One of the hardest parts of writing an article broadly addressing the issue of burnout in anesthesiologists is the breadth of contributing, mitigating, and ambiguous factors that arise in both the experience of clinical practice and the analysis of data. Our presented data demonstrate an increase in the incidence of burnout and self-reported staffing shortages and highlights a high intention to leave the current job within the next 2 yr.

When presenting the latest results on our colleagues’ experiences, we were limited by not just word count but also our own experience and perspectives. In such an instance, we awaited eagerly the responses of our fellow anesthesiologists to glean from our presented data additional points of view, broader consideration of potential causes, and deeper exploration into possible solutions.

We were not disappointed. In the intervening months since publication of our follow-up study of burnout in U.S. attending anesthesiologists who were American Society of Anesthesiologists members, four letters have been published by Anesthesiology, taking on some of the points of view related to our follow-up. 

In their letter, Gong, Tan, and Huang highlight similar scholarly work being done for the Chinese anesthesiologist population but it surprisingly shows an improvement in rates of burnout since the start of the COVID-19 pandemic. These authors speculate that the improvement may be a result of enhanced investment in both the overall healthcare system but also human resource management within the healthcare system since the beginning of the COVID-19 pandemic and even before then since the 2018 recognition of anesthesiologist shortages. Specifically, they cite the targeted national focus on increasing the anesthesiologist workforce to combat staffing shortages, a concern echoed by an increasing number of anesthesiologists in the United States over time.

Furthermore, their response rate was greater than our own, and they credit this to the use of more agile social media constructs to conduct the actual survey instrument, removing an avoidance barrier often encountered when soliciting participation via email only. Finally, it is our hope that this correspondence may lead to a collaboration between two very large national societies to address burnout in anesthesiologists with a broader base of experience.

Sorensen and Cleary present the vital role of residents and the unique burnout-inducing impacts of training.  While residency is a brief period in comparison to the length of a career, it is a critical period for establishing habits and approaches to work–life integration. It is a wonderful perspective offered and we agree with the points made. Our group attempted to study this population in a similar manner with surveys yielding minimal responses, leading to an inability to analyze that data. Clearly, a recruitment process other than email invitations is required for our youngest colleagues.

However, as we have heard from attending anesthesiologist colleagues throughout the country, the attending anesthesiologists are burned out. As such, we are not bringing our best teaching selves to the table and are not being the best advocates for our vulnerable trainees. Even while most of us are doing the best we can, this dynamic weakens the teacher–trainee relationship and erodes both the quality of education received by the trainee and professional fulfillment experienced by the attending anesthesiologist. We have heard from attendings their deep frustration that they seem unable to muster the same enthusiasm for teaching that once came naturally. This adds a layer of guilt and shame to the burnout being experienced by attending anesthesiologists, while trainees feel frustrated and undervalued.

There is a natural tension that must exist among education, professionalism, and well-being, which is addressed by one of the authors of this response. In “The Weaponization of Wellness,” written for the Pediatric Anesthesia Article of the Day in response to an article by Rosenbaum, “Being Well while Doing Well – Distinguishing Necessary from Unnecessary Discomfort in Training,” leaders in anesthesiology education and well-being highlight that an outsized focus on education, professionalism, or well-being will erode the neglected forces. It is the work of those in teaching roles to at once promote appropriate discomfort required for growth while advocating for reasonable working conditions that support and optimal educational conditions for trainees.

In their letter, Ellinas, Njoku, and Chandrabose focused on the link between sense of support in the workplace, burnout, and intention to leave.3  They contend that sense of “belonging” links all three of these factors (attrition, burnout, and sense of support) and outline the ways in which belonging is specifically difficult in anesthesiology (e.g., isolation, relative anonymity within the team). They concentrate on the act of community building as a strategy that ought to be employed by anesthesia leadership at every level in order to enhance employee belonging and retention.

Phillips and Ballard focus on the motivational aspects of a career in anesthesiology  citing their perception of an unfortunate shift from anesthesiology being “a calling” to being “a job.” Our findings suggest a similar trend. The combination of the corporatization of medicine, the exhaustion of the attending anesthesiologist workforce through the pandemic that compounded and increased staffing shortages, and the resultant decline of teaching and mentoring quality for our youngest colleagues as noted above are the result of this shift. Phillips and Ballard cite the Areas of Worklife Model to approach improvement in workplace engagement. They explain that, although the cost of burnout is alarming, and the solutions seem elusive, approaching the problem from a problem-solving standpoint, where one seeks incremental positive progress, will ultimately improve the environment and fulfillment for us all.

We are deeply grateful to our colleagues all over the world and humbled to have written something garnering such varied interest from so many perspectives. The problem of burnout, belonging, sense of support, and progress is one that must be tackled by not just one country, but by the entire global medical community—by not just one cohort, but by clinicians at all career stages. Our work represents just the tip of the iceberg and the true work toward improved culture is only beginning. Put simply, the interest represented by these letters gives us hope for the future of our healthcare community.