Are surgeons happy in practice? Examining a quarter-century of Alberta’s surgical graduates ============================================================================================= * Cassidy Frayn * Valerie Masson * Shannon Erichsen * Jonathan White ## Summary Every year, hundreds of new surgeons graduate from residency programs across Canada. Much time and effort is spent on preparing these surgeons for independent practice, but there is little literature about the career trajectories of surgeons after they finish training and enter practice. We surveyed all surgeons graduating from the residency programs of a single Canadian medical school over 25 years (1985–2010). Most respondents rated their job satisfaction as high/very high and indicated they would still pursue a residency in surgery and/or their specialty if they had it to do over again. This commentary discusses important information about where our graduates go and what their careers are like, challenging existing stereotypes about careers in surgery. Our survey findings should be communicated to students interested in careers in surgery. Much literature exists about the teaching of surgery in medical school and surgical residency. There is, however, a paucity of information about what happens to surgeons after they graduate from residency and go into independent practice. Little has been written about practising surgeons in terms of what their professional lives are like, and what provides them with satisfaction in their lives and careers. In popular culture, television dramas often present a stereotype of the practising surgeon as being overworked and unhappy and facing personal problems related to being “married to the job.”1 Negative stereotyping is not unique to surgery, but the image of the overworked and miserable surgeon may explain why many medical students do not consider a career in surgery. The purpose of our project was to examine the professional lives of Canadian surgeons in practice. We chose a cohort of surgeons who had graduated from the residency programs of a single Canadian university over a 25-year period. We aimed to learn more about their lives and practice and to see whether stereotypes presented by popular culture were supported by data. We chose to focus specifically on physician job satisfaction, as this has been identified as an important factor in patient outcomes.2 We also hoped that gaining a better understanding of the opportunities and challenges faced by surgeons in practice might allow us to better prepare today’s graduates for their careers. ## Who responded? All 389 surgery residents who graduated from the University of Alberta between January 1985 and December 2010 were identified. Of these, 7 were deceased and 13 could not be traced. We used an anonymous online mixed-methods survey to collect information. Questions were chosen based on a review of the literature and were a combination of selected response items, Likert scales, and open-ended constructed response items. We piloted a draft version of the survey with 5 local surgeons who provided feedback and suggested changes. The final version of the survey contained 44 items in 4 main areas: demographics, current surgical practice, job satisfaction and questions related to residency training. Over the course of a month, 161 graduates completed the online questionnaire (42% response rate). The male:female ratio was 7:1. More than three-quarters of respondents were between 35 and 54 years old; only 12% were older than 54 years. Most (84%) respondents were married or living with a partner; 7.6% were divorced. The modal number of children was 2. More than half of respondents were located in Alberta, and almost three-quarters were located in Canada; other graduates were located in the United States (20%) and Saudi Arabia (7%). There was good representation of all surgical specialties (Table 1) and of all years sampled, with preponderance toward more recent graduates (55% graduating in 2001–2010 v. 25% in 1985–1995). View this table: [Table 1](http://canjsurg.ca/content/58/5/296/T1) Table 1 Demographic characteristics of survey respondents ## What did they tell us? The majority of respondents were in active practice in Canada. Most (93%) reported working in an urban location with a population of more than 50 000. Most respondents reported being in a group practice with other surgeons (54%). A majority described themselves as working in an academic setting (55%). Most respondents reported they had had “no difficulty” or “very little difficulty” finding a job once they finished their training (86%). The average graduate works 60 hours per week, with three-quarters of this time spent on clinical care; 2 days a week are spent in the operating room, and call accounts for about 6 nights per month. Three-quarters of respondents rated their job satisfaction as high or very high. Three main themes were identified as important components of this satisfaction: job factors, patient factors and interpersonal factors. Three-quarters of our graduates described themselves as holding leadership positions. Most felt they had been well prepared for practice by residency and felt the most important lessons learned were related to surgical technique and clinical judgment. When asked whether they would choose to pursue a residency in surgery and/or their specialty again, more than 80% agreed or strongly agreed. In 2008, Cyr-Taro and colleagues3 surveyed 34 general surgery graduates and found that 90% would choose their current job again. Konrad and colleagues4 identified 10 facets relating to physician job satisfaction. These included relationships with peers, patients, staff and community; autonomy; pay; resources; intrinsic satisfaction; free time away from work; and administrative support. Our graduates described most of these facets in their responses, focusing particularly on intrinsic satisfaction and on their relationships with patients and colleagues. We were surprised that 86% of respondents reported little difficulty finding a job, especially with the current concern over the lack of positions in certain specialties. The Royal College of Physicians and Surgeons of Canada has published a recent report focusing on unemployment among specialists.5 Our findings may relate to the fact that many of the respondents graduated before recent changes in the job market; it is likely that current graduates may report greater difficulty finding jobs. ## Implications of our survey Our survey was one of the largest of its type and, to our knowledge, it was the first to focus on multiple surgical specialties in a Canadian setting. Our findings may be limited by the possibility of nonresponse and recall bias as well as the lack of a validated tool for physician job satisfaction. We attempted to minimize this effect by keeping the survey as short as possible and by sending out multiple follow-ups and reminders to invite surgeons to participate. To avoid spurious comparisons among specialties, we did not perform subgroup analyses. Surgeons graduating from the University of Alberta from 1985 to 2010 have achieved a high level of job satisfaction in a wide variety of practice settings. In contrast to the negative stereotypes found in popular media, we found that the surgeons who answered our survey were very satisfied with their jobs, in a stable relationship and working an average of fewer than 65 hours per week. Our findings challenge existing stereotypes about careers in surgery and should be communicated to students interested in careers in surgery. ## Acknowledgements The authors thank Tracy Berryman, Kat Pederson and Karee Moffatt for administrative support, Dr. Bin Zheng for his assistance with survey design, and the Surgery 101 summer students for their assistance. ## Footnotes * **Funding:** Sources of support for this project were the Tom Williams Endowed Chair in Surgical Education, University of Alberta Health Professions Education Summer Studentship, Faculty of Medicine and Dentistry, University of Alberta. * **Competing interests:** None declared. * **Contributors:** All authors contributed substantially to the conception, writing and revision of this commentary and approved the final version for publication. * Accepted April 7, 2015. ## References 1. Hirt C, Wong K, Erichsen S, et al.Medical dramas on television: a brief guide for educators.Med Teach 2013;35:237–42. 2. Williams ES, Skinner A.Outcomes of physician job satisfaction: a narrative review, implications, and directions for future research.Health Care Manage Rev 2003;28:119–139. [CrossRef](http://canjsurg.ca/lookup/external-ref?access_num=10.1097/00004010-200304000-00004&link_type=DOI) [PubMed](http://canjsurg.ca/lookup/external-ref?access_num=12744449&link_type=MED&atom=%2Fcjs%2F58%2F5%2F296.atom) [Web of Science](http://canjsurg.ca/lookup/external-ref?access_num=000182648600003&link_type=ISI) 3. Cyr-Taro AE, Kotwall C, Menon R, et al.Employment and satisfaction trends among general surgery residents from a community hospital.J Surg Educ 2008;65:43–9. [PubMed](http://canjsurg.ca/lookup/external-ref?access_num=18308280&link_type=MED&atom=%2Fcjs%2F58%2F5%2F296.atom) 4. Konrad TR, Williams E, Linzer M, et al.Measuring physician job satisfaction in a changing workplace and a challenging environment.Med Care 1999;37:1174–82. [CrossRef](http://canjsurg.ca/lookup/external-ref?access_num=10.1097/00005650-199911000-00010&link_type=DOI) [PubMed](http://canjsurg.ca/lookup/external-ref?access_num=10549620&link_type=MED&atom=%2Fcjs%2F58%2F5%2F296.atom) [Web of Science](http://canjsurg.ca/lookup/external-ref?access_num=000083447700010&link_type=ISI) 5. Frechette D, Hollenberg D, Shrichand A, et al. (2013) What’s really behind Canada’s unemployed specialists? Too many, too few doctors? Findings from the Royal College’s employment study (The Royal College of Physicians and Surgeons of Canada, Ottawa).