Organized Surgery Begins to Battle Burnout

Originally posted in heelskicksscalpel.com

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.

General Surgeon Lifestyles -- Linking to Burnout: Medscape Survey by Carol Peckham March 28, 2013
General Surgeon Lifestyles — Linking to Burnout: Medscape Survey
by Carol Peckham
March 28, 2013

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.

Embed from Getty ImagesThe 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.

Emotional awareness (how are you feeling, how does what you are feeling impact your behavior, and how does what you are feeling impact those around you)

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. Embed from Getty Images

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.”

Slide1It 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.

Fantasies of a Busy Surgeon Mom

Originally posted on heelskicksscalpel.com

  1. Driving past runners donning their night gear just shy of 6am as I head into work, I think, “I would love to be hitting the pavement every morning before work. My days always go better if they begin with run.” Alas, I just can’t make myself do it and be ready for work on time. And, after 12-16 hour days (when I am not on call, 26-40 hours when I am) I am usually too tired and hungry to get it together after work.  Embed from Getty Images
  2. Looking at this month’s calendar and seeing the school curriculum night this Wednesday and dinner with visiting professor next Wednesday and kids’ activities past 7:30pm every Mon/Tue/Thu/Fri, I muse “Wouldn’t it be great to actually go do that couple’s rock climbing class or attend the cheese making workshop one of these nights?” Between work, kids, and work-related travel the idea of making it out, just the two of us, at least twice a month has completely fallen by the wayside. Embed from Getty Images
  3. Seeing all the pictures of fabulous girls’ nights marching along my Facebook feed I contemplate “I would love to go for mani/pedis or finally try paint night with the girls.” Unfortunately, ‘the girls’ don’t exist in my life. Alas, a group of women (heck, even just one woman) in my age range with similar interests, who get(s) me, would love to hang out with me, and have/has a schedule that allows for regular get togethers with me just don’t/doesn’t exist in my life. Embed from Getty Images
  4. Waking up, yet again, in a little pool of drool on the couch with the DVR at the end of the show, I think to myself “I wonder what it’s like to not fall asleep during a much anticipated episode of a binge-watchable series or the football game or the Emmys…” Unfortunately, with my chronic sleep deficit putting me in a semi-recumbant position for any period of time soon leads to a slumber, mind you not a restful slumber just one that will subsequently mess up any hope I have of regaining a reasonable sleep wake cycle. Embed from Getty Images
  5. Having another frustrating call with my father about a health issue I think to myself “I would really like to be one of those children who goes to appointments with their aging parents.” I do my best but often work gets in the way (as it also does for my own doctor and dentist visits). So much gets lost in the translation between me, my parents, and their healthcare providers that I suspect that it leads to more stress and anxiety among all of us and the benefit of me having purposely settled near my family is lost. Embed from Getty Images

To be sure there are ways to overcome to all of these issues. My adult life has essentially been a series of work arounds to fit it all in. Some days I succeed and other days I just fantasize about what it would be like to not have to put so much mental energy into these work arounds so I could just let life unfold with me being the socializing, fitness buff, present mother, attentive daughter, and effective TV watcher that I dream of being.

My Kids Have Hijacked My Weekends

Originally posted at heelskicksscalpel.com

There is a high level alert going on in our household these days. What’s terrorizing me, you ask?

My kids’ activities.

I recall the time BK (before kids) when my time off of work was my time. Time to plan and to do (or to not). Sometimes I just spent all day in my pjs if I was lucky enough to have a weekend off. No agenda. Just a day away from the frenetic pace that  was the hallmark of my day job (and my night job and my weekend job!).

IMG_4007Then came the kids. Okay, it was work when they were infants. They had to be fed and diapered and generally kept alive. But their needs were simple and if I didn’t need to be in to be at work on a Sunday, I could sip a cup of coffee and read the Times while the baby (and later the toddler and the baby) were in my proximity. I kept them from sticking a fork in an outlet but essentially got IMG_4006to do my own, grown-up thing that made me happy. And when everyone was old enough, I was even lucky enough to sleep past 8am–a true luxury for a surgeon.

No longer true. Every weekend is now consumed by my kids activities.

Whether it’s 8am baseball practice or a 9am Field Hockey tournament over an hour away, forget sleeping in even though no one is awaiting a soggy overnight diaper change. Then mid-day rolls around and there is likely a dance show, a classmate’s birthday party, and another practice that vie for my kids’ time. And they don’t drive yet.

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IMG_3656We are forced to divide and conquer (thus separating me from my awesome husband who I actually like to spend time with when I am off). We are forced to eat in the car on the run when there just isn’t enough time between activities to sit down to a meal. We guzzle gallons upon gallons of gas going to and fro from event to event, some of which are on opposite sides of the state.

I can’t remember the last time I had an unscheduled weekend for myself. I struggle trying find time to get together with friends who are experiencing the same level of terror in their homes. I literally have gone years without seeing friends who live in the same very small state because with our kids we just don’t have time to be with anyone else on the weekends. In fact, I was so pleased with myself heading into this weekend. I managed to arrange both a work outing on Friday and a Sunday BBQ with my Ragnar van mates. I planned this as soon as the call schedule came out. And wouldn’t you know, out comes the email that the make-up baseball game starts a half hour before the work event and the playoff coincides exactly with Ragnar reunion.

Aaaaaaaaaargh!

My kids have hijacked my weekends and it’s infuriating. I want to support their interests (trust me I’m no Tiger mom; other than encouraging physical activity and retaining some cultural interests these kids a choosing to over-extend themselves with extra-curriculars and parties and playdates) but I can’t say I would shed a tear if they up and quit dance or ball or hockey.

Well maybe I would. If my kids end up too unidimensional to get into college then they’ll have nowhere to go after high school and I really need to get my weekends back.

Reflections on ‘The Great Work Life Debates’

Originally posted at heelskicksscalpel.com

Last week I, along with nearly 10,000 other surgeons of various specialties, attended our profession’s premier annual meeting, the American College of Surgeons Clinical Congress. Of these, some 50 attended a panel session I chaired called the “Great Work Life Debates.” Embed from Getty Images

Quite honestly, I was so relieved by the turnout.

Every conference needs to have a last day and the desire of attendees to duck out before that day (especially given work life issues such as not spending another night away from your nursing infant or not missing another OR day) is totally understandable. Nevertheless, some sessions will be assigned the dreaded last session of the last day.

So yes, leading up it, I was filled with dread that the co-moderator, six speakers, and I would be the only people in attendance. I was delighted to be wrong.

Embed from Getty ImagesWhy did these hearty surgeons stick around for this session? Why were there so many men (also much to my delight) in the audience? Were they there searching for the right answers to the Great Work Life Debates? Did the panelists even have any answers to provide?

The committee sponsoring the session was the American College of Surgeons Women in Surgery Committee (WiSC). I would posit, however, that in the modern era issues of balancing the demands of work and the demands of life at home (or as I like to think of it, the joys of my profession with the joys of my personal life) are not limited to women surgeons. WiSC just happens to have taken the lead in bringing such issues to a format that I imagine years ago was limited to the best technique for such and such procedure or what’s new with such and such surgical disease.

Just because male surgeons of a particular generation may have propagated a particular stereotype about how they valued or prioritized their work relative to their life outside of work does not mean that the male surgeons of today fit into that stereotype. Just because women are increasingly represented in surgical careers does not mean that socio-cultural norms for women surgeons’ roles outside of work have dissipated. An so, I believe that both men and women sought out this session because more circumscribed professional meetings are less likely to address non-biomedical topics even though concerns for wellness both in and out of work—wholeness as a person inclusive of professional and personal needs—transcend surgical specialties, and yes even gender.

Surgeons, irrespective of specialty, gender, or sexual orientation, who haven’t found a life partner, may be prone to wonder whether they should marry another surgeon or seek a non-surgeon with whom to spend the rest of their days outside of the hospital. Those who do have partners, may wonder how to make it work for the long term irrespective of their lifemate’s profession. Surgeons of both genders who do not have children may be experiencing deep inner desire to start a family or may be frustrated by the perception that choosing not to have a family is somehow not acceptable. And, those with children surely have days when inevitable stress of modern day parenting leave them wondering why they did it just as they surely have days when every worry, whether it is about work or home or world peace, is dissipated by boundless giggles of a toddler or the unexpected talkativeness of an otherwise moody teen.  Surgeons whose careers or family situations throw childrearing into chaos must consider the pros and cons of care rendered by nannies in the home or childcare in the diverse, highly regulated environment provided by out-of-home daycare. And, no matter what option or combination of options they choose there will be less than perfect days when both work and child(ren) will be needing you at the exact same moment.

Surgeons—not male surgeons, not female surgeons—but just surgeons sharing similar work life concerns came together to listen to these Great Work Life Debates. These points (and barring time limitations we could have point/counterpointed countless other work life dilemmas) were argued by women with different life experiences, different perspectives, and different debate tactics but both the pros and the cons resonated with the women and the men in the audience who it seems, based of their feedback thus far, simply desired a venue that acknowledged that we surgeons are in fact humans—we have lives outside of work, lives that are made ever more complex by long hours, possible lives at risk while we are working, and myriad other professional demands (which include, by the way, attending such meetings for so many hours/year for continuing medical education credits).

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So what was the bottom line for the men and women who stayed for one of the last sessions on the last day of our conference? Not surprisingly there wasn’t one.

Thus, while marriage is challenging no matter what your day job is (if it wasn’t they would just call it dating forever!) you can’t always control who you fall in love with; a loving, supportive spouse will make your work more manageable whether he/she understands to a tee what you go through every day work or has a vague understanding of why you sometimes come home tired or distracted or not at all. But you too have to be loving and supportive in return and that rendering of love and support may take different shapes.

While children come with the stress and anxiety of raising them along with the costs (~250-500k per child up to 18 years before including the costs of college according to one debator) raising them also brings the joy of nurturing, chubby cheeks, Disney World vacations, etc. but choosing to be childfree also brings many joys (e.g. unfettered travel that need not involve animatronics, increased focus on nurturing your relationship with your partner, increased time to pursue personal wellness) that parents often forego or delay.

Finally, both a nanny and daycare can provide a loving, caring environment replete with both educational and emotional growth while you are working but relying on a single individual may limit diversity and back-up options while relying on daycare increases the day to day burden of prepping the child(ren).  Either way, your children will know you are their parent and they will love you back even on the days when things don’t go smoothly.

My hope is that listening to a spirited debate on these issues related to the dilemmas of partnering, parenting, and childcare will have enabled the audience thoughtfully consider what matters to them and various strategies to help alleviate the strain between the joys of work and the joys of personal life. While there are no perfect solutions (and to strive for a vision of perfection is to set yourself up for disillusionment in your choice of life partner, your decision to (or not to) have children, or your childcare preferences), it’s about crafting a reasonable approach to your own great work life debate based on self-reflection and practical needs.

A hobbyless life

Originally posted on heelskicksscalpel.com. And, I no longer use the term work-life balance.

Work-life balance is hard. If you are passionate about your work, and your work involves long hours, life and death situations, and tight deadlines, how do you fit life part of work-life balance in? And, as much as you love your family, if you have a working spouse and kids with schedules about as full as full time jobs (and that’s only after school), how do you have a life outside of work and family?

I will confess, I have no idea what the answer to those two questions is. I am trying, as many of the posts on this blog might suggest, but truthfully I feel pretty clueless. I am in awe of those friends and colleagues who spend quality time with their family, set age group records in triathlons, take a ton of in-house call, get a decent amount of federal funding, and then take on a hobby or two. They knit, they golf, they collect stamps. I have honed no such skills or interests (unless you can count shopping as skill but my husband calls it a bad habit for which I need an intervention).

A few years ago at a job interview I was asked what my hobbies were. I had prepared and prepared to be drilled on why I wanted an academic career as a trauma surgeon and how I was going to achieve my academic goals in a modern medical environment. I was ready to talk about my growing family. (Nothing like asking for extra time between back to back to back interviews with senior male surgeons so that you can, ummm, pump breast milk.) But I was literally catatonic when it came describing my hobbies. It didn’t help that the person interviewing me was a nanogenarian who avidly road his bike for miles daily and was an antiquities collector. “Ummmm, I guess my kids are my hobby,” I said without the least bit of conviction.

Don’t get me wrong, I love, love, love my kids. The decision to have them was not one we made lightly. I absolutely wanted to be a mother and luckily my husband wanted to be a father. Happily, we were able to discuss and modify our professional priorities to make the life part work for our family, especially when the kids were really young. While it has very hard over the years for me to find time to really *be* with my children (e.g. to not just be near them whilst half asleep, or worse yet fully dead to the world recovering from a brutal call, but to really engage with them), is “being” with them really a hobby?

A quick internet search reveals that:

A HOBBY is a pursuit outside one’s regular occupation engaged in especially for relaxation; an activity or interest pursued for pleasure and not as a main occupation.

But honestly, though being with my children is my number one priority when not occupied by my occupation, some days being with my children is the furthest thing from relaxing. Bedtime routines, presence of green vegetables, absence of digital screen-based stimuli, etc. can often be infuriating. As a family we have kayaked in the ocean, gone to Broadway musicals, and engaged in arts & crafts. But none of these activities would qualify me as a kayaking, show tunes, or crafting enthusiast. Would I do more of these if I could? Quite frankly I am not sure. These and other family activities have definitely been a lot of fun and provided great respite from the work part of work-life balance; however, none have really sparked a passion in me. For me the these activities are not for the pleasure of the activity itself but for the joy of being together. (Of note, I have tried being to together on shopping trips as a strategy but it brings no one but me joy and eventually the vociferous protests of the children sap that too.)

So, between the challenges of balancing a demanding work schedule with the unpleasurable tasks of parenting and squeezing in those moments of togetherness that do bring pleasure, I am at a loss for hobbies. (I wish I were at that point in my life with exercise and fitness were a hobby but quite frankly they remain a chore; I am working on that but that is a topic for another blog post.)

So for now, I suppose I will settle for a reasonably well-balanced hobbyless life. When I perfect that, I will move on to cultivating some hobbies.