Burnout is a global problem in the medical community. Surgeons are not different and suffer from it. In the last edition of BJS, Christina Gellini from the Department of Surgery of the University of Rochester Medical Center (NY, USA) published a paper talking about this problem, reasons and how to deal with it.
According to the author, 50% of surgeons and 69% of general surgery residents are suffering from burnout. These are impressive numbers, with a negative impact in personal and professional life. Surgeons are susceptible to burnout because of long working hours, long training, bad hierarchy, and bad habits.
The top reasons for surgeon’s burnout presented by Christina are:
- Excessive administrative tasks
- Time spent at work
- Lack of respect from administrations, colleagues, and staff
Hospital and Department directors are one of the main reasons for a surgeon’s burnout. They are the main reason for the burnout present in the entire medical community. Many do not care about workers or patients; they just care about numbers. They nominate themselves “leaders”, but a true leader is recognized only by others. They are only bosses. It is common to know about someone who is going to a leadership course. These courses are ridiculous and non-sense. Why? Because no one can learn how to be a leader. If you were not born a leader, you will never be one. Leadership is a character issue, and character is not teachable.
Surgeons do not usually recognize themselves as burnout victims. They are taught to be strong and to suppress displays of weakness. Surgeons must submit blindly to authority and must put patients above themselves. Christina Gellini says that this toxic environment exists among surgeons and unfortunately is becoming normalized. Additionally, I think those who think differently and talk against it are bullied by others. This must be put to an end.
Surgeons are constantly struggling with increasing administrative demands without any compensation, expansion of time, or resources. Doctors are meant to treat patients, not to deal with increasing bureaucracy. Both the governments and the hospitals' directors do not understand this and do not recognize they are wrong. That is why the healthcare system is cracking. Always keep in mind: Patients go to a hospital to be treated by a doctor! This is the only reason for a hospital to exist.
Dedicating 20% of our time to the area of practice we enjoy, is inversely related to burnout. Another important tool to decrease burnout is to unplug when not on call. However, it is common for a surgeon to see his work invading his home: complete records, prepare for the next day's surgery and still receive phone calls from work. In Portugal, this is the rule, but it must end. Every worker has the right to rest and to temporally forget his workplace. To avoid burnout, a surgeon must be able to unplug. However, the toxic idea that it is normal to call someone after hours is ingrained in Portuguese society. Portuguese public hospitals only reflect society’s lack of respect for labor rights.
Christina Gellini talks about the pandemic and what it unleashed. Covid highlighted the cracks in the system. Many doctors just said enough is enough and opted for early retirement. Because of the actual cracked healthcare system, younger doctors will eventually not have the opportunity to learn from older experienced doctors. This is very disturbing for me. Surgery is not supposed to be learned only from books, images, and videos. Surgery, like whole medicine, is a social activity involving all surgeons in an active discussion of cases, techniques, and outcomes. Unfortunately, those in charge do not understand this, and will never do. Although Covid highlighted the cracks in the system, nothing seems to be changing. I believe burnout will increase in a near future.
The author says we all must promote wellness efforts within organizations. Will this change something? We all know what the problem is. Are administrations and governments able to recognize they are the reason for the cracked system and doctor’s burnout? I believe not. They are the system.
She says surgeons must be able to work within the dysfunction while trying to change the system. What are doctors doing and trying for decades? Should surgeons change the system or seek another system? Like everyone, surgeons run away from toxic environments and bad bosses. No surgeon leaves a peaceful, friendly, innovative, and efficient working place. Sometimes, happiness is just next door (another hospital, another department, another country). Sometimes only by closing a door, you can open another one. I did it. Months later, I knew it had been the right decision.
Would like to highlight a sentence from the author: “Healthcare systems need to recognize that caring for physicians is not only good for business but also the right thing to do.”
Changing a system is not easy and sometimes impossible. No one can move a mountain without pain. A mountain only moves by force. Only by “beheading the snake” we can stop this toxic ingrained environment that has infected worldwide health care systems. Otherwise, burnout will become the rule among surgeons and general surgery residents.
Link to PubMed:
Dr. Carlos Eduardo Costa Almeida
General Surgeon