By John S. Gaul, MD

Despite increased recognition of physician burnout, the goal of achieving a better “Work-Life” balance is elusive and we often fall short of the ideal.

We have learned from the Mayo Clinic study that Orthopedic  surgeons are at very high risk for burnout; of 25 different medical specialties, Orthopedics came in fifth place. Even more worrisome is the fact that the problem is getting worse, not better. There are many aggravating factors. More and more of us are employed or have financial ties to larger health care organizations, resulting in loss of control and independence – with concomitant loss of income as well. By our nature, we are perfectionists and tireless workers and have been rewarded throughout our training for these traits. Now we find ourselves in an increasingly imperfect and challenging world where internet popularity polls invite anonymous criticism, patient expectations exceed what we can deliver, and third party oversight may become unchecked and onerous. In our city, perhaps like yours, we deal with three completely different EMR systems that communicate with each other as if we were building the Tower of Babel.

One of the increased stressors identified in the Mayo study was the implementation of EMR. This study and others have documented decreased physician-to-patient interaction time as we huddle over these networks of selfish silicon devoting more eye contact with the EMR screen than our patients. Mix all of this together and voilà: we have created the Perfect Storm for burnout. If we don’t become more resilient to burnout, we risk disastrous consequences for ourselves and our patients. How do we do that? I am still learning and am far from an expert. Shaken by the suicide of two physicians that I have known, I sought the advice of my colleagues and here are some of our collective thoughts.

First, recognize that as surgeons, we are at higher risk and we need to be proactive.

We must establish our priorities and strive to perform meaningful and engaging work. Satisfaction and enjoyment come to us if we enjoy what we do and do it well.  By necessity, this does take precious time and effort. But without that reward of accomplishment, we will have less energy to devote to our families and ourselves. Beware the seduction of higher income and professional accolades. There is a trap here. To paraphrase the Harvard Business Review, “when people who have a high need for achievement have extra time or energy, they will unconsciously allocate it to activities that yield the most tangible accomplishments…[another surgery case, one more consult, another presentation, not saying no at work]…In contrast, spending time and energy with your spouse, children [and yourself] doesn’t offer the same immediate sense of achievement. Those who are driven to excel have an unconscious propensity to under-invest in our families and over-invest in our careers—even though intimate and loving relationships with families are the most powerful and enduring source of happiness.”

We must strive for good relationships with our family, colleagues, and friends. Discuss issues, stressors, and goals with your partner. One author recommends spending time with our family at least 90 minutes a day.  I’m not sure if this is the magic formula but it’s important for your goals and your partner’s to be in alignment. Exert control over your schedule. If you are on call during your child’s “meet the teachers” night, switch call and go to your kid’s school with your partner. Are you dreading the day after call when you get called by patients demanding to be worked on? (“The ER doctor said I had to see you TODAY.”). Reward yourself after being on call by blocking or reducing your schedule so you can absorb those patients (or have an arrangement where your practice partners share the load). Get out of the office and have dinner with your family, give the kids a bath, read to them for bedtime. Hire a sitter and take your spouse on a date night once a week.

With your colleagues, seek out experienced mentors and meet with them. Interact with colleagues at your level as well, and mentor younger physicians. In Charlotte, the hand surgeons meet twice a month for a journal club. We discuss a few articles to keep up to date but I find the real treasure is the discussion between older experienced partners, younger physicians just starting their practice, and eager fellows and residents. Instead of picking a zillion articles, we discuss just a few and this leaves time for some amazingly stimulating and refreshing discussion. Yes, you can do it over the internet, but there is an advantage to being in same room: all the ingredients are there and the recipe just turns out better that way. With this education, we become ambassadors of good surgical practice and care — rewarding for us but invaluable to our patients.

Develop a life outside of medicine. Work on favorite hobbies or find and develop new ones. One colleague took a course at the local community college and learned how to lay bricks; his project started with a weekend patio project, which morphed into be a multi-year backyard construction zone with beautiful stone work. He exclaimed, “It feels great to crack rocks and build with my hands.” Another colleague resumed his previously dormant and suppressed love of motorcycles. If you have a talent for music and play an instrument, consider doing this for your own enjoyment or perhaps with a band or in church. Consider forming a book club with some of your neighbors that have absolutely nothing to do with medicine. Or just read or listen to non-medical books.
I think exercise and/or meditation has always been an antidote to stress. Probably best if done several times a week, not just on the weekend. For many it may be golf or tennis, for me it can be a bike ride or a jog in the park.

Finally, if it gets too much, take more time off or change jobs entirely. One of my partners who was on the verge of burnout quit for 6 months and took a sabbatical in New Zealand, unsure if he would ever return to his Orthopedic practice. He did return to our practice but no longer worshiped the productivity god, saying the trip saved his life.

Remember to think about this every day. Ask for help when you need it, and be sensitive to that time when our colleagues need us to stop, listen, and talk. We are lucky to work in a wonderful and rewarding profession but we must healthy to enjoy the ride.

Charlotte, NC
January 8, 2019