Burnout and Mental Health in Orthopaedic Surgeons

Burnout is an occupational syndrome, not a character flaw, and in orthopaedic surgery it is common. A 2025 systematic review of 34 studies covering 8,471 orthopaedic surgeons put the mean prevalence of burnout at 48.9%. This article sets out what burnout is and how it is measured, what the orthopaedic surveys actually show, the drivers with evidence behind them, the second-victim response after a complication, the interventions that have been tested, and the confidential services surgeons and trainees can use.

The short answer: individual habits help a little, organisational change helps more, and confidential help is available to every surgeon in the UK, Australia, New Zealand and the US.

What is burnout?

Christina Maslach and Michael Leiter define burnout as a psychological syndrome that emerges as a prolonged response to chronic interpersonal stressors on the job. Its three key dimensions are overwhelming exhaustion, cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment.

The World Health Organization uses the same three dimensions in ICD-11, where burn-out is "a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed". The WHO lists it as an occupational phenomenon (opens in a new tab), not a medical condition, and the term applies only to work.

Most surgical studies measure burnout with the Maslach Burnout Inventory (MBI), which scores each dimension on its own subscale.

Studies do not all define a "case" the same way. The Australian trainee survey below counted anyone with high emotional exhaustion or high depersonalisation as burned out; the French survey called abnormal scores on two or three subscales "severe burnout". That is one reason headline figures vary so much.

Burnout and depression are related but not the same thing, and studies measure them separately. In the American College of Surgeons survey, burnout and depression were each independently associated with suicidal ideation, which is why both need to be asked about.

How common is burnout in orthopaedic surgeons?

Two caveats apply. Response rates were often low, and people under strain may be more (or less) likely to reply. And the spread from 15% to 90.4% reflects real differences in setting, subspecialty and grade, so a single number for "orthopaedic burnout" is a summary, not a constant.

The surrounding numbers matter as much as the burnout rate. In the US data, which cover all surgical specialties:

• 6.3% of surgeons reported suicidal ideation in the previous 12 months; among those aged 45 and over it was 1.5 to 3.0 times more common than in the general population.
• Only 26% of surgeons with recent suicidal ideation had sought psychiatric or psychological help, and 60.1% were reluctant to seek help because of concern about their medical licence.
• 15.4% had scores consistent with alcohol abuse or dependence (13.9% of men, 25.6% of women), and burnout and depression were both associated with higher odds.

For how burnout feeds recruitment, retention and rural shortages, see the orthopaedic workforce crisis.

What drives burnout in orthopaedic surgery?

The drivers below come from the studies above rather than from anecdote.

The same studies identify protective factors: dedicated mentorship, seniority, sufficient exercise and family support in the 2025 review, and making time for hobbies and limiting alcohol in Sargent's survey.

Two features of surgical culture amplify these drivers. Training is an apprenticeship, so progression depends on the judgement of senior surgeons, and trainees who fear looking "not cut out for surgery" are slow to admit they are struggling. And orthopaedics gives immediate, visible feedback in the post-operative radiograph, which makes it easy to treat a biological failure, such as infection or non-union, as a personal one. See working under a difficult boss and coping with complaints and litigation for those specific pressures.

Self-doubt is common too. In a 2023–24 survey of 441 UK orthopaedic trainees and consultants using the Clance Imposter Phenomenon Scale, 92% reported moderate to intense imposter symptoms (opens in a new tab). Scores were higher in trainees than consultants and in women than men, and 49% said it had discouraged them from applying for leadership roles. The women in orthopaedic surgery post covers the gender dimension.

The second victim: what happens after a complication?

Albert Wu's 2000 BMJ editorial named the doctor involved in a serious error the "second victim"; the patient and family are the first. The response is not random. Interviews with 31 clinicians after adverse events identified six stages:

1. Chaos and accident response
2. Intrusive reflections
3. Restoring personal integrity
4. Enduring the inquisition
5. Obtaining emotional first aid
6. Moving on

The authors concluded that the trajectory is largely predictable, so institutions can identify at-risk clinicians early and offer support. Several participants found that taking part in improvement or patient-safety work helped them enjoy their work again.

The orthopaedic data are stark. In a UK survey of 65 trauma and orthopaedic trainees from ten deaneries, complications caused sadness in 77.8%, guilt in 69.8%, and anxiety and embarrassment in 63.5% each; 40.3% said a complication affected them outside work. Only 22.2% had been offered formal support, and only 15.6% felt their training programme prepared them for the emotional impact. Non-blaming, informal debriefs were repeatedly cited as helpful.

Morbidity and mortality meetings are essential for learning, but they serve the system, not the surgeon. The clinical review and the colleague's welfare need separate conversations. If a colleague has had a bad outcome, do not give them "space": contact them that day, acknowledge that it is hard, and offer time to talk. For the personal side of processing a complication, read dealing with a complication: the second victim.

Which interventions reduce burnout?

Two meta-analyses frame the evidence.

West et al. (Lancet, 2016) pooled 15 randomised trials (716 physicians) and 37 cohort studies (2,914 physicians). Overall burnout fell from 54% to 44%, high emotional exhaustion from 38% to 24%, and high depersonalisation from 38% to 34%. The authors concluded that both individual-focused and structural or organisational strategies can produce clinically meaningful reductions.

Panagioti et al. (JAMA Internal Medicine, 2017) included 19 controlled studies of 1,550 physicians. Interventions produced a small reduction in burnout (standardised mean difference −0.29, about 3 points on the MBI emotional exhaustion scale). Organisation-directed interventions had a larger effect (−0.45) than physician-directed ones (−0.18), supporting the view that burnout is a problem of the whole organisation, not only of individuals.

None of these trials was in orthopaedic surgeons, and the coaching and small-group trials were in medicine, family medicine and paediatrics. The direction is consistent, though: structure and protected time do more than exhortation to be resilient.

What can individual surgeons and trainees do?

Resilience is recovery, not endurance. A surgeon who keeps pushing without recovering is heading for exhaustion, however tough they look. The habits below are low-cost and fit a surgical week; they are not substitutes for treatment.

• Protect sleep first. Sleep deprivation tracked every distress measure in orthopaedic residents. After nights, plan recovery as deliberately as the rota; see sleep, night shifts and the surgeon.
• Keep a life outside medicine. A hobby, a sport or a group where nobody cares about your waiting list. Making time for hobbies was associated with less dysfunction in Sargent's survey.
• Move. Exercise was protective in the 2025 review. Look after your back and neck in theatre too; see surgical ergonomics.
• Watch the alcohol. Using a drink to come down after a bad list is how a coping habit becomes a problem.
• Have a mentor and a peer. A senior who has had screws pull out and joints dislocate, and a colleague at your own stage to debrief with. See finding an orthopaedic mentor early.
• Debrief after heavy shifts. Five minutes with the registrar or resident before going home: what happened, what was hard, what is handed over.
• Use small pauses. Thirty seconds at the scrub sink or between cases, a few slow breaths, a phone-free break. These are ways to reset attention, not proven treatments.
• Close the day. Leave the hospital mentally as well as physically. A few lines on what went well and what was difficult can stop the day replaying at 2 am.
• Register with your own GP, outside the hospital where you work, before you need one.

When to get professional help

Act the same day if you notice:

• thoughts of suicide or self-harm
• increasing reliance on alcohol or other substances to manage distress
• persistent inability to sleep despite exhaustion
• dread or panic at the thought of going into the hospital
• low mood or loss of interest lasting weeks rather than days

What can departments and training programmes do?

The meta-analyses point at organisations, so the main levers sit with consultants, training directors and employers:

• Protected time for facilitated peer groups, as in the West small-group trial.
• A routine, non-blaming debrief after every serious complication, with a named person who checks on the surgeon involved and an offer of formal support. In the UK trainee survey most were never offered it.
• Safe rotas and real leave. Hours and on-call burden are among the most consistent risk factors.
• Mentoring schemes rather than leaving mentorship to chance.
• Senior surgeons who talk openly about their own difficult cases and the help they used. It costs a consultant little and changes what a trainee believes is permitted.

Burnout during exam preparation

Fellowship exam preparation, whether FRCS (Tr & Orth), FRACS or the ABOS boards, adds months of study to a full clinical job, and it is where many trainees first hit a wall. Burnout here is arithmetic: sustained demand outrunning recovery for long enough. Trying harder usually makes it worse.

Early warning signs:

• your reading speed halves but your hours do not
• you read the same page three times and retain nothing
• irritability spills into theatre or home
• food, exercise and friends start to feel like time stolen from revision

What helps:

• Schedule recovery as carefully as study. Sleep comes before the extra late-night hour.
• Work in focused blocks with genuine breaks, and take at least one lighter day each week.
• Keep one relationship and one interest alive throughout.
• If low mood, poor sleep or lost motivation has lasted weeks rather than days, talk to a supervisor, a colleague or your GP.

For the practical side, see balancing exam study with a clinical job, how many hours to study for a fellowship exam and managing exam performance anxiety. If the result does not go your way, read failing an exam is not the end.

Will seeking help affect my registration?

This fear keeps surgeons away from care: 60.1% of US surgeons with recent suicidal ideation were reluctant to seek help because of their licence. The rules are more supportive than most surgeons assume.

• Australia: Ahpra's mandatory notification guidance (opens in a new tab) sets a higher threshold for treating practitioners than for other notifiers. A treating practitioner must notify about impairment only when there is a substantial risk of harm to the public, a threshold set "to give practitioners the confidence to seek help without the fear of a mandatory notification".
• England: NHS Practitioner Health (opens in a new tab) states that it would inform the GMC or an employer only in exceptional cases where a doctor is putting patients at serious risk, and that this is seldom necessary. Patients may use a pseudonym for telephone advice.

Where can surgeons get confidential help?

If you are in crisis now: in the UK call Samaritans on 116 123 or text NHSPH to 85258 (Shout); in Australia call Lifeline on 13 11 14; in New Zealand call or text 1737; in the US call or text 988. Your employer's employee assistance programme is another confidential route.

Service details checked against each organisation's website in October 2026; check the site for current hours and eligibility.

Burnout is predictable, measurable and partly preventable. The surgeons who last are not the ones who feel nothing; they are the ones who recover, ask for help early and work in departments that make both possible.