American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Avoid Surgeon Burnout with Lifestyle Modification

OCTOBER 29, 2019
Clinical Congress Daily Highlights, Tuesday Second Edition

There’s no question that surgeon burnout has become a real problem. A Medscape survey concluded that 44 percent of physicians suffer from burnout.

At the top of the list of burnout sufferers: General surgeons.

The issue is: How do we reduce and prevent burnout?

A number of different approaches were discussed at a crowded panel discussion Tuesday afternoon entitled “Surgeon Health, Well-Being and Joy: A New Paradigm to Prevent Burnout in Surgery.”

Mary L. Brandt, MD, FACS, Texas Children’s Hospital, Houston, believes that we need to come up with a new definition of burnout as a condition. While it’s good that burnout was recently recognized by the World Health Organization, she thinks we can do better at defining and staging it.

She believes burnout is a kind of inflammation due to multiple factors. It may start with the failure to take care of oneself. Then it may progress to the failure to recover from “injuries,” whether they consist of an unfortunate patient outcome or a conflict at home or in the workplace. Finally, it may be due to moral distress, which can be caused by institutional policies and rules, the demands of patient care and/or negative influences of society such as racism and sexism.

“I call it ‘physician distress syndrome,’” Dr. Brandt said.

Ultimately, after addressing the root causes of burnout, she said, surgeons need to discover a way to find meaning in their work again, to develop a sense of joy in what they are doing.

Surgeons need to find a way to combine mindfulness and motion to build a sense of ease in their bodies, emotions and nervous systems, said Pamela Grace Stokes, BS, Fairfax, CA, who has developed a program she calls Mindful Motion.

Surgeons need to put at ease their nervous systems, which are always on alert for threats, she said. She described a number of techniques, such as conscious breathing, cross-shoulder tapping, and breathing in deeply and letting out a big, audible “sign of relief” before we meet with patients or go into the operating room.

Burnout among physicians really took off with the Triple Aim of health care – the health of populations, better care, and lower costs – said Christina Cellini, MD, FACS, University of Rochester Medical Center, NY. As a result, the physicians’ workloads have gone up: they feel a lack of control; they are required to constantly measure, fill out electronic health records, and do other tasks that distract them from providing care for patients.

“The system is what really accelerated burnout, starting with asking physicians to do more with less,” Dr. Cellini said. “Physician wellness needs to be added, making it the quadruple aim.”

That’s why institutions need to help reduce some of the causes for burnout among surgeons and other physicians. That means developing wellness programs to address burnout among their physicians, Dr. Cellini said. Unfortunately, these programs often arrive due to a tragic event.

Dr. Cellini has her own personal wellness program, too, including: Making marginal clinical notes (“I just give the basics”); Friday is a hard stop for her work schedule; Cellini’s rule: “If I’m not on call, I don’t exist”; early morning workouts; say “no” and don’t feel obligated to give a reason.

Surgeons who have a good quality of life, exercise, have a circle of family and friends, find meaning in their work and focus on what’s important in life tend to be resistant to burnout, said Manju Subramanian, MD, Boston University, MA.

“Every 1 percent of time spent on meaningful activities really helps surgeons resist burnout,” she said. Since the effect peters off at 20 percent, she said, hospitals and other medical organizations should follow the 80/20 rule: If they allow their physicians to pursue meaningful activities 20 percent of the time, they will be willing to spend 80 percent on activities important to the organization.

Other approaches useful in preventing burnout include hiring a professional coach, increasing communications skills, finding joy at work and at home, and outsourcing the things not commensurate with their skill level, such as clerical duties at work or laundry at home, she said.

Finally, surgeons can build grit and resilience, the ability to recover from burnout, said Raphael C. Sun, MD, Texas Children’s Hospital/Baylor College of Medicine, Houston. This requires a combination of values, insights and self-care, he said. This must be addressed on an individual and institutional level.

“If we put physicians first, I believe patients will be better off for it,” Dr. Sun said.

Additional Information:

The Panel Session, Avoiding Surgeon Burnout with Lifestyle Modification, was held Tuesday, October 29 at the American College of Surgeons Clinical Congress 2019 in San Francisco (program, webcast and audio information).