TO THE EDITOR: We read with great interest the systematic review by Berardo et al. 1 (Berardo L, Gerges C, Wright J, et al. Assessment of burnout preventio n and wellness programs for US-based neurosurgical faculty and residents: a systematic review of the literature. J Neurosurg. Published online October 30, 2020. doi: 10.3171/2020.6. JNS201531), which addressed the issue of preventing burnout among neurosurgery faculties and residents by the implementation of wellness programs. Because of the particular nature of the job of the neurosurgeon who is entrusted to operate in delicate anatomical regions, neurosurgical training programs are renowned as very demanding. Recently, concerns have been raised regarding the well-being of the physicians at work, leading to the adoption of new laws such as the maximum weekly working time for residents set at 48 hours in France. Nevertheless, this duration seems difficult to apply in neurosurgery because residents need to learn from emergency cases during night shifts, as well as from regular surgery that requires sufficient operating room exposure. 2 Residents are usually stressed by being in a low postgraduate year, insufficient operating room exposure, hostile mentors, additional social stress (family conflicts and financial issues), and work-life imbalance. 1 New contemporary concerns are the mismatch between the growing number of students in the neurosurgery programs and the low number of fellowships available (which induces stressful uncertainty for the residents’ future early career), 3 the limited access to neurosurgical literature and publication opportunities, and the fearful atmosphere caused by the recent judicialization of neurosurgical practice, which can lead to defensive attitudes and even professional disenchantment. 4

Beyond these considerations, Baumgarten et al. showed that specific personality traits such as openness, agreeableness, and conscientiousness were protective, whereas neuroticism was negatively associated with burnout. They also showed that pleasure at work was protective. 5 Shakir et al. reported that the diminution of social and personal stressors was associated with increased grit and resilience among residents, and that these two characteristics were protective. 6