230 K. Troppmann and C. Troppmann

result, you are able to work in a targeted and focused area in which you can excel and/or that may allow for more flexibil- ity, or even a decrease of the work hours.

When at work, you must be highly organized and effi- cient. In that regard, we refer to the chapter in this book that is specifically dedicated to optimizing time manage- ment. Regardless of the practices adopted to optimize time management, it is important to learn to delegate and to trust those to whom work is delegated. This involves employ- ing only judiciously selected people, and then continuously developing them.Also, look for colleagues who are successful with their time management and try to learn from them.

For implementation of any of the above measures, a cul- ture of open communication with the departmental chair or divisional chief is important.This will allow the surgical lead- ership to better understand stressful aspects and challenges of routine clinical and research business, and to devise and implement alterative measures as necessary. Moreover, an open communication culture among colleagues allows for discussion and debriefing after adverse clinical outcomes (e.g., patient death), which have been shown to be risk factors for distress and psychological imbalance.21

The recommendations discussed in this section can be dif- ficult to execute as many of them require a change of indi- vidual mindset and culture, particularly when it comes to patient care-related changes.

Conclusion

When trying to balance personal and work life, it is important to acknowledge that there is no generally applicable blue- print. Work–life balance is different for different individuals and, like an ever-swinging pendulum, may be different for the same person at different times in his or her life. Striving for that balance requires ongoing follow-up, monitoring, and adjustment as needed. Regardless of the pathway you choose, it would be a fallacy, however, to get caught up in the belief that your personal life can be placed on hold indefinitely or

Chapter 14.  Work–Life Balance and Burnout 231

until retirement.The latter is a mistake all too often commit- ted by surgeons, particularly by those who overinvest them- selves in their professional lives.

Besides the measures that individual surgeons can take to prevent or correct work–life imbalance and related problems, such as burnout, the surgical profession as a whole (surgeons, academic and nonacademic departments and institutions,and professional societies) must advocate for, and work toward, effecting change at the surgical workplace. Such necessary change includes creation of more part-time and other flexible surgical work opportunities, broader implementation of shift work for surgeons (as has already occurred in some hospitals on at least some services [e.g., trauma surgery]), the creation of surgical hospitalist positions,and increasing the availability of childcare at the workplace. Although these proposals may sound far-fetched to some, other countries have already moved on even further. For instance, in the Netherlands, the concept of part-time work has now also permeated to the level of surgical training.36 That such considerations are not a luxury but may turn into a necessity in the not too distant future, is also evidenced by the recent statement of a Dutch medical leader “…if we insisted on full-time surgeons, we would have a personnel problem.”36

Ultimately, it is only the combination of mindful effort and goal setting at the personal and professional level, coupled with focused institutional, national, and societal surgical advocacy that will change how surgeons can cope with chal- lenges of maintaining physical and emotional health in the face of the ever increasing complexities and demands of their profession.A change in surgical culture, including acceptance of the fact that it is appropriate to talk about work–life imbal- ance issues and burnout, will result in a better and more sus- tainable lifestyle for surgeons. Such change benefits not only individual surgeons, but also departments and patients, since work–life imbalance and burnout are risk factors for under- performance at work and medical errors.

Appropriate attention to these matters will help you to bet- ter enjoy and appreciate the innumerable rewards and gratifi- cations that can be derived from the surgical profession.

232 K. Troppmann and C. Troppmann

Implementation of at least some of the recommendations discussed in this chapter will also make you a better spouse, parent, friend, surgeon, colleague, mentor, educator, and researcher. If you are able to balance your life, the legacy you will leave behind will be far greater in its impact and influence on your family, patients, and the surgical community.

References

 1. Blaisdell FW. Development of the city-county (public) hospital. Arch Surg. 1994;129:760-764.

 2. Irani JL, Mello MM, Ashley SW, Whant EE, Zinner MJ, Breen E. Surgical residents’ perceptions of the effects of the ACGME duty hour requirements 1 year after implementation. Surgery. 2005; 138:246-253.

 3. Fischer JE. Continuity of care: a casualty of the 80-hour work week. Acad Med. 2004;79(5):381-3.

 4. Vanderveen K, Bold RJ. Effect of generational composition on the surgical workforce. Arch Surg. 2008;143:224-226.

 5. Troppmann KM, Palis BE, Goodnight JE Jr, Ho HS, Troppmann C. Women surgeons in the new millennium. Arch Surg. 2009;144: 635-642.

 6. Harms BA,Heise CP,Gould JC,Starling JR.A 25-year single institu- tion analysis of health, practice, and fate of general surgeons. Ann Surg. 2005;242:520-529.

 7. Johnson JT, Wagner RL, Rueger RM, Goepfert H. Professional burnout among head and neck surgeons: results of a survey. Head Neck. 1993;15:557-560.

 8. Kuerer HM, Eberlein TJ, Pollock RE, et al. Career satisfaction, prac- tice patterns and burnout among surgical oncologists: report on the quality of life of members of Society of Surgical Oncology. Ann Surg Oncol. 2007;14:3043-3053.

 9. Kuerer HM, Breslin T, Shanafelt TD, Baile WB, Crawford W, Balch CM. Road map for maintaining career satisfaction and balance in surgical oncology. J Am Coll Surg. 2008;207:435-442.

10.Sharma A, Sharp DM, Walker LG, Monson JR. Stress and burnout in colorectal and vascular surgical consultants working in the UK National Health Service. Psychooncology. 2008;17:570-576.

11.Streu R,McGrath MH,GayA,Salem B,Abrahamse P,AldermanAK. Plastic surgeons’ satisfaction with work-life balance: results from a national survey. Plast Reconstr Surg. 2011;127:1713-1719.

Chapter 14.  Work–Life Balance and Burnout 233

12.Yost WB, Eshelman A, Raoufi M, Abouljoud MS. A national study of burnout among American transplant surgeons. Transplant Proc. 2005;37:1399-1401.

13.Balch CM, Freischlag JA, Shanafelt TD. Stress and burnout among surgeons: understanding and managing the syndrome and avoiding the adverse consequences. Arch Surg. 2009;144:371-376.

14.Balch CM, Shanafelt T. Combating stress and burnout in surgical practice: a review. Adv Surg. 2010;44:29-47.

15.Benson S,Truskett PG, Findlay B.The relationship between burnout and emotional intelligence in Australian surgeons and surgical train- ees. ANZ J Surg. 2007;77(suppl 1):A79.

16.Benson S, Sammour T, Neuhaus SJ, Findlay B, Hill AG. Burnout in Australasian Younger Fellows. ANZ J Surg. 2009;79:590-597.

17.Katz A, Mallory B, Gilbert JC, et al. State of the practice for pediat- ric surgery–career satisfaction and concerns. A report from the American Pediatric Surgical Association Task Force on Family Issues. J Pediatr Surg. 2010;45:1975-1982.

18.Schroen AT, Brownstein MR, Sheldon GF. Comparison of private versus academic practice for general surgeons: a guide for medical students and residents. J Am Coll Surg. 2003;197(6):1000-11.

19.Shanafelt TD, Balch CM, Bechamps GJ, et al. Burnout and career satisfaction among American surgeons. Ann Surg. 2009;250:463-471.

20.Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251:995-1000.

21.Shanafelt TD, Balch CM, Dyrbye L, et al. Special report: suicidal ideation among American surgeons. Arch Surg. 2011;146:54-62.

22.Campbell DA Jr, Sonnad SS, Eckhauser FE, Campbell KK, Greenfield LJ. Burnout among American surgeons. Surgery. 2001;130:696-705.

23.Troppmann KM, Palis BE, Goodnight JE, Ho HS, Troppmann C. Career and lifestyle satisfaction among surgeons: what really mat- ters? The National Lifestyles in Surgery Today Survey. J Am Coll Surg. 2009;209:160-169.

24.Colletti LM, Mulholland MW, Sonnad SS. Perceived obstacles to career success for women in academic surgery. Arch Surg. 2000;135:972-977.

25.Rollman BL, Mead LA, Wang NY, Klag MJ. Medical specialty and the incidence of divorce. N Engl J Med. 1997;336:800-803.

26.Frank E, Biola H, Burnett CA. Mortality rates and causes among U.S. physicians. Am J Prev Med. 2000;19:155-159.

27.Lindeman S, Laara E, Hakko H, Lonnqvist J.A systematic review on gender-specific suicide mortality in medical doctors. Br J Psychiatry. 1996;168:274-279.

28.Association of American Medical Colleges. AAMC Data Book: Statistical Information Related to Medical Schools and Teaching Hospitals.Washington:AAMC; 2001.

234 K. Troppmann and C. Troppmann

29.Kibbe MR,Troppmann C, Barnett CC Jr, et al. Effect of educational debt on career and quality of life among academic surgeons. Ann Surg. 2009;249:342-348.

30.Maslach C, Jackson SE, Leiter MP. MBI: The Maslach Burnout Inventory: Manual. Palo Alto: Consulting Psychologists Press; 1996.

31.Dyrbye LN, Shanafelt TD, Balch CM, Satele D, Sloan J, Freischlag J. Relationship between work-home conflicts and burnout among American surgeons. Arch Surg. 2011;146:211-217.

32.Powell AC, Nelson JS, Massarweh NN, Brewster LP, Santry HP. The modern surgical lifestyle. Bull Am Coll Surg. 2009;96:33-37.

33.Charon R. Narrative Medicine: Honoring Stories of Illness. Oxford: Oxford University Press; 2007.

34.Berger J. A Fortunate Man: The Story of a Country Doctor. New York: Random House; 1997.

35.Pellegrini CA, Britt LD, Hoyt DB. Sleep deprivation and elective surgery. N Engl J Med. 2010;363:2672-2673.

36.Bennhold K. Flexible workweek alters the rhythm of Dutch life: going part time appeals to both sexes. The New York Times. December 30, 2010; p.A10.