What orthopaedic surgery tells us about the structure of burnout.

The shift begins before sunrise. There are charts to review, pre-op scans to scan again, residents to supervise, consent forms to finalize. The first patient is anesthetized before most of the city has poured a cup of coffee. The case runs long. The second one longer. Between surgeries, the inbox fills. The pager chirps. A suture clinic is behind schedule. A trainee needs a word. An insurer wants documentation before approving a procedure that has already been performed. By the time the last note is finished, it’s late. The next day will begin in five hours.

In surgery, the work is physical and exacting; the hours often hit 70–80 per week. The patients arrive early. The cases run long. The documentation piles up. Slowly, the work stops being a calling and starts feeling like a calculation. And somewhere between the OR and the inbox, a familiar feeling sets in—one shared by nearly half of practicing orthopaedic surgeons.

Burnout. It doesn’t show up all at once. It accumulates quietly in the gaps between what the job requires and what the system allows. One call shift, one missed family event, one broken workflow at a time. It affects more than half of orthopaedic surgeons, one of the highest rates in medicine. For residents and trauma subspecialists, that number climbs even higher.

A Familiar Problem The stats, while striking, are not new. Physician burnout was first formally studied in the 1980s, but for decades it was seen as a background issue – common, regrettable, and largely unavoidable. What’s shifted is not just its prevalence, but its persistence. Despite growing awareness and the rise of wellness initiatives, burnout rates remain stubbornly high across nearly every specialty.

In orthopaedics, the trend is particularly acute. A 2024 umbrella review found that burnout affects approximately 49% of practicing orthopaedic surgeons. Among trauma and oncology subspecialists, rates exceed 60%. For residents, the numbers are worse. Multiple studies place burnout among orthopaedic trainees between 50% and 66%, with PGY-2 residents – those just stepping into higher clinical responsibility – reporting the lowest sense of personal accomplishment.

The Cost of Normalized Strain

What drives this is no longer speculative. Burnout among orthopaedic surgeons closely tracks with a familiar set of conditions: long hours, limited control over schedules, administrative load, and shrinking time for direct patient care. In one 2023 survey of over 8,000 surgeons across the U.S., those working more than 65 hours per week were significantly more likely to report symptoms of burnout. But volume alone isn’t predictive. Surgeons who reported low schedule flexibility or high EHR-related frustration were more likely to screen positive, even when their total hours were comparable to peers.

“The problem,” one attending put it bluntly at a 2023 resident wellness forum, “is that we’ve built a system that treats time like it’s infinite, and attention like it’s free.”

The cost of that design shows up far beyond individual well-being. Burned-out physicians are more likely to report medical errors, lower patient satisfaction, and reduced engagement with trainees. Departments with high burnout rates see higher turnover, more early retirements, and greater recruitment difficulty. What starts as personal fatigue often becomes a system-wide liability.

The Strongest Systems Still Need Support

Orthopaedic surgeons are not easy to wear down. They operate through the night, stand for hours in lead, and carry physical and emotional weight with little fanfare. The field demands precision, judgment, and endurance – often all at once. And still, many describe their work with pride: in the restoration of movement, in the privilege of technical mastery, in the quiet gratification of a job well done. This is not a workforce in retreat. It is one that shows up – day after day, case after case – with skill, purpose, and conviction.

But they are not immune. In a 2022 study of academic surgeons, those who reported high professional satisfaction still showed elevated rates of depersonalization: an early warning sign for long-term disengagement. And among faculty with over 20 years in practice, those planning early retirement cited burnout more frequently than reimbursement or case volume.

This is where much of the public narrative falls short. Resilience does not prevent burnout. It delays it. When it becomes the only solution offered, when the system becomes dependent on the internal reserves of clinicians rather than their working conditions, burnout becomes inevitable, even among the most capable.

Scaling What Already Works

Much of the institutional response to burnout has focused on individual resilience. Wellness workshops, mindfulness seminars, and self-care initiatives have become standard fare in medical training and continuing education. These efforts are not without merit – particularly for early-career physicians navigating the steepest years of clinical practice. But as the data shows, burnout is not merely an individual experience. It is often a structural signal.

Evidence points consistently to a few interventions that make a measurable difference. Schedule autonomy – being able to influence clinic flow, operating room time, and call distribution -correlates with lower burnout, even in high-volume practices. Mentorship is similarly important. Residents and early-career surgeons with strong professional support networks report higher job satisfaction and greater psychological safety. This is especially critical for groups historically underrepresented in the field.

What stands out is not the scale of these interventions, but their intentionality. Redistributing on-call duties, formalizing mentorship, improving access to administrative support – these are operational adjustments, not overhauls. Yet they are the changes most consistently linked to improvements in engagement, retention, and well-being. They work not because they reduce the complexity of the job, but because they rebalance how that complexity is managed.

The implication is not that institutions must do more of everything. It is that, increasingly, they have the data to do more of what works.

An Industry-Wide Opportunity for Charting Course

This strain is not a sign of failure. It is a sign of care complexity. Health systems are balancing clinical excellence, financial constraints, regulatory pressure, and workforce sustainability – all at once. But the growing evidence suggests that better balance is possible.

Some of the most promising changes are practical. Departments that reduce non-clinical load – through medical scribes, streamlined EHRs, or AI-assisted documentation – are already seeing improvements in clinician well-being. Allowing surgeons more control over their schedules, particularly in outpatient and operative settings, helps sustain engagement over time. Formal mentorship, especially in the early years of practice, remains one of the most effective, least costly interventions.

Programs don’t need to reinvent their models to offer meaningful support. Many already do. Some invest in internal mentorship structures. Others partner with national workshops or surgical education hubs. Centers like OLC, where trainees and practicing surgeons periodically sharpen skills and receive hands-on instruction, can serve as valuable extensions of that ecosystem. Exposure to expert faculty, even in short bursts, provides a layer of professional connection that many residents and institutions benefit from.

The challenge is no longer figuring out what’s wrong. It’s ensuring that what works becomes easier to access, more consistently offered, and part of the fabric of the profession.