US surgeons are burned out and the numbers are staggering. Whether experiencing emotional exhaustion, depersonalization, or a low sense of personal achievement, 4 in 10 US surgeons exhibit signs and symptoms of burnout. Among neurosurgeons that number jumps to nearly 60%. Burned out surgeons are more likely to report substance abuse, clinical depression, and suicidal ideation. They are more prone to medical errors.
Interestingly, academic practice, trauma sub-specialty, increased nights of call, longer hours worked, younger age, female gender, and small children at home were all risk factors for burnout. For those of you who are new to this blog, I am a female academic trauma surgeon who routinely works long hours and takes in-house call while my small children are at home.
To be clear, these data prove associations and associations do not equal causation; but still, it is sobering to think that so many who entered a profession to fundamentally improve the lives of others are themselves leading such troubled lives due to their chosen occupation.
The occupational hazards of surgical careers are multiple. We suffer moral distress when our patients experience complications or die whether or not an error occurred. We develop compassion fatigue by bearing witness to our patients’ collective and continuous suffering no matter how successful any individual’s outcome may be. Due to our long and often erratic hours, we suffer from chronic fatigue and sleep deprivation. The physical plight caused by fatigue is complicated by many hours on our feet and maintaining awkward postures in the operating room. By routinely putting our patients before ourselves, we often exhibit illness presenteeism. Not infreqeuently, we face the double bind of choosing between being there for our patients or being there for our family. Meanwhile, whether it’s catching up with billing and coding one day, keeping up with meaningful use another day, or spending days studying subjects totally irrelevant to one’s daily practice for maintenance of certification, delivering care in the modern error mandates many a frustrating task that ultimately does nothing to benefit our patients. Furthermore, there is constant fear of litigation that might ruin us in financially or reputationally. And so, it is not surprising that so many of us are burned out.
All is not dark, however. There are ways for us to be well and resilient. They require both individual effort and culture change. Importantly, they demand emotional awareness. When we understand how we are feeling impacts both our perceptions and our actions, we can act in a way that props us up rather than gets us down.
I was heartened this past week that the American College of Surgeons chose to put surgeon wellness and resiliency on equal footing with the likes of “what’s new in hernia repair” or “ethical challenges in geriatric surgery.” There were a number of educational panel sessions tackling burnout head on. Whether is was about bouncing back in the face of personal loss, gender discrimination, pathways to help surgeons recovering from alcohol abuse back into clinical practice, or managing fatigue, the program was replete with informative sessions on burnout avoidance. Mindfulness, time management, kinship, and down time were emphasized as was physical fitness.
And for the first time ever, the College had a fitness program. As that youngish female academic trauma surgeon with two kids who has struggled with tending to herself after spending her youth, college, medical school, residency, fellowship training, and early years on faculty essentially ignoring personal wellness, I was delighted that this change was happening at my profession’s annual meeting. It was something of a pilot test offering only a very early morning Zumba and a Yoga class, but it was a start. Sure many surgeons at this meeting probably went to the hotel gym or hit the lakefront running path but these efforts happened without the largest surgical professional organization’s imprimatur (hey I even got an American College of Surgeons yoga mat!) or beckoning. These surgeons are likely the 6 in 10 of us who aren’t burned out. But that doesn’t mean we should ignore the self-neglect of our brothers and sisters in the occupation. So this simple step of organizing these fitness events indicated to all attendees that the College both encourages and supports surgeons taking care of themselves.
Making time for fitness has been shown to reduce burnout so I hope the College expands their offerings this time next year. I invite the College to challenge us surgeons to find time for wellness within the already overwhelming conference that offers 5 days of educational sessions geared at making us better surgeons technically and intellectually. The annual Clinical Congress of the American College of Surgeons has essentially had this format the entire time that I have been attending (every year for the past 12 years). With the pilot fitness program the College chose hours and days specifically to not interfere with this typical format. However, given that all the data shows that prioritizing wellness is a key factor in combatting burnout and that wellness takes on many forms, the College should offer multiple offerings–whether it is meditation, or high intensity interval training, or barre, or a knitting circle, or Zumba, or TRX, kick boxing, or spinning, or running– at different times throughout the conference thereby forcing us to prioritize just as I was forced to prioritize between “surgical jeopardy” and “what’s new in body contouring.”
It will be hard for us to make these choices but we need the practice. I figure its easier to choose wellness when there are no cases to be done or patients waiting in the ER or clinics to be staffed, when there are no lives at risk other than our own.