American Surgeons in Crisis: Implications for Healthcare
November 4, 2012 by Robert Wascher
Filed under Depression, Job Stress, Kids, Mental Health, Physicians, Risk of Depression, Surgeon Burn-Out, Surgeon Burnout, Weekly Health Update, Work-Life Balance, alcohol, alcohol abuse, lifestyle, surgeons, surgery
A new study finds that more than half of surgeons are experiencing work-home conflicts that threaten their personal and professional wellbeing.
AMERICAN SURGEONS IN CRISIS: IMPLICATIONS FOR HEALTHCARE
As I have discussed in previous columns (The Silent Epidemic of Surgeon Burnout and Depression, Epidemic of Alcohol Abuse Among Surgeons), there are quiet and evolving, and disturbing, developments within the community of American surgeons, and these developments may portend of significant potential future problems for surgeons, and for patients who require surgical care. Now, a newly published research study, which appears in the current issue of the Archives of Surgery, further suggests that the epidemic of surgeon burnout and depression is indeed real, and has serious potential implications for both surgeons and their patients.
In this study, 7,197 active surgeons were surveyed, electronically, by the American College of Surgeons, using questions from validated surveys that assess for career burnout, depression, quality of life, alcohol use, and other measures of satisfaction with both personal and professional life attributes.
When asked if they had experienced any significant conflicts between their “work lives” and their “home lives” within the previous three weeks, an astounding 53 percent of the queried surgeons replied, “Yes.” Thus, more than half of all surgeons who participated in this confidential survey reported substantial and distressing conflicts between their professional lives and their home lives within the preceding three weeks.
When the study’s authors analyzed the personal and professional factors that were most closely associated with “work-home conflicts,” and with both personal and professional dissatisfaction, a clearer picture emerged. For example, the number of hours worked per week, having children, the surgeon’s gender, and the type of surgical practice were all closely linked with work-home conflicts, and with lower levels of personal and professional satisfaction. For example, surgeons who practiced at Veterans Administration hospitals were 91 percent more likely to report work-home conflicts when compared to surgeons in private practice, while surgeons who practiced at an academic medical center were 19 percent more likely to report such conflicts when compared to private practice surgeons. Not surprisingly, having children at home was associated with a 65 percent greater likelihood of work-home conflict when compared to surgeons without children at home. Working more hours per week and being younger were also factors associated with a higher likelihood of work-home conflict, as was being a female surgeon (i.e., when compared to male surgeons). Surgeon specialty was also significantly linked to work-home conflicts and overall lower satisfaction levels, with broadly practicing general surgeons being twice as likely to report work-home conflicts as surgeons in other specialties (e.g., breast surgeons, heart surgeons, neurosurgeons, and other subspecialist surgeons).
The high level of work-home conflicts identified among surgeons is an issue of great concern to all of us, as such conflicts were significantly associated with career burnout, exhaustion, decreased quality of life, depression, relationship difficulties, alcohol abuse, and overall career dissatisfaction by scientifically validated surveys. Surgeons reporting recent work-home conflicts were also substantially less likely to recommend surgery as a career option to their children.
In addition to higher levels of burnout, depression, alcohol abuse, relationship difficulties, and career dissatisfaction, surgeons who reported recent work-home conflicts were also 77 percent more likely to be planning to reduce their clinical work hours, and71 percent more likely to be planning to leave their surgical practices for reasons other than planned retirement.
At a time when the demand for some types of surgical care is already outstripping the supply of experienced, competent surgeons in many areas of the country, the findings of this study are cause for considerable concern. For example, looking into the near future, our population is aging, and many acute and chronic diseases that require surgical treatment are more common in elderly patients. Therefore, there is real concern that an increasingly burned-out surgeon workforce, and a declining interest in the more challenging surgical specialties (like general surgery) by today’s medical students, will someday soon leave the United States with an inadequate number of experienced surgeons to meet our nation’s healthcare needs.
All of the above noted adverse factors within the American surgeon community, once again, raise the concern that adequate levels of surgical care may not be available in the not too distant future if significant changes in surgical training and surgical practice are not considered and implemented, particularly in the workhorse specialty of general surgery. The surgical community has been, admittedly, slow to appreciate or embrace generational changes in perceptions about work-life balance, and has only grudgingly (and recently) acquiesced to external pressures to treat its surgeons-in-training in a more considerate and supportive manner, compared to the conditions that surgery interns and residents toiled under during my era of training, as well as previous generations of surgical trainees. (When I was a surgical intern, in the late 1980s, there were no limitations on the number of hours that interns and residents were expected to work in the hospital, including the number of nights spent on call for emergencies within the hospital, and it was not uncommon for us to spend 100 to 120 hours inside the hospital each and every week.) Regardless of how more senior surgeons feel about it, it must be acknowledged that the current generation of medical students and young surgeons, both male and female, are much more concerned about work-life balance, and overall quality of life issues, than was typical for my generation of surgeons.
On a brighter note, the American College of Surgeons’ sponsorship of this research study, and others like it, suggests that the older generation of surgeons who currently serve as senior leaders and mentors for young surgeons and surgical trainees may, finally, be coming to grips with the rather dramatic shift in attitudes and priorities among their young charges. Hopefully, it is not too late to make meaningful structural changes in surgical training and surgical practice conditions before there are widespread adverse public health consequences to the ongoing crisis among the community of surgeons in the United States….
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Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author
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