By Anu Bajaj
A while back, my father texted me, “How is work and office, I bet you don’t have any problems or hitches.” I responded to him, “No problems…just wish I had more time in the day to get everything done.” His response made me smile, “I can transfer my time to you.” I wish that he really could.
Life as a plastic surgeon – or for anyone — doesn’t seem to stand still. Within the past year, I have moved into a new office, hired two additional employees, taken my recertification exam for the ABPS, and continued to do surgery, run, and remain active in ASPS through involvement in multiple committees. And I have struggled to adjust to the changes in my life and still make time for the people and things I love.
As I read the article on plastic surgeon burnout in this month’s issue of PRS (1), I found that I could relate. I have thought extensively about my personal relationship with my profession, and how it relates to the other aspects of my life – there have been times when I have struggled to find an appropriate balance between work and the rest of life, and I can recall many Monday mornings in the past when I have cried as I have driven to work.
Physician burnout has been a relatively hot topic during the past few years and previous blog posts have discussed it as well; it is defined as “emotional exhaustion, depersonalization, and perceived lack of personal accomplishment” and can affect all aspects of our lives. Some of the predictors of physician burnout that the study found included “working more than 70 hours per week, spending more nights on call, or having compensation based on billing” as well as junior academic rank. When I hear these predictors, my mind turns to the period of my life when I worked in academics and felt as if I had no control over my schedule – I can remember grueling days of performing two and even three free flaps in a day followed by a night of hand call. While many of us can recall workweeks of over 100 hours as residents, we also believed that this schedule would be temporary and a time would come when we could better control our lives. Sometimes when this time never arrives, it can be frustrating and demoralizing.
I found it interesting that the article says that microsurgeons and aesthetic surgeons were the most likely to experience burnout. I am a microsurgeon who performs between 35 and 50 free flaps a year in a private practice setting. I wonder if this higher degree of burnout amongst microsurgeons is also related to a lack of control of time and scheduling? Many microsurgical reconstructions are performed in conjunction with ablative surgeons and microsurgeons are always “on call” for potential flap complications. For my own practice, I have tried to minimize the disruptions to my personal life by limiting my free flaps to Mondays – so hopefully, any emergencies don’t disrupt the weekend and occur during the workweek.
The reality is that we work in a profession where our job is to care for others. And others don’t necessarily understand or care to understand our daily stressors. And some days, we put out more fires than others. In one day, you can deal with one patient who is upset about the long wait in your office, another patient with a hematoma of the breast who requires a return to the operating room, another patient who is upset about the denial of her surgery by her insurance company, etc. – the list is endless, but each of them has turned to me to fix her problem, and there is only one of me. This sense of urgency and the perception that we, the physicians, are responsible can contribute to the sense that we lack control over the situation and have “no time.”
One reason we should discuss why we experience burnout is only if we understand the why can we understand how to prevent and treat it. I remember reading one article last year that advised physicians to practice “mindfulness.” I do believe that focusing on the present and truly being present in our patient interactions does help eliminate the background noise that makes our lives so frustrating. Nevertheless, the current healthcare climate including the increasing amount of administrative work and the devaluing of physicians does create a lot of background noise that contributes to burnout.
The study did find that being in practice for over 15 years was associated with lower burnout rates. Are physicians who have been in practice longer better able to control their time and schedules? Are they better able to focus on the individual patient and not be inundated with background noise? Dr. Murphy explores some of these issues in his Discussion about this study. I’m not sure if I have an explanation for this finding because I have discovered that I am more frustrated with the non-surgical aspects of my job today than I was many years ago.
But to return to the beginning of this blog when my father offered to transfer his time to me… I have to realize that there will never be enough time in the day, but sometimes you just have to take the time and play in the sprinklers. I usually run in the mornings with both of my dogs – Guinness and Scout. Some days I get frustrated with their stops – each has to pee and poop, and neither will do it at the same time. Then once spring starts, and everyone starts running their sprinklers in the morning, Guinness believes that these magical devices coming from the ground and spewing water were put on this earth specially for him to play. When I see how happy he is, I have to sit back and smile. There will always be more patients to placate, more charts to complete, and more insurance denials to fight. The best I can do is to tackle each one, one at a time.
1. Burnout Phenomenon in U.S. Plastic Surgeons: Risk Factors and Impact on Quality of Life
Qureshi, Hannan A.; Rawlani, Roshni; Mioton, Lauren M.; Dumanian, Gregory A.; Kim, John Y. S.; Rawlani, Vinay Less
Plastic & Reconstructive Surgery. 135(2):619-626, February 2015.
Discussions of the referenced article:
2. Discussion: Burnout Phenomenon in U.S. Plastic Surgeons: Risk Factors and Impact on Quality of Life
Hunter, John G.
Plastic & Reconstructive Surgery. 135(2):627-628, February 2015.
3. Discussion: Burnout Phenomenon in U.S. Plastic Surgeons: Risk Factors and Impact on Quality of Life
Murphy, Robert X. Jr.
Plastic & Reconstructive Surgery. 135(2):629-630, February 2015.