By Kyla Wright
“So, tell me – why general surgery?”
My mouth begins reciting a premeditated answer before my mind has time to catch up. We are only a few weeks into interview season and, already, I must resist the temptation to let motor memory takeover and instead maintain some degree of authenticity in my words.
Though interview season feels like an imitation game at times, it offers a unique opportunity for reflection: preparing for anticipated interview topics, applicants like me reflect on their values, strengths, weaknesses, and ability to cope with and face the challenges of a career in surgery. Many questions (E.g., What do you believe is the most rewarding aspect of a career in surgery? Can you maintain a work-life balance?) address a common theme – how will you achieve and maintain occupational wellness in your future career as a surgeon?
Occupational wellness is a term that recognizes personal satisfaction and enrichment in one’s life through work. It recognizes the importance of traveling a career path through which you will be challenged and acquire skills that are both personally meaningful and gratifying for you. Though I was unaware of the term at the time, occupational wellness is something that I have contemplated frequently, both when deciding my future specialty and throughout the residency application process. For me, pursuing a career in a specialty that will continually challenge me both technically and intellectually, and provide me with the opportunity to make a profound impact in my patients’ lives, seemed essential to achieving occupational wellness.
Admittedly, I’m writing this discussion in the position of predicting what features of a future career will make me happy and fulfilled. I’ve gotten glimpses into the gratification that comes with making an impact in a patient’s life, even if relatively small as a student, that I anticipate will only magnify as my responsibility in patient care increases. That said, with greater responsibility, I foresee the challenges I’ve encountered as a student will intensify in parallel – namely, coping with poor patient outcomes and avoiding so-called “burnout.”
As a student, I’ve already received countless warnings of burnout – a feared syndrome characterized by emotional exhaustion and depersonalization that is perhaps one of the biggest threats to occupational wellness. And based on a quick search of the literature, the warnings are warranted: rates of burnout among physicians have increased (and job satisfaction decreased) over the years [1, 2] and, among surgeons, are higher in females [3,4]. There are many driving factors, including changes in the structure and process of health care, workload and job demands, culture and values, and work-life balance to name a few [1,2]. But the critical question is: what do we do about it?
It starts by recognizing the problem, both at an institutional and personal level. Institutionally, we can improve occupational wellness and minimize factors contributing to burnout by aligning values and strengthening culture, promoting flexibility and work-life integration, providing resources to promote resilience and self-care, and cultivating and establishing communities that address the needs of different cohorts (e.g., women, physicians with young children) that may be at greater risk [2, 5]. On a personal level, we must recognize that the adaptive personality traits that make us thorough and caring providers to our patients are frequently accompanied by maladaptive traits that make it difficult for us to relax or set limits and easy to carry an excessive sense of responsibility and guilt [6]. Periodic self-assessment is imperative, aiming to identify which parts of our work and personal life are most meaningful and making those activities a priority [2].
So, as I reflect during my residency interviews on why I’m choosing a career as a surgeon and what aspects of my life and future career are most meaningful to me, I invite you to pause from your own careers and reflect as well: What is most important to you? Why do you do what you do? And if you don’t know where to start, I hope you find the links listed below helpful:
Resources:
Work-Life Integration: https://www.facs.org/for-medical-professionals/news-publications/journals/rise/articles/work-life/
Avoiding Burnout & Promoting Resilience: https://www.facs.org/media/v4udjmz0/08_kaups_avoiding-burnout_promoting-resilience.pdf
Avoiding Burnout – the Personal Health Habits and Wellness Practices of Surgeons: https://journals.lww.com/annalsofsurgery/Abstract/2012/04000/Avoiding_Burnout__The_Personal_Health_Habits_and.4.aspx
Stress & Burnout Among Surgeons: https://jamanetwork.com/journals/jamasurgery/fullarticle/404847?resultClick=1
References:
1 Hunt, Kelly K., and Hannah F. Wingate. “Satisfaction and sustainability in a surgical career.” Annals of surgical oncology 25.10 (2018): 2785-2789.
2 Horowitz, Carol R., et al. “What do doctors find meaningful about their work?.” (2003): 772-775.
3 Shanafelt, Tait D., et al. “Burnout and career satisfaction among American surgeons.” Annals of surgery 250.3 (2009): 463-471.
4 Jackson, Theresa N., et al. “The physician attrition crisis: a cross-sectional survey of the risk factors for reduced job satisfaction among US surgeons.” World journal of surgery 42.5 (2018): 1285-1292.
5 Shanafelt, Tait D., and John H. Noseworthy. “Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout.” Mayo Clinic Proceedings. Vol. 92. No. 1. Elsevier, 2017.
6 Gabbard, Glen O. “The role of compulsiveness in the normal physician.” Jama 254.20 (1985): 2926-2929.
Kyla Wright grew up in Spokane, WA and attended college at the University of Washington where she studied Neuroscience and Bioethics. She is currently a fourth-year medical student at NYU Grossman School of Medicine and is applying to general surgery residency training programs. Her fields of interest include Endocrine Surgery and Trauma/Acute Care Surgery, but she is looking forward to exploring each field of surgery further during her training! In her free time, she enjoys exploring NYC with friends, reading, enjoying the outdoors, dancing, and playing the piano!