VESS13 - Institution of a vascular surgery acute care service line improves resident and faculty wellness

Objectives: Vascular surgeons have one of the highest rates of burnout among surgical specialties. This burnout is often attributed to high patient acuity and a high clinical workload. There have been few reports of practical steps to improve this clinical burden. Acute Care Service (ACS) models of care are a potential solution that has been used among general and trauma surgeons. This work studies the impact of a vascular ACS model on faculty and resident work-life satisfaction.

Methods: This is a retrospective analysis of prospectively collected Accreditation Council for Graduate Medical Education (ACGME) survey results from faculty and residents. ACGME wellness results were assessed from the 2018-2019 academic year to the 2022-2023 academic year. The ACS model was implemented for residents in June 2020 and for faculty in January 2021. The ACS service structure assigns an attending surgeon and resident team in-house, without elective cases, on a weekly basis to cover all urgent and emergent vascular consultations and procedures. Data from the 2019-2020 academic year made up the pre-ACS model, while the ACS model included survey years 2020-2022 for residents and 2021-2022 for faculty. Survey question results were binned into domains consistent with the Maslach Burnout Inventory (MBI). Continuous comparisons of Likert scale data were performed using one-sided Wilcox-ranked-sign tests.

Results: There were 5-8 residents and 6-7 faculty respondents each year, with a nearly 100% response rate across all years. The mean wellness score for faculty was 3.08 prior to the ACS model and 3.60 after its implementation (p < 0.001). Similarly, for residents, the mean wellness score was 3.18 prior to the ACS model and 3.72 after its implementation (p < 0.001). Both residents and faculty saw an improvement of median scores in MBI domains of emotional exhaustion (Faculty:2.9 vs 3.4, p< 0.001; Residents:3.1 vs 3.6, p=0.001) and personal accomplishment (Faculty:3.3 vs 3.8, p=0.005; Residents:3.5 vs 4, p=0.046) (Figure 1). Jointly, faculty and residents reported improvement in their sense of workload, support, and respect at work under the ACS model (p < 0.05). They also reported increased engagement at work, found it easier to relax, and were less weary outside of work (p < 0.05).

Conclusions: A vascular ACS model leads to improvement in both faculty and resident wellness, with improvement in both emotional exhaustion and personal accomplishment, without affecting patient care and without reducing clinical workloads. Future work in this area should focus specifically on identifying similar practice patterns to optimize physician wellness and patient care.