The practice of surgery provides significant privileges and rewards, but with accompanying responsibilities and challenges. As surgeons become more experienced and mature professionally, some of the most difficult issues they face fall outside the realm of patient care and medical knowledge. At times, behavioral, physical, judgment and impairment issues may damage and derail a surgeon’s ability to practice safely and effectively. Most surgeons know colleagues whose careers have been limited by these issues; some have personal experience. To help surgeons develop a better understanding of these problems, the American College of Surgeons (ACS) Board of Governors Committee on Physician Competency and Health has posted Being Well and Staying Competent: Challenges for the Surgeon on the members-only Web portal at www.efacs.org.
In the past, the expectation was that surgeons dealing with fatigue, illness, and other issues that can lead to impairment could, and should, "tough it out". The occasional acknowledgement of human frailty was mostly limited to cautionary tales of surgeons who were considered not resilient enough to meet the demands of surgical practice. Impairment and how to address it is rarely a component of surgical training; hence, most surgeons are far more comfortable managing a bowel obstruction than an impaired colleague. Additionally, surgeons may not realize that some of the personality traits we value in ourselves and our colleagues (compulsiveness, a heightened sense of responsibility, perfectionism) may predispose them to dysfunction and impairment. Consequently, situations and behaviors that are detrimental to patient care and surgeon wellbeing are sometimes ignored and rationalized.
The Governors’ Committee on Competency and Health has been studying these issues since 2008, when, with the support of the College, the committee commissioned a survey of the Fellows, asking about personal characteristics, practice situations, quality of life, professional satisfaction, issues relating to fatigue, and other topics. Most surgeons described good quality of life, and nearly three-quarters stated that, given the choice, they would again choose surgery as a career. Nonetheless, the large-scale response of nearly 8,000 Fellows reflected significant rates of burnout, depression, and other issues related to professional satisfaction and work-life balance.
Another survey performed in 2010 had a somewhat different focus, with questions addressing interpersonal relationships, work-life balance, coping mechanisms, and substance abuse. Responses to this study corroborated previous findings but also demonstrated high rates of substance abuse. Surgeons who reported making a major medical mistake in the three months prior to completing the survey were much more likely to offer responses indicating burnout, particularly emotional exhaustion and depersonalization, regardless of whether the patient was harmed.
A new resource
The committee examined the survey results carefully and solicited feedback, questions, and concerns from Fellows and decided to develop a readily available resource that Fellows could use to both identify and address these concerns. A previous pamphlet on The Impaired Surgeon was published in 1992 through the ACS Committee on Physicians’ Health (the precursor to the current committee) and revised in 1995. This resource primarily dealt with impairment due to alcohol or substance abuse. The evidence from the surveys and our personal experience suggested that the challenges facing surgeons are more wide-ranging. Discussion among committee members about the complexities of the identified problems led to the topic selections for Being Well and Staying Competent: Challenges for the Surgeon.
The committee members who contributed to this resource acknowledge that few of them are experts in these areas, but are surgeons with practical experience who are aware of the challenges and seek to offer assistance. Topics explored in the document include surgeon burnout, substance abuse, sleep deprivation, age impairment, the disruptive physician, boundaries, and credentialing issues.
The committee chose to post the document on ACS Portal to provide rapid access to this resource in a digital format. In addition, select sections of the resource are serving as the basis of a series of article in the ACS Bulletin, http://bulletin.facs.org/.