Table 2.

Global and organizing themes with illustrative quotes

Global themes	Organizing themes	Illustrative quotes
Stressors
	Work–life Integration	A ‘manageable’ workload: I work probably around 50-plus hours a week, which is not bad. […] I try to avoid evening meetings for myself and others. I just feel like we shouldn’t intrude in that time. […] I feel like it's manageable, for sure. [E]
	Administration-related Concerns	Inaction: And when we need support to support the growth we don’t get it, so we’re like on our little island. […] [W]e ask for stuff, we don’t get it. If there’s a problem, we say, ‘This is a solution.’ Nothing happens. [K]
	Time and Productivity Pressures	Competing priorities: I have learned to not put resident meetings during the clinical week because I can’t focus 100%, and if there’s a patient that’s not doing well, I can’t be fully present, and sometimes I say things not in a good way, so I don’t do that anymore. [P]
	Operating Room Factors	Resource shortages: [The problem is] budget and staffing, it’s infrastructure and staffing. And it’s a culture that’s been decimated by this 25 to 30% turnover, net turnover, and then monthly continued turnover. [O]
	Lack of Respect	Hard to feel valued: I have great leadership skills in certain areas, but I think I always never feel like I belong in the room, especially when the room is very predominantly old, male, and white. […] [I]n those settings, especially when you're new and especially when you're young, it is hard to speak up and it’s hard to feel valued. [H]
Satisfaction
	Service	Serving the underserved: [R]eally, this part of the country is one of the most underserved for obesity. And so, the opportunity here is really phenomenal about how we can impact our community, and that really appealed to me. [A]
	Challenge	Achieving difficult, positive outcomes: So, I think a lot of times for surgeons, that [satisfaction] comes from validation, doing a great case that somebody else thought was unresectable that you got out or getting through a circumstance that was really hairy. [F]
	Autonomy	Clinical ‘free range’: But the types of cases I want to do, if I wanted to try something new, getting residents involved, I have a lot of autonomy as far as that goes. […] [A]t [previous place], it was the opposite. […] [I]f you had an idea, and you brought it to a committee […] if they decided it wasn’t going to happen, it doesn’t happen. […] But [here] I’m given pretty free range with what I want to do, and that’s been great. [K]
	Leadership	Learning how things work: [T]he last five to six years, I’ve had a pretty heavy administrative component to my job, which really involves hospital work with EPIC, transition to the new electronic medical record. […] That's taken up a lot of time, but it’s been meaningful in the sense I’ve learned how things work in the hospital [9]
	Respect and Recognition	Being respected: I’ve felt pretty lucky. I’ve felt very respected professionally in most of my workplaces. [Q]
Support
	Team	Amazing nurses: Some of the nurse managers in the operating room are amazing. That’s the only word you can use for these people. There are times where they will get us additional rooms […] because they know stuff isn’t going to stop, and the sooner we get cases done, the sooner we’ll be free to do more stuff or other cases and so on. And to their credit, […] there are times when the place just hums along wonderfully. [J]
	Personal	Supportive spouse: I have, I would say arguably the best [spouse] ever, so. But basically, she’s the reason why I can do all that I can do and allows me to reach and do these things and grow in my career while also maintaining balance at home. [A]
	Leaders	Ways leaders show they value you: I think leadership can really be important in making you feel valued. So, if faculty don’t feel valued in their institutions they are going to look elsewhere. And whether that be valued by salary, or support, or whatever it is that you feel that makes you valued. [M]
	Institution	Supportive policies/processes: And a lot of the things, like onboarding here and all the structures put into place are actually designed to make sure that the physicians can live happy, healthy lives, which is super nice. [N]
Values
	Professional	Valuing quality: The most important thing is always to deliver quality, safe surgical care to patients. […] Whether or not I operate, or whether or not I watch them or observe them, monitor them clinically, do a major operation, my goal is always to take care of them, not to harm them, not to cause complications, not to do any of that, or not to miss things. [L]
	Personal	Valuing family: We were far away from everyone [during COVID]. My dad is older […], and we didn’t see him for almost a two-year stretch there. It’s hard for him to travel so far and have to take connected flights. And so, just really eye-opening during a time when we had to be geographically isolated, that we would prefer to be close to our family and not be so far away. […] [M]y family always brings me joy. [Q]
Suggestions
	Individual level	Allow flexibility: [Leaders have] said, ‘No, we’re going to continue to have Zoom meetings,’ which I think is great […]. I can Zoom into a meeting, get done what I need to do, and then if I haven’t showered for the day and I want to go for a run, I can do that […]. It seems like a small deal that will allow somebody to have this little shred of flexibility, but I think it’s important. [C]
	Organizational level	Improve OR efficiency: I think first thing that comes to mind in terms of just building our practice and getting, and even just our mission to help our patients is improving the efficiency of our operating rooms. [H]
	System level	Normalize time off: I mentioned earlier paid maternal and paternal leave. That sounds wonderful and great and everything, but surgeons have this sort of mentality that we don’t need to take time off, it looks weak. But maybe normalizing behavior and modeling behavior that it’s okay if you do that. [M]