Burn, Baby, Burn—Preventing Surgeon Burnout

There’s no getting away from it. Being a surgeon is tough. While adrenalin can keep a tired, overworked doctor through surgery, there’s only so long the buzz can last. As every doctor knows, it’s hard work maintaining a full operating schedule and dealing with the endless charting and bureaucracy of modern medicine.

While successful surgeons have great people behind the scenes, even the best managers and schedulers cannot protect the surgeon from the time-consuming minutia that eats into doing what they do best—perform surgery.

Surgeon burnout is on the rise

Given how medicine is changing and the increasing bureaucratic pressure on doctors, it’s no surprise surgeon burnout is on the rise. According to a physician burnout survey conducted by the Mayo Clinic and the AMA, burnout rates were higher for all specialties in 2014 compared to 2011. Burnout increased from 48.3 percent to 59.6 percent for orthopedic surgery, while general surgery subspecialties rose from 42.4 percent to 52.7 percent.

While there’s a host of factors that contribute to burnout, the main culprits are working too long and too hard on too little sleep.

It’s no secret that trainee doctors are sleep deprived. Residents are expected to work up to 80 hours a week, with shifts often lasting longer than 24 hours. Once their qualifying days are behind them, most physicians work a more manageable—though still heavy—40-60 hours a week. According to the AMA, however, some choose to keep pace with the residents, working anywhere from 61-80 hours a week.  

Over time, this situation is just not sustainable. Even if a doctor believes he can get by with the minimum of sleep (a la Thomas Edison, who famously thought sleep was a waste of time), without adequate rest and relaxation, fatigue and decreased performance will set in. 

Restricting “flight” time

There’s a reason the Federal Aviation Administration strictly regulates the number of hours an aircrew can operate without taking a mandated break. No one wants to imagine their pilot sitting at the controls about to nod off. Similarly, no one wants to imagine their surgeon in this capacity as they’re about to open them up with a scalpel. Patients want their surgeon to be well rested and alert when they perform surgery, whether it’s a simple cataract or a complicated heart procedure.

Maximizing time in the OR may have diminishing returns

To make the most efficient use of their OR time, surgery usually starts early in the day—often by 7 am. So while most people are still hitting the snooze button or waiting for that first java hit to kick in, surgeons have already been up for hours prepping for a long day of surgery. Unless they put themselves under serious curfew, they run the risk of consistent early mornings leading to serious sleep deprivation and impaired performance.

Performance in the OR isn’t the only thing at stake. Exhaustion can also affect the surgeon’s interpersonal behavior and turn encounters with patients into a nasty episode of HOUSE rather than a pleasant exchange with Dr McDreamy… which can have serious implications.

In his bestselling book Blink, Malcolm Gladwell highlights research about the differences between surgeons who had been sued and those never been involved in legal action. The likelihood of being sued stemmed entirely from the way the surgeons talked to their patients rather than in the quality of information they provided. The surgeons who had never been sued spent more time with their patients and were more patient-focused. “They were more likely to engage in active listening, saying things such as “Go on, tell me more about that,” and they were far more likely to laugh and be funny during the visit.”

Says Gladwell, “Interestingly, there was no difference in the amount or quality of information they gave their patients; they didn’t provide more details about medication or the patient’s condition. The difference was entirely in how they talked to their patients,” which is something tired, grouchy and burnt out surgeons would do well to remember.

Schedule some mandated R&R

In many practices, there is already four-weeks mandated vacation for surgeons, but not all practitioners take the minimum time off required. For the safety of patients and the surgeons themselves, make sure the minimum vacation time is scheduled into the calendar.

Consider limiting OR time

Likewise, work with the surgeon to come up with a reasonable limit on operating hours and office hours each week. It may be that scheduling just one less procedure a week makes the difference. Immediate financial implications aside, adding breathing room into the schedule will ultimately pay dividends.

If all else fails… start small

If you face massive resistance to these changes, or don’t feel comfortable suggesting them, start small. Sell the surgeon on the virtue of taking a proper lunch break rather than chowing down a soggy sandwich in front of the computer. And if this is too much for your busy surgeon, encourage them to get up and take a five-minute walk every so often. Just taking a short break and switching off, even if for only a few moments, can do wonders for tiredness and stress.

All physicians are familiar with the idiom “Do as I say, not as I do”. Surgeons need to make sure they lead by example, and take care of their health and wellbeing. Having the chance to step back and catch up on their ZZzzzs and hobbies might be just what an exhausted surgeon heading towards a meltdown needs to prevent burnout.