Speaking anonymously to Spinal News International, a career and life coach for physicians said that the most effective way to address the issue of physician burnout, in his experience, is “experimental learning during the course of a three- to six-hour workshop on the topic, where physicians can dig deep into their own life experience and come up with specific individual action steps and timelines to address their own unique stressors and circumstances.” This is what Todd J Albert (Hospital for Special Surgery, New York, USA) did at the Scoliosis Research Society (SRS) annual meeting (10–13 October, Bologna, Italy), where he organised a pre-course half-day meeting focusing on physician mental health and wellness.
Dedicating time to physician well-being has been one of the hallmarks of Albert’s SRS presidency this year; in July, he gave a keynote address at the International Meeting on Advanced Spine Techniques (IMAST; 11–14 July, Los Angeles, USA), where he advocated for the adoption of certain individual- and institution-level interventions to help lessen the strain on surgeons’ mental health.
However, at SRS, the focus was broader, encompassing many different surgeons’ experiences of both excellent and poor mental health, and the ambition greater, with multiple suggestions of tools and lifestyles aimed at self-awareness and improvement. Increasingly over the last few years, mental health has been recognised as a significant concern for physicians. Research by Tait Shanafelt (Mayo clinic; Stanford Medicine, Stanford, USA) involving surveying 7,000 physicians found that there are 400 physician suicides a year in the USA, twice the suicide rate of the general American population. Death by suicide is the second leading cause of death among medical residents. Fifty-four percent of doctors say they are burned out; 88% acknowledge they are moderately to severely stressed, and 59% of doctors say they would not recommend a career in medicine to their children. The study investigators also report that, between 2011 and 2014, there was an increase in the percentage of physicians reporting burnout, and a decrease in the number of surgeons who believed they experienced a good work-life balance. North American orthopaedic surgeons rate in the lowest third of all care workers for work-life satisfaction, and the highest for rates of burnout.
This is the backdrop to the pre-meeting course put together by the SRS, spearheaded by Albert. The course was separated into two sessions: physician preservation and physician growth. Emphasising the importance of discussing physician wellness with an international group of delegates, Albert told Spinal News International: “Physician well-being and problems with burnout are an increasingly recognised problem in our healthcare community. It cuts across national and international lines as well as across specialties within healthcare. Therefore, it is incredibly important to focus on this topic within our conference, and even more importantly at an international conference.
“The delegates leave the meeting with a sense of purpose and begin their wellness journey, which starts with recognition and the ability to identify those who may have a problem with their emotional well-being in a non-punitive fashion. Further, we hope that they will learn tools to begin to manage these issues and embark on improved wellness behaviours. Other conferences are increasingly taking this mantle and identifying and teaching about wellness and tools to enhance physician well-being and decrease burnout. Certainly, we are doing this at the Hospital for Special Surgery (New York, USA) as well.”
Attending Faculty member at SRS Teresa Bas (la Fe University and Polytechnic Hospital, Valencia, Spain) told Spinal News International that, in her experience, there is not a strong focus in Spain on physician well-being. She comments: “My biggest take-away from the pre-course meeting as the need to have a coach—someone to help you improve your practice. This topic is specifically significant for physicians practicing in Spain because no one has worried about this issue, and surgeons are viewed as ‘lone rangers’. People believe that having a coach means you are lazy, which is nonsense. I think we need to change this mind-set in Spain; we need an awareness and a recognition of the importance of both physical and psychological health.
“I think talking about surgeons’ health is hugely important. The well-being of the surgeon is transmitted to the patient through the performance and care the surgeon is able to provide; it is important for physicians to take care of themselves and to take the necessary measures to work in the healthiest way possible.
“The course also stressed the importance of mindfulness to retrain your brain to more easily relax from stress situations, doing a sport to improve surgical dexterity and to eliminate toxic energy, and eliminating toxic friendships.”
Though unconfirmed, several SRS attendees who will be hosting international conferences in 2019 expressed interest in including a similar symposium at their event. Samir Dalvie (Hinduja Healthcare Surgical, Khar, India) stressed to Spinal News International that the pre-course meeting was a congress highlight, and that he now hoped to have a focus on physician wellness at a future AOSpine meeting in India.
Dalvie elaborates: “All meetings focus on clinical material and research. This session was a refreshing change from the monotony of such presentations. The topics were very interesting, and tackling issues such as burnout, well-being, time management and mentoring have a great practical impact on our daily lives. Meetings should increasingly address concerns of physicians about their practice and personal lives, as a healthy and happy physician can deliver the best care.”
Speaking specifically about the impact this session could have on physicians in his country, Dalvie continues: “The problems which surgeons face are universal, and there would be few variations in these across countries. Indians tend to be even more buried in the professional side and neglect their own well being as well as their family, due to greater demands on physicians by our patient population. The avenues for leisure and recreation tend to be fewer, and few surgeons have well developed extra-curricular interests. Such sessions will serve as an eye opener for Indian doctors, and hopefully will be the beginning of a welcome change in lifestyle and habits.
“I left with a greater awareness of the importance of my own personal development, maintaining my health and happiness, and spending time with family. I would hope that following a few tips would great;y reduce the stress of my profession.”
The conversation about physician burnout has transformed into international action.