With the pandemic persisting for nearly 2 years, our well-being—essential in the operating room, home, and community—has come under threat as never before. Burnout among surgeons, already on the rise before the pandemic, appears to continue an upward trajectory. The question is: What can we, as individuals and as a professional organization, do?
Rest assured that the American College of Surgeons (ACS) is focusing on this issue. We’ve assigned high priority to developing resources that promote well-being and prevent burnout. Our website now features a dedicated section on wellness, along with special programs, peer-reviewed research, blogs, support services, and toll-free hotlines, all demonstrating our commitment to enhancing resilience and well-being.
The ACS has long prioritized well-being, resilience, and work-life balance across the professional life cycle, in all specialties and practice settings. In 2008, we conducted a series of studies identifying the drivers of surgeon distress—anxiety, depression, fatigue, lack of career satisfaction, and burnout, and from that work, created a surgeon well-being index. More than 1,000 ACS members participated in a survey, with most respondents mistakenly believing they had achieved a state of average or above-average well-being. After taking the validated Physician Well-Being Index and receiving individualized feedback, 46.6% committed to making specific lifestyle changes to enhance their scores and their health.
More recently, the ACS has developed a portfolio of resources, along with an infrastructure of networks that offer support and guidance for managing stress. Most notably, we established a formal surgeon Well-Being program. We’ve created and conducted a series of offerings for young surgeons to enhance wellness and work-life balance. We’ve compiled resources derived not only from the College, but also from the American Medical Association, Accreditation Council for Graduate Medical Education, National Academy of Medicine, and Association of American Medical Colleges. We have developed a webinar series about surgeon wellness and work-life balance for those in private practice or academic settings.
Why We’re So Vulnerable
Burnout is, of course, a long-standing issue in the physician community, with 52% of surgeons reporting they have experienced burnout. It’s estimated to affect up to 69% of surgical residents, with approximately 20% attrition, according to the Annals of Surgery. Our work is essential and lifesaving, yet we practice in an environment that does not always seem to prioritize the patient or the surgeon. We face unique challenges among physicians, exacerbated by the COVID-19 pandemic, in which we tackle the competing demands of clinical, business, and administrative tasks.
We operate in a rapid-pace environment of disruptive change, technological innovation, and decision-making. We’re under increasing pressure to see more patients more quickly. We’re confronting stricter regulations, closer scrutiny, and higher public accountability, all accompanied by the threat of lower reimbursement and income. In the rare instance of adverse events, some suffer moral injury in silence or in isolation. We are high achievers and hold ourselves accountable to deliver our best for each patient every time. Failure is not an option.
The COVID Conundrum
COVID has exacerbated existing problems and has rendered us increasingly vulnerable. No one could have predicted 2 years ago that we would be literally putting our lives at risk to care for patients. Demands on us have expanded—at the hospital as well as in our homes and communities—as we seek to balance the competing needs.
Surgeons have been on the front lines of this crisis since the beginning. Some of us have been redeployed to provide needed care outside of our typical subspecialties. We risk exposure to the virus and for a time may have had inadequate PPE, testing protocols, or access to vaccines. A shortage of nurses and other healthcare providers compounds the difficulties of delivering proper care. Patients are postponing essential screening and interventions on an unprecedented scale. Many of us have stopped or limited elective procedures at least twice in the interest of public safety, shrinking our incomes and frustrating our patients. While the pandemic has amplified the heroic actions of some surgeons, it has forced others to opt out or even retire. Further, there has been an increasing coarseness of rhetoric in the public sphere in which misinformation has negatively affected patients and those who seek to provide evidence-based care at every turn.
Next Steps and Meaningful Interventions
An all-important step in battling burnout is self-care, a practice that seldom comes naturally to members of our profession who are hardwired to sacrifice in the service of our patients. Many institutions and hospitals offer assessments, counseling, and referrals through an existing program. Small communities or tightly knit hospitals may experience challenges with confidentiality. This is an area in which the ACS may be able to provide resources.
If possible, we should all endeavor to focus a bit more on ourselves and engage with support systems already in place. Communication with mentors, peers, and colleagues can be cathartic. As difficult as it may be to do so in some climates this winter, try to get outside, add a modest amount of physical activity, download an app for mindfulness or meditation, confide in an empathetic surgeon colleague who understands your experience. The ACS, your professional association, is building programs for support in this area as well.
Self-care also can involve showing empathy and concern for others. This can take many forms: donating blood—desperately needed in many communities, providing a listening ear to a colleague, or helping provide sound evidence-based information in your community. Your elected officials need to hear from you on a topic where your expertise is meaningful. Counterintuitively, some find themselves bolstered and uplifted by giving more because the impact, the return on investment, can be re-energizing. The ACS can help connect you with any one of these opportunities for service.
We also need to address the significant systemic issues that contribute to surgeon burnout. Clearly, our profession must advocate for reforms that are fair, equitable, and do not pit one specialty against another within a narrow slice of the healthcare system. We will champion policies that ensure the highest quality for our patients with resources that allow us to continue providing exemplary care in our communities. Hospitals and systems should continue to prioritize restoring the numbers of ancillary healthcare workers on our teams. The ACS can play a role in these important areas.
It is essential that we remove the stigma surrounding burnout. At every level of training (UME, GME, or CME), curricula should include educating learners about the value of sound mental health habits. Our profession should reflect a priority placed on hospitals, government agencies, and other institutions pursuing policies and protocols that foster surgeon well-being. As leaders in our practices, institutions, departments, or hospitals, we want everyone within the surgical ecosystem to be vigilant about identifying the exhaustion, depersonalization, and lack of efficacy that can be signs and symptoms of burnout. Ask your colleague if he or she is doing okay. Follow up if your partner says something concerning or defeatist. Let’s not lose even one more accomplished colleague from our profession.
To provide excellent care for our patients, we must invest in ourselves. We do it for our own sake—for the lives and careers that we have worked so hard to establish—and we do it for our patients, our families, and our friends. Take care of yourself, and know that the ACS is here to support and uplift you at many of these crossroads.
If you have comments or suggestions, please send them to Dr. Turner at executivedirector@facs.org.
