In a well-attended Panel Session at Clinical Congress 2023, Shifting Surgeon Culture: Work-Life Balance, Career Satisfaction, and Retention, surgeons spoke on existing challenges and the need for improvement within the culture of surgery.
There has been much discussion over how burnout is becoming an increasing issue for surgeons, said Sharmila Dissanaike, MD, FACS, a trauma, burn, and acute care surgeon from Texas Tech University Health Sciences Center in Lubbock. In spite of this perceived sense of career dissatisfaction, though, some surveys have shown that being a surgeon is one of the happiest careers in the US.
“One of the reasons we’re not as miserable as we think we are is that we find a lot of job satisfaction and meaning in our work,” Dr. Dissanaike said, and in spite of administrative burden and other considerations, “that protects us in ways that we don’t acknowledge.”
Still, job satisfaction is tied to some specific elements of being a surgeon, including:
- Time commitments required or expected in the field
- Practice setting (Academic surgeons are generally more satisfied than those in private practice.)
- Payment concerns (Surgeons worry about relative, rather than absolute, pay.)
- Gender (Women surgeons tend to be less satisfied due to disparities at home as well as the workplace.)
Marc A. de Moya, MD, FACS, a trauma and critical care surgeon at the Medical College of Wisconsin in Milwaukee, focused specifically on the time aspect of surgeon culture—particularly the need to define a reasonable workload.
Dr. de Moya admitted that due to his training, he knew he had a bias toward admiring surgeons who were “always in the hospital, working day-in and day-out.” As his career progressed and he became tasked with defining full-time employment (FTE) for a surgeon, though, Dr. de Moya looked into how reasonable work affected appropriate staffing numbers, equity in how surgeons responsible for call are valued, and leveling expectations of trainees and new faculty.
“I do not think it is weak to define what we might think is a reasonable workload. In fact, I think it does a disservice not to,” Dr. de Moya said, who then discussed some of his past and ongoing research to define a unit of FTE and what matters most to surgeons, which can help create a more balanced profession.
Although surgeons must be individually talented to succeed in the field, in many cases, part of that success is predicated upon the team culture found in a practice environment. Erin E. Perrone, MD, FACS, a pediatric surgeon at University of Michigan Health in Ann Arbor, described how training surgeons’ concept of teamwork has evolved in the last century.
“The concept of surgical hierarchy has led to many amazing accomplishments. Unfortunately, it’s also led to some traumatic experiences,” Dr. Perrone said, who described the difficult environments created in the Halsted and Churchill training systems.
To foster a truly collaborative team that advanced surgeon excellence, Dr. Perrone and colleagues at the University of Michigan created the “Michigan Promise,” a six-component investment to supporting faculty and residents. Starting with creating a culturally competent and inclusive work environment, the institution then focuses on helping faculty and staff achieve their goals, provide leadership development training, recruit a diverse cohort, create innovative strategies for ongoing professional growth and scientific discovery, and expand outreach and service to local, regional, national, and global partners.
Surgical culture is at an inflection point, where the well-being of surgeons is now taking on a much more prominent role in discussions of the field, according to pediatric surgeon Mary L. Brandt, MD, MDiv, FACS, from the Baylor College of Medicine in Houston, Texas. But there is a still a long way to go to achieve the “revolution” needed to ensure well-being.
Dr. Brandt said that surgery is currently in the “Well-being 1.0” phase, which emphasizes a personal responsibility to become more resilient. “Well-being 2.0” is the aspirational goal to create a mindset of physician-administrator partnership to create practical and sustainable solutions.
More awareness of the physician “injuries,” discussions about well-being, and research are taking place. However, “it doesn’t feel like we’re making much progress, and many of us feel like it’s getting worse,” Dr. Brandt said, citing troubling statistics in surgeon burnout, suicide, and divorce, among others.
She suggested that it’s time to move beyond the incremental changes of Well-being 2.0 into the bold, fundamental changes of “Well-being 3.0,” which will require surgeons to prepare themselves for change through compassion, name what issue they are experiencing and not ignoring them, and figuratively decide whom they work for—employers or patients.
On-demand viewing of the session is available on the virtual meeting platform for Clinical Congress registrants through May 1, 2024.
