Cost of burnout on physician health and surgical performance explored

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NEW YORK—It’s the recurring theme on the conference circuit that stubbornly refuses to subside but one whose toll is great and lasting. At the VEITHsymposium in New York (Nov. 19–23, 2019), it was the turn of Samuel R. Money, MD, of the Mayo Clinic and based in Scottsdale, Arizona, to take up the baton in a talk entitled, “Vascular surgery burnout: Why it occurs. Is it related to occupational or ergonomic ailments and pain? What can be done to prevent and fix the problem?”

Money first turned to workload statistics derived from Society for Vascular Surgery (SVS) surveys. “The average vascular surgeon in North America works 63 hours per week,” he said. “That includes 10-and-a-half hours of work at home. Average call days per week: two-and-a-half to three. If that doesn’t make you tired looking at it I’m not sure what else will.”

Some 41% of vascular surgeons have reached the criteria of being burnt out, Money went on. He referenced a recent study focused on how much pain surgeons were in after a day of operating. The majority, 78.3%, had moderate to severe physical pain after a full day.

Furthermore, the SVS ergonomic survey looked at different types of surgery as having different amounts of pain, Money elaborated, with surgeons who perform open surgery (predominantly neck and back) having the most and those who undertake endovenous the least.

Some 40% of vascular surgeons are in chronic pain, he said. “Physical pain, we have demonstrated, correlates with burnout. More pain yields more burnout symptoms.

“We did a little experiment where we looked at posture in the OR [operating room]. We know that the more you lean forward the worse your posture is, the more weight there is, for example, around your neck, around your back. Stand straight, and your head weighs 10–12Ilbs. Lean forward to look at your phone like most of us do, and your head increases in weight to almost 60Ilbs.”

Money and colleagues used a system of four categories—mild, moderate, high and severe stress—to calculate time spent in each range.

“If you look at the neck posture, a one on the scale is basically neutral. A four is leaning forward or back probably to the maximum,” he said.

The results, he explained, were striking. “Three quarters of the time while operating, [among] 15 surgeons doing 35 cases or so, the neck is in a high or severe stress position—the trunk approximately 40% of the time in a high stress position.”

The solutions to this reality for surgeons range from easy to not so easy, said Money, and are grouped into three classes: pre-op, peri-op and lifestyle. He listed some: Padded floor mats. Good footwear. Screens should be 10–20 degrees below eye level. Table height should be adjusted.

If you can sit down in a case, use an adjustable surgical chair up and down rather than straining the back and neck. Posture awareness. Regular exercise. Yoga. “There’s even a group in Denmark that’s developing a surgical specific exercise routine,” Money added.

He concluded, “Remember more than half of us feel that physical discomfort we suffer during surgery will affect our ability to perform surgery. We have to reduce this.”

In other settings in recent times, meanwhile, doctors have sought to quantify revenue loss from burnout.

Anita Blanchard, MD, associate dean of faculty wellness programs at the University of Chicago, told the American Society for Dermatologic Surgery annual meeting (Oct. 24–27, 2019) in Chicago: “Burnout doesn’t just begin when you become an attending physician,” she said. “It happens as early as medical school. There’s something about what we’re doing with training; in some ways, our system creates the problem.”

She referenced a Stanford University survey that showed 21% of physicians with symptoms of burnout left within two years compared with 10% of physicians with low burnout symptoms. Carrying out a similar survey at her institution, Blanchard and colleagues probed a five-year period among those who had resigned or retired. They found that it costs $250,000 to replace someone and make up for the lost revenue.

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