A groundbreaking national survey led by researchers at the University of British Columbia has uncovered a stark reality in Canada's orthopaedic surgery community: 62.8% of responding orthopaedic surgeons screen positive for burnout, with moral distress emerging as a key driver. This cross-sectional study, published in the British Columbia Medical Journal, marks the first use of full-length validated tools like the Maslach Burnout Inventory and Measure of Moral Distress for Health Care Professionals to quantify these issues specifically among Canadian orthopaedic surgeons. The findings paint a troubling picture for patient care, physician retention, and the broader health system, while spotlighting urgent needs in medical education and residency training programs across Canadian universities.

Burnout in physicians, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, has long been a concern, but rates in surgical specialties like orthopaedics appear particularly acute. Moral distress, defined as the psychological stress arising when clinicians cannot act according to their ethical values due to external constraints, compounds this. In this study, burned-out surgeons reported significantly higher moral distress scores, with common triggers including resource shortages, long surgical wait times, administrative pressures to cut costs, and workplace conflicts.

Methodology and Participant Insights

The research team, including medical student Cameron J. Leong and UBC orthopaedics faculty such as Dr. Anthony Cooper, distributed anonymous online surveys via the Canadian Orthopaedic Association mailing list and UBC networks from August 2023 to October 2024. Of approximately 1,100 invited, 215 responded—a 19.6% response rate—comprising 186 attending surgeons and 28 trainees (residents and fellows). Participants hailed from diverse practice settings, reflecting a national snapshot.

Using the Maslach Burnout Inventory (MBI), surgeons screened positive for burnout if scoring 20 or higher on emotional exhaustion or 10 or higher on depersonalization. Moral distress was measured via the MMD-HP scale. Statistical analysis employed multivariate logistic and linear regressions to pinpoint risk factors, revealing moral distress as the strongest predictor (odds ratio 1.03 per unit increase).

Striking Statistics: Burnout Breakdown

The 62.8% overall burnout rate breaks down to 61.8% among attendings and a higher 71.4% for trainees, signaling early onset in residency. Median emotional exhaustion scores were identical at 28 for both groups, but trainees showed higher depersonalization (median 11 vs. 9). Burned-out surgeons logged more weekly work hours (up to 100% burnout at 81-100 hours) and administrative time.

• 32.9% of burned-out surgeons considered leaving their role due to moral distress
• 56.2% of those with burnout had either left or contemplated departure linked to moral distress
• Top moral distress causes: lack of admin support for patient care issues (e.g., bed shortages), resource constraints compromising care

These figures exceed general physician burnout rates from the Canadian Medical Association's 2025 survey (46%), underscoring orthopaedics' vulnerability.

Root Causes: Beyond Workload

While long hours contribute, the study emphasizes systemic issues. Administrative burdens—EHR documentation, insurer pressures—erode time for patient care. Canada's orthopaedic surgeon shortage (3.5 per 100,000, lowest in G7) exacerbates wait times, forcing ethical compromises. Moral distress peaks when surgeons witness suboptimal outcomes due to bed shortages or equipment lacks, fostering helplessness.

Younger surgeons face heightened risks, possibly from residency rigors or adapting to post-pandemic demands. No sex differences emerged, contrasting some prior data, but trainees' elevated rates highlight training vulnerabilities.

Photo by David Trinks on Unsplash

Implications for Higher Education and Medical Training

As primary trainers of future orthopaedic surgeons, Canadian medical schools like UBC, University of Toronto, and McMaster bear responsibility. Residency programs, often 5 years under Royal College oversight, embed high-stress cultures. The study's trainee burnout (71.4%) signals needs for wellness integration from day one.

Universities are responding: UBC Orthopaedics promotes mentorship and empathy training via CMA tools to curb burnout. U of T's Surgery Department mandates wellness policies addressing stress mitigation. Resident Doctors of Canada offers resiliency curricula—cognitive behavioral tools, peer support—for programs nationwide.

Patient Care and System-Wide Risks

Burnout correlates with errors, turnover, and attrition, straining Canada's surgeon shortage. High moral distress risks exodus: 33% considering quits imperils access to joint replacements, trauma care. Costs mount—recruitment, locums—while patients endure waits exceeding benchmarks.

For details on the study, visit the full BCMJ publication.

Evidence-Based Solutions from Academia

Institutions prioritize top-down fixes: AI scribes, streamlined EHRs cut admin by 20-30% in pilots. Peer support groups, wellness committees foster dialogue. UBC and peers advocate coaching—RCTs show 13% burnout drops.

Residency innovations include mindfulness (orthopaedic RCTs reduce exhaustion), incentivized exercise. CMA's Physician Wellness Hub offers burnout screeners, resources. Canadian Orthopaedic Association webinars on fatigue recognition aid prevention.

• Implement moral distress protocols: ethics consults, leadership training
• Residency caps on hours, mandatory wellness days
• University-led research: track interventions' efficacy

Explore CMA wellness resources for programs.

Broader Context: Surgeon Wellness Trends

Orthopaedics mirrors surgical trends—2023 meta-analysis showed no rising burnout but persistent 41% prevalence. Post-COVID, CMA notes slight dips (53% to 46%), yet surgeons lag. Females, early-career face disparities elsewhere, but this study found none.

Universities like Western, Calgary integrate wellness in curricula, partnering industry for simulations reducing real-case stress.

Photo by charlesdeluvio on Unsplash

Future Outlook: Actionable Pathways Forward

Optimism lies in awareness: UBC's study spurs policy. Fund residency wellness, expand training spots amid shortages. Track via annual surveys, pilot interventions.

For orthopaedic career seekers, universities offer resilient paths—clinical research roles balance demands. Aspiring surgeons, prioritize wellness-focused programs.

Stakeholders—unis, COA, governments—must collaborate, ensuring sustainable careers yielding top patient outcomes.