We are writing to express our team’s keen interest and appreciation for the insightful study published in Anesthesiology, “U.S. Attending Anesthesiologist Burnout in the Postpandemic Era” by Afonso et al.  As peers from China, we are particularly intrigued by the parallels and variances we have observed between the findings presented and our analogous research in China.

The use of the Maslach Burnout Inventory in both American and Chinese surveys reveals a disturbingly high prevalence of burnout among anesthesiologists across the board. Before the pandemic 59.2% of anesthesiologists in the United States experienced burnout, which increased to 67.7% after the pandemic.  Our survey in China, which included all anesthesiologists, showed a national cross-sectional survey burnout rate of 69% prepandemic which interestingly decreased to 52.7% postpandemic.  Specifically for Chinese attending anesthesiologists, the burnout rate was 73% prepandemic and 42.6% postpandemic.

This unexpected trend in China, despite high baseline levels, deserves attention. Risk factors for anesthesiologist burnout in both the United States and China include a perceived lack of support and severe staffing shortages.  In 2018, China had 76,000 anesthesiologists for a population of 1.4 billion, far fewer than the 2.4 anesthesiologists per 10,000 people in the United States and Europe. The United States has also recently faced severe staffing shortages, with 35.1% of attending anesthesiologists reporting shortages in 2020, rising to 78.4% in 2022.  These staffing challenges have likely contributed to high burnout rates in both countries. To address this, China has taken steps to increase its anesthesiologist workforce. In 2018, China’s National Health Commission (Beijing) released Document 21, which aims to increase the number of anesthesiologists to 90,000 by 2020 and 140,000 by 2030. Local governments and hospitals have also been working to increase the number of formally trained anesthesiologists and promote the sustainable development of this workforce. According to the Chinese Society of Anesthesiology, the number of anesthesiologists in China has increased to 105,000 in 2023, an increase of 38% from 2018. Although there is still a significant shortage, this increase may partially explain the decrease in burnout rates. However, we must acknowledge that our research did not follow the same individuals over time, and burnout has complex, multifactorial causes. Therefore, the observed improvements in staffing are likely only one of several contributing elements.

Understanding the complexities of anesthesiologist burnout is essential for developing better interventions and improving their well-being and job satisfaction. Both the U.S. and Chinese studies emphasize that support from leadership at an organizational level is crucial in preventing burnout.  Furthermore, our research in China investigated the psychologic status of anesthesiologists, revealing a positive association between burnout and mental health issues such as depression, anxiety, and posttraumatic stress disorder.  Although the causality between psychologic status and burnout and the impact of COVID-19 on mental health is not entirely clear, prioritizing the psychologic well-being of anesthesiologists is likely beneficial for mitigating burnout. In addition, we believe that pressures related to scientific research and advancement in one’s career might also influence burnout, an aspect that could be explored in future studies. Therefore, it is imperative for our team leaders to pay more attention to improving the work environment and providing additional support to colleagues. Of course, considering the differences in culture and healthcare systems, our interventions need to be adapted accordingly.

It is noticed that our studies have achieved response rates of greater than 70%, possibly due to our WeChat (Tencent, China)–based data collection. Frankly, our methodology took advantage of the use of WeChat, for either social interactions or professional communication to streamline the survey process. Our respondents could conveniently complete the questionnaire on their mobile devices in only a few minutes. Compared to traditional surveys, WeChat has contributed greatly to the response rate of our study.

In conclusion, anesthesiologist burnout is an international problem that requires a global response. Recent studies suggest significant regional variations and potential strategies for improvement. Further research is needed to understand these differences and develop effective interventions. We look forward to further research and dialogue in this area and hope to collaborate with researchers worldwide to improve the working conditions and mental health of anesthesiologists. Addressing burnout is a marathon, not a sprint, and our commitment to this effort is unwavering.