
|
Variable
|
Burnout syndrome
|
Adjusted OR
(95% CI)
|
p-Value
|
|
No
|
Yes
|
|
Sex
|
|
Male
|
97 (36.47)
|
67 (25.19)
|
Reference
|
0.81
|
|
Female
|
38 (14.29)
|
64 (24.06)
|
1.12 (0.47–3.13)
|
|
Age
|
|
< 40 y
|
59 (22.18)
|
65 (24.44)
|
Reference
|
0.013
|
|
> 40 y
|
76 (28.57)
|
66 (24.81)
|
2.6 (1.5–5.23)
|
|
Status, no. (%)
|
|
Single
|
119 (45)
|
127 (48)
|
Reference
|
0.51
|
|
Married
|
153 (57.7)
|
143 (54)
|
0.8 (0.41–1.74)
|
|
Workplaces, no. (%)
|
|
Medical school
|
50 (19)
|
55 (21)
|
Reference
|
|
|
Provincial hospital
|
102 (38.5)
|
133 (50)
|
1.32 (0.27–5.32)
|
0.505
|
|
Other
|
92 (34.6)
|
77 (29.2)
|
2.20 (0.42–9.16)
|
0.386
|
|
Work experience, no. (%)
|
|
< 5 y
|
115 (43.23)
|
74 (27.82)
|
Reference
|
|
|
> 5 y
|
20 (7.52)
|
57 (21.42)
|
3.7 (2.1–8.16)
|
0.03
|
|
Monthly income, no. (%)
|
|
> 70,000 THB
|
20 (7.7)
|
33 (12.5)
|
Reference
|
|
|
60,001–70,000 THB
|
61 (23)
|
144 (54.2)
|
1.32 (0.27–5.32)
|
0.062
|
|
< 60,000 THB
|
194 (73.1)
|
88 (33.3)
|
2.70 (1.37–9.58)
|
0.03
|
|
Average number of patients in service monthly, no. (%)
|
|
< 40
|
101 (38)
|
93 (35)
|
Reference
|
|
|
41–60
|
102 (38.5)
|
133 (50)
|
1.08 (0.36–2.50)
|
0.843
|
|
> 61
|
71 (26.9)
|
44 (16.7)
|
2.10 (0.52–8.24)
|
0.697
|
|
Average length of stay for a patient in service (d)
|
|
< 10 d
|
101 (38)
|
155 (58.3)
|
Reference
|
|
|
> 10 d
|
173 (65.4)
|
110 (41.7)
|
2.3 (1.22–8.24)
|
0.006
|
|
Average number of patients requiring ventilator in the ICU monthly, no. (%)
|
|
< 20
|
81 (30.8)
|
88 (33.3)
|
Reference
|
|
|
21–30
|
103 (39)
|
99 (37.5)
|
0.72 (0.3–1.73)
|
0.458
|
|
> 30
|
81 (30.8)
|
77 (29.2)
|
1.29 (0.56–2.96)
|
0.545
|
|
Average number of end-of-life care patients monthly, no. (%)
|
|
< 5
|
103 (39)
|
138 (52)
|
Reference
|
|
|
> 5
|
162 (61)
|
121 (45.8)
|
1.56 (0.66–3.67)
|
0.313
|
|
Average number of ICU deaths monthly, no. (%)
|
|
< 5
|
61 (23)
|
77 (29.2)
|
Reference
|
|
|
5–10
|
133 (50)
|
99 (37.5)
|
0.62 (0.2–1.53)
|
0.318
|
|
> 10
|
71 (26.9)
|
88 (33.3)
|
1.38 (0.26–2.54)
|
0.45
|
|
Average number of working hours per day, h (%)
|
|
< 10
|
30 (23)
|
30 (22)
|
Reference
|
|
|
10–12
|
48 (37)
|
45 (33)
|
1.12 (0.37–2.61)
|
0.73
|
|
> 12
|
50 (40)
|
63 (45)
|
2.15 (0.63–7.13)
|
0.58
|
|
Average number of cases operated per day (%)
|
|
< 5
|
67 (52)
|
64 (46)
|
Reference
|
|
|
6–10
|
35 (27)
|
39 (28)
|
1.34 (0.28–2.72)
|
0.64
|
|
> 10
|
26 (21)
|
35 (26)
|
2.57 (0.68–6.21)
|
0.43
|
|
Average number of patients seen in outpatient services per day (%)
|
|
< 30
|
59 (46)
|
61 (44)
|
Reference
|
|
|
30–40
|
32 (25)
|
37 (27)
|
1.18 (0.34–3.56)
|
0.57
|
|
> 40
|
37 (29)
|
40 (29)
|
2.47 (0.58–6.51)
|
0.73
|
|
Rest days receive on average per week
|
|
Adequate
|
48 (18.04)
|
61 (22.93)
|
Reference
|
|
|
Not adequate
|
87 (32.71)
|
70 (26.32)
|
2.82 (0.95–8.32)
|
0.313
|
|
Average number of rest days you need in 1 week, no. (%)
|
|
≤ 2 d
|
6 (23)
|
14 (58.3)
|
Reference
|
|
|
> 2 d
|
20 (76.9)
|
10 (41.7)
|
6.8 (2.56–8.72)
|
0.027
|
|
Feel that poor sleep quality during working
|
|
No
|
126 (40)
|
51 (60)
|
Reference
|
|
|
Yes
|
10 (18.75)
|
80 (81.25)
|
19.77 (1.35–8.72)
|
0.015
|
|
Have you ever had a conflict with a patient care team (physicians, resident, nurses) in your job?, no. (%)
|
|
No
|
11 (45)
|
11 (48)
|
Reference
|
|
|
Yes
|
15 (57.7)
|
13 (54)
|
0.8 (0.41–1.74)
|
0.51
|
|
Average number of rest days you need in 1 week, no. (%)
|
|
≤ 2 d
|
61 (23)
|
155 (58.3)
|
Reference
|
|
|
> 2 d
|
204 (76.9)
|
110 (41.7)
|
6.8 (2.56–8.72)
|
0.027
|
|
Do you feel that your assignments in the job description are too many?, no. (%)
|
|
No
|
81 (30.8)
|
177 (66.6)
|
Reference
|
|
|
Yes
|
184 (69.2)
|
88 (33.3)
|
4.1 (2.95–11.32)
|
0.04
|
|
Have you ever felt that you were unsuitable for a job in neurosurgeon?, no. (%)
|
|
No
|
153 (57.7)
|
155 (58.3)
|
Reference
|
|
|
Yes
|
112 (42.3)
|
110 (41.7)
|
1.1 (0.56–2.96)
|
0.561
|
|
Have you ever felt like quitting caring for an neurosurgical patient within the past year?, no. (%)
|
|
No
|
4 (15.3)
|
14 (58.3)
|
Reference
|
|
|
Yes
|
22 (84.6)
|
10 (41.7)
|
14.6 (0.56–2.96)
|
0.013
|
Abbreviations: CI, confidence interval; ICU, intensive care unit; OR, odds ratio.
Note: Values are presented as mean or n (%). p-Value corresponds to independent t-test and chi-square test.
Discussion
This study investigated BOS among Thai neurosurgeons and found a high prevalence, characterized by elevated levels of EE, DP, and reduced PA. Key risk factors identified included being over 40 years old, having less than 5 years of experience in neurological surgery, perceiving an excessive workload, earning a monthly income below 60,000 Baht, contemplating quitting their neurosurgery job in the past year, desiring more than two vacation days per week, and having patient lengths of stay exceeding 10 days. BOS is described as a work-related condition characterized by a range of signs and symptoms.[10]
[11] In this study, the diagnosis of BOS was based on the Thai version of the MBI-HSS, which consists of 22 questions and assesses burnout across seven levels of severity. The scores derived from this inventory were used for diagnosis. However, the diagnostic value may vary among different personnel in various studies, complicating comparisons. Neurosurgeons, while also working in high-pressure environments, face different kinds of challenges that could contribute to burnout. These include surgical stress, neurosurgeons deal with complex, high-stakes surgeries that require precision and focus, often for extended hours. The physical and mental toll of such surgeries can lead to burnout over time. Life-or-death decision-making, like ICU professionals, neurosurgeons are frequently faced with decisions that can determine a patient's survival or quality of life, contributing to stress and emotional strain. Emotional impact, given the nature of neurological conditions, neurosurgeons may experience emotional strain from dealing with patients who face severe, life-altering conditions, or complications that can result in poor outcomes. High expectations and public scrutiny, neurosurgeons are often expected to perform at an exceptionally high standard, and the public and institutional scrutiny they face can increase the pressure and potential for burnout. While comparing burnout in ICU professionals provides valuable insights into one aspect of health care burnout, a more comprehensive comparative analysis that includes neurosurgeons' burnout would offer a broader understanding of burnout across health care specialties. Such a comparison would help identify whether the stressors specific to the ICU environment (e.g., constant critical care and EE) are also present in neurosurgery, or if other factors such as surgical demands, lack of work-life balance, and specialized patient outcomes contribute uniquely to neurosurgeons' burnout. A few key points of comparison might include workload and time pressure, comparing the long hours and emotional intensity faced by ICU professionals with those experienced by neurosurgeons could reveal unique stressors in each specialty. Psychological toll and emotional stress, while both ICU professionals and neurosurgeons deal with life-or-death situations, the emotional burden of performing highly specialized surgeries might have a different impact on neurosurgeons. Support systems and resources, both groups might struggle with lack of institutional support or resources, but the way support systems (e.g., mental health resources, peer support, etc.) are structured for ICU professionals versus neurosurgeons could differ significantly. Although focusing on ICU professionals' burnout provides essential insights into the health care field, incorporating a comparative analysis with neurosurgeons could enhance the overall understanding of burnout in high-pressure medical environments. A more holistic approach to comparing burnout across different specialties would offer better strategies for prevention, such as tailored interventions to support specific groups based on their unique stressors. A previous study identified several key risk factors for burnout, including younger age, male gender, single or childless status, limited work experience, extended working hours, and caring for patients at the end of life.[12] The prevalence of BOS among general physicians has been reported at 45%, while studies on health care workers have indicated rates ranging from 25 to 33%.[12]
[13]
[14] In this study, 138 Thai neurosurgeons (52%) were found to have BOS, with EE at 42%, DP at 38%, and reduced PA at 46%. In a previous study,[14] the rates were significantly lower, with EE at 17.1%, DP at 5.5%, and PA at 7.7%. In contrast, a similar study among public health staff found higher levels of burnout, with EE at 68.1%, DP at 53.7%, and reduced PA at 56.5%. This study compares the experiences of BOS among Thai neurosurgeons to those of physicians in psychiatric units. The findings suggest that neurosurgeons report higher levels of BOS, likely due to the demanding nature of their work, which involves managing complex neurological conditions associated with higher mortality rates, while psychiatrists typically care for outpatients. Differences in compensation, rest periods, and outcome expectations further contribute to this disparity. When comparing Thai neurosurgeons to their international counterparts, the prevalence of BOS is notably higher among the Thai cohort, which may be attributed to lower salaries and less time for rest. Additionally, neurosurgeons in university hospitals tend to report less fatigue than those in provincial hospitals, potentially linked to variations in workload. Historically, neurosurgery has presented significant challenges, with fewer assistive technologies and less effective treatment options compared to what is available today. However, ongoing pressures, organizational factors, and excessive workloads have exacerbated burnout among Thai neurosurgeons. A critical risk factor identified is the perceived low income of Thai neurosurgeons relative to their responsibilities. Legal repercussions from mistreatment can heighten stress levels. Furthermore, the shortage of neurosurgeons results in longer patient admissions; those lasting over 7 days often indicate severe symptoms, which can lead to feelings of inadequacy among neurosurgeons when treatment outcomes are poor. The likelihood of considering leaving patient care within the past year is a significant indicator of impending burnout. Key factors associated with burnout include age, work experience, perceptions of excessive workloads, and the demands of senior supervision, along with the responsibility of caring for multiple patients. Emotional support responsibilities and a high level of accountability further increase the risk of BOS. While this study highlights important factors influencing BOS among Thai neurosurgeons, it does not identify specific causes. The presence of colleagues and supportive organizational structures may help mitigate burnout. A significant correlation was found between the level of stress and the EE and DP domains of the MBI.[15]
[16] Addressing burnout in neurosurgeons requires multifaceted approaches, institutional support, hospitals, and medical institutions can implement wellness programs, offer mental health resources, and create a more supportive work environment to mitigate stressors. A culture that prioritizes well-being can help reduce burnout. Improved work-life balance, encouraging reasonable working hours, shift work, and time off for recovery can allow neurosurgeons to maintain a balance between their professional and personal lives, which is crucial for preventing burnout. Peer support and mentorship, creating networks where neurosurgeons can discuss challenges and support one another can help combat isolation and reduce the emotional toll of the profession. Training on stress management, offering resources and training on stress management, mindfulness, and emotional resilience can provide neurosurgeons with tools to manage the high demands of their profession effectively. Thai neurosurgical societies and institutional committees should take the lead in developing policies and setting benchmarks to address the causes of stress, reduce burnout, and enhance job satisfaction. The impact of the identified factors on burnout remains insufficiently understood. However, this review provides important insights, suggesting that Thai neurosurgeons may experience high levels of burnout, which could potentially affect the quality of neurosurgical patient care. Future research should focus on effectively managing the factors negatively impacting Thai neurosurgeons. Additionally, further studies are needed to identify definitive causes and deepen understanding across diverse Thai neurosurgical societies. This study is the first conducted in Thailand to specifically focus on neurosurgeons across various hospitals, taking into account the variability in work conditions across different institutions. While multivariate analysis was conducted to identify significant risk factors, limitations include a small sample size and a questionnaire that addresses only general risk factors without delving into specific causes. As a result, the applicability of these findings across different hospitals may be limited.
Conclusion
In this study, we observed a high prevalence of BOS among Thai neurosurgeons. Burnout among neurosurgeons is a critical issue that requires recognition, targeted interventions, and institutional support to ensure that neurosurgeons can continue to deliver high-quality care without compromising their mental and emotional well-being.
