I want to summarize the findings of “Road Map for Maintaining Career Satisfaction and Balance in Surgical Oncology,” (Kuerer HM et.al. 2008. Journal of the American College of Surgeons. 207(3):435-442).  The insights extend well beyond surgery.

In their survey of 549 surgical oncologists, 24% reported emotional exhaustion, 15% feelings of depersonalization (decreased empathy), and 10% low personal achievement.  These three domains of the Maslach burnout inventory are the antithesis of job engagement, energy, involvement, and a sense of efficacy, according to the authors.   Not engaging in research, perceiving a lower quality of life (in surgeons who reported performing on average 11 or more operations per week), and age younger than 50 were twice as likely to be associated with burnout.

That those older than 50 were less likely to experience burnout may be multifactorial:

• natural selection: those who experienced burnout may have left already for other settings and thus were not included in the survey
• entitlement: professors, section chiefs, and/or or department chairs, who tend to be older surgeons, may have more resources for being productive, such as secretaries, nurse practitioners, and laboratory technologists
• privilege: older surgeons may have shifted clinical burdens, such as the bulk of night and weekend call, to younger surgeons to allow them to “build their practices”
• travel: older surgeons may be traveling more to other settings to speak and attend meetings

Why should performing research be associated with lower burnout scores?  Surgeons who perform research usually have protected time, i.e. days when they are not responsible for seeing patients.  While their full-time clinical colleagues (aka “the grunts”) may feel that they are in a state of siege from the time that they arrive at work until they leave, surgeons who do research may have time to reflect, that they can decide how to spend, rather than be on the “electronic leash,” a term of (less-than) endearment for the beeper. 

I know because I am a “recovering academic surgeon,” who used to perform grant-funded research in the molecular biology of colorectal cancer (Cohn K, Macnab J, Ornstein D, Wang F, DeSoto LaPaix F, Phipps K, Edelsberg C, Zuna R, Stein J, Mott L, Tosteson T, Dunn J, Steeg P. Association of nm23-H1 allelic deletions with distant metastases in colorectal carcinoma: Results of a 5-year follow-up study. Cancer, 1997; 79:233-244.)

Standard intrapersonal recommendations to combat burnout include (Cohn KH. Better Communication for Better Care: Mastering Physician-Administrator Collaboration, Chicago, Health Administration Press, 2005.):

• Cultivating a sense of perspective and humor
• Vacation
• Exercise
• Meditation
• Seeking counseling when feeling the need to treat symptoms of burnout with alcohol or other habit-forming substances

Standard interpersonal recommendations to treat burnout include:

• Respecting colleagues’ nights and weekends off duty
• Sharing feelings with others who have related a stressful event or multiple events
• Showing concern when colleagues exhibit symptoms of burnout and helping them obtain assistance before patient care suffers

The authors admit that controversy persists over whether “systems” need to be changed or whether we need to provide more opportunities that faculty perceive as professionally enhancing and intrinsically rewarding.  Why not do both?  In Collaborative Learning: Becoming More Comfortable with Paradox, I  quoted F. Scott Fitgerald that “the test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time and still retain the ability to function.”

I was pleased that Kuerer et. al. discussed “the critical importance of mentorship,” both to the mentor and mentee: “there is no greater joy than helping others to find their way and feel wanted, understood, and supported…. Receipt of mentorship is not limited to any particular point in one’s career, and mentees can concurrently or consecutively use a broad network of mentors to develop different kinds of expertise.”

Building on Kuerer et. al., I wrote Collaborative Co-mentoring, to point out that each person brings valuable knowledge, experience, and wisdom to the table.  When I helped set up a physician co-mentoring program recently, I asked physicians, “What makes a great co-mentor?” They replied:

• Personal connection
• Passion
• Insight
• Availability
• Active listening
• Mutual respect
• Clear vision and expectations

What do you think:

• What can we do to monitor and deal with burnout proactively?
• Do we currently acknowledge healthcare professionals in distress without penalty?
• If not now, when?

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn