13 Jul 2016


I recently completed a 1-year hospital based fellowship that is designed to provide faculty and staff with the expertise and skills needed to advance academic careers in medical education.  While I originally applied for the fellowship in order to improve my teaching style, I was particularly drawn in by the wellness sessions. I learned about the high prevalence of physician burnout, which is 30-40% amongst American surgeons1 and the many signs to help recognize it in myself and in others.  I also became more aware of the resources  available to help someone who is dealing with burnout.

As the only surgeon in the group, it quickly became obvious to me that many of the solutions to preventing burnout required time and rearranging one’s schedule, for example, to go to a yoga class or meet with a peer support person. Of course, the irony was not lost on the other participants that actually trying to make time to fit in more activities is part of the challenge to using these resources.  One of my co-fellows pointed out how physicians often “can’t make time” for wellness until they are seriously ill.  It is only when a physician has a significant change in their life, like cancer, or a heart attack, that they are able to free up time for daily radiation therapy or cardiac rehab. These stories have always bothered me, they suggest that work-life balance is as simple as getting one’s priorities straight and “making time” for friends, family, and self.

Most of us want to give our patients everything we have because we care about them.  It’s not as simple as choosing between “work” and “life.”  The line is blurred when “work” includes helping people that you have gotten to know well and care about and who have entrusted you with their health/lives.

What limits the time I have for my family and favorite activities is not that I am a workaholic or afraid that a colleague would see me leave for lunch. It is a little voice in my head that, despite it being well after “normal” work hours and knowing my patients are in stable condition with an in-house resident watching over them, still thinks “Why do I get to be out in my garden at 7, enjoying a late summer sunset while those patients are still sitting in the hospital, waiting?” Yes, that’s right, I feel guilty about it.  For me, and I imagine others out there, ever since finishing my surgical training I have had a big component of guilt associated with my free time because there is a human on the other end, not feeling well.  In fact, instead of trying to find more time for wellness I often wonder if I could have spent just a few more minutes with one of my patients or a few extra moments reading the latest journal article.  So where does appropriate responsibility and work ethic cross the line into self-destructing guilt?

 Shortly after my fellowship session where we had discussed wellness, I had one of those life events when I really did need to cancel everything. My grandmother passed away unexpectedly and my mother needed support.  I canceled a very full all day clinic to go to the funeral and stay overnight at my mom’s house the night before.  One of my partners generously picked up a call that night at the last minute.  And I didn’t feel guilty, not even for a second.  I thought back to that fellowship session and again thought about what my non-surgeon colleagues had pointed out during that session and realized that they were right. In some ways, my grandmother’s death was what it took for me to be out of work and not feel guilty about it.   So instead of trying to find ways to “make time” for those priorities I am trying to find a way to be guilt-free while using that time.


1. Shanafelt, T. Ann Surg Oncol (2008) 15: 400. doi:10.1245/s10434-007-9725-9



J.S. is a general surgeon from Boston, MA.



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