The surgical employment landscape has shifted substantially over the past few decades. In addition to the long work hours and unpredictable schedules that have been an enduring hallmark of the profession, surgeons also now face increased productivity pressures, administrative burden, and limited control over clinical resources. These conditions have resulted in high rates of burnout and attrition.
To help support sustainable surgical careers, the ACS has released a framework of workplace standards that are measurable and can be customized by surgical discipline.
The framework, Developing Specialty-Specific Workplace Standards for Surgeons, was released today in the Journal of the American College of Surgeons.
“Our goal was to create guidance that would align surgeon well-being with patient safety and system efficiency, while promoting career longevity and workforce stability within the surgical profession,” said Douglas E. Wood, MD, FACS, FRCSEd, ACS Board of Regents Vice-Chair and lead author of the framework. “Surgeons love their jobs. We are dedicated to patient care, and we want to help ensure that we create a workplace environment that allows us to continue providing excellent care, while also attracting a new generation of the best and brightest into the profession.”
The proposed framework draws on existing literature, benchmarking across medical specialties that have established workload and coverage standards, and input from practicing surgeons and health system leaders. Recommendations address:
- Call schedule and compensation
- Access to the OR, clinic, and resources
- Inpatient census limits
- Clinical support and team composition
- Fatigue mitigation and wellness support
- Compliance and administrative burden
The framework is adaptable so that each surgical discipline—as well as specialties outside of surgery—can create standards that are customized and relevant to their specialty. The ACS has had formal conversations with more than a dozen other medical associations, all of which are preparing their own manuscripts using the ACS framework as the foundational document.
In addition to Dr. Wood, authors of the framework include ACS Regent Philip R. Wolinsky, MD, FACS; Chief of Staff Connie Bura; Young Fellows Association Immediate Past Chair Christopher Dodgion, MD, MSPH, MBA, FACS; Resident and Associates Society Immediate Past Chair Rachael Essig, MD; Regent Diana L. Farmer, MD, FACS, FRCS; Immediate Past First Vice President Nancy L. Gantt, MD, FACS; Board of Regents Chair Lena M. Napolitano, MD, FACS, FCCP, FCCM; Regent Shelly D. Timmons, MD, PhD, FACS; Regent David J. Welsh, MD, MBA, FACS; Board of Governors Vice-Chair Robert D. Winfield, MD, FACS; and Executive Director & Chief Executive Officer Patricia L. Turner, MD, MBA, FACS.
In an accompanying commentary, Toward Sustainable Surgical Practice: Defining Workplace Standards for the Modern Era, JACS Editor-in-Chief Thomas K. Varghese, MD, MS, MBA, FACS, applauded the initiative: “Surgery has long equated excellence with endurance. The next chapter requires intention. Defining workplace standards is not about lowering expectations; it is about aligning professional commitment with thoughtful system design. If excellence is to persist across careers and generations, the environments in which surgeons practice must be built to support it.”
More information to assist surgeons with workplace issues is available in the practice management section of facs.org. These include resources for negotiating contracts, running a successful practice, wellness, malpractice risk, and surgeon unionization.
