The Board of Governors’ (B/G) Committee on Physician Competency and Health serves the following purposes: (1) examine issues related to surgical competency, emphasizing credentialing and practice within expected community standards; and (2) promote maintenance of physical and mental wellness among Fellows of the American College of Surgeons (ACS). Thanks to the hard work of the members of the committee and outstanding leadership provided by previous Chairs, most recently Krista L. Kaups, MD, FACS, the committee has continued to address issues that affect every surgeon.
In the past, little data were available to indicate how stressors affect surgical practice. However, recent data have shown that none of us is immune to the effects of stress and the potential for burnout. The increasing demands of surgical practice—including more elderly patients with complex surgical problems, rapidly evolving technology, long hours, fewer surgeons available to take emergency room call, declining resources and reimbursements, and the decline in the general public’s overall view of the medical profession—contribute to stress. The current uncertainty about the direction of the entire health care system and the role that surgeons will play in the future are also factors to consider in maintaining mental wellness.
To help gather data on the current levels of stress among surgeons, the first survey of Fellows, spearheaded by Gerald Bechamps, MD, FACS, with the support of the College, was conducted in 2008. The survey was developed with the assistance of Tait Shanafelt, MD, and other physicians at the Mayo Clinic, Rochester, MN. A total of 7,905 fellows responded to the anonymous electronic survey. The results were startling. Among the most significant findings was a 40 percent rate of burnout among the respondents.1 Burnout is a syndrome characterized by emotional exhaustion and depersonalization (or cynicism) in relationships with colleagues or patients and accompanied by a sense of inadequacy or reduced personal accomplishment. Surgeon burnout was associated with specialty choice (highest odds ratios in trauma, urology, otolaryngology, and vascular surgery), having children younger than age 21, number of hours worked per week, number of nights on call, and compensation based entirely on billings. Hours worked and number of nights on call increased the risk of burnout in both academic and private practice surgeons. Also of concern, nearly one-third of respondents screened positive for depression and 6 percent exhibited suicidal ideation.
Another survey of the Fellows was completed in 2010 with support of the College. Nearly 7,000 Fellows responded to this survey, which addressed interpersonal relationships, work-life balance, coping mechanisms, and substance abuse. The data showed that alcohol is by far the most widely used or abused substance.2 The rate of alcohol abuse or dependence was 15 percent among the entire group, which exceeds the rate in the general population. The rate for male surgeons was 14 percent and for female surgeons it was 25 percent. Not surprisingly, a strong association between alcohol abuse or dependence and burnout was noted. On a positive note, however, the literature has shown that surgeons who suffer from substance abuse have high rates of recovery if they participate in a structured program and agree to long-term supervised monitoring. These surgeons generally are able to return to active practice.
A new 2013 survey is due to be distributed shortly to the ACS membership, again funded through the generosity of the College. Dr. Shanafelt and his colleagues at the Mayo Clinic have again assisted in the development of the survey. This new survey differs from prior surveys in that the goal is to determine how accurately surgeons are able to assess their level of well-being and distress in comparison with their peers. The hypothesis is that physicians, and surgeons in particular, are not very good at making this assessment. Indeed, most physicians and surgeons are unable to recognize that they need help or to make changes until a crisis occurs. This survey includes a self-assessment tool that will allow surgeons to compare their distress levels and level of well-being with a national sample of 7,000 physicians. Electronic follow-up contact will occur three to four weeks after the initial survey to see if participants have made any changes or plan to make changes based on their self-assessment. This trial will be the first conducted by the ACS, and one of the few trials to evaluate whether an electronic resource can help effect positive change.
Physician health document
The committee developed a booklet on the impaired surgeon in 1992, which was subsequently revised in 1995. Updating and revising the booklet to reflect new challenges facing surgeons today has been a major focus of the committee. Thanks to the hard work and strong leadership of Dr. Kaups, this new document, titled Being Well and Staying Competent: Challenges for the Surgeon, has recently been completed. This document is a complete rewrite and involved many hours of work by dedicated committee members, including conference calls and face-to-face meetings. This updated version is timely and addresses important physical and mental wellness topics and offers links to self-assessment tools and other online resources (see sidebar at the top of this page). Currently, Being Well and Staying Competent is available online in its entirety through the ACS Members-only portal at www.efacs.org. In addition, the Bulletin will periodically publish excerpts from the document, beginning with next month’s issue.
The prior surveys are the source of, or have at least been cited in, a large number of publications, articles, and other documents (see bibliography), and several more are in development. Currently under examination are comparisons between rural and urban surgeons with respect to stressors and burnout level, and plans are being discussed to develop surveys for international Fellows. The issue of aging and competency is coming to the forefront. It is anticipated that this complex and difficult issue will necessarily be a major focus of the committee over the next few years. The new 2013 survey of the Fellows will need to be completed; the data will then be analyzed, and compared with findings from the two previous surveys. Thus far, the committee has depended on the generosity of the College for financial support. A stable funding source and mechanism will need to be developed so that the important efforts and productivity of the committee may continue.
It is important to note that the committee’s accomplishments to date are largely due to the hard work of each of the committee members, especially Dr. Kaups and Mick Oreskovich, MD, FACS. The author also acknowledges the major contributions of other prior committee members and past-chairs including Kenneth Sharp, MD, FACS; Dr. Bechamps; and John Hanks, MD, FACS.
Finally, Dr. Shanafelt and his colleagues at the Mayo Clinic must be recognized for their outstanding help with developing the surveys and analyzing the data.
- Shanafelt TD, Balch CM, Bechamps GJ, Russell T, Dyrbye L, Satele D, Collicott P, Novotny PJ, Sloan J, Freischlag JA. Burnout and career satisfaction among American surgeons. Ann Surg. 2009;250(3):463-471.
- Oreskovich MR, Kaups KL, Balch CM, Hanks JB, Satele D, Sloan J, Meredith C, Buhl A, Dyrbye LN, Shanafelt TD. Prevalence of alcohol use disorders among American surgeons. Arch Surg. 2012;147(2):168-174.
- Shanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele D, Collicott P, Novotny PJ, Sloan J, Freischlag J. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995-1000.
- 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(4):371-376.
- Kuerer HM, Breslin T, Shanafelt TD, Baile WF, Crawford W, Balch CM. Roadmap for maintaining career satisfaction and balance in surgical oncology. J Am Coll Surg. 2008;207(3):435-442.
- Dyrbre LN, Shanafelt TD, Balch DM, Satele D, Freischlag J. Relationship between work-home conflicts and burnout among American surgeons: A comparison by sex. Arch Surg. 2011;146(2):211-217.
- West CP, Dyrbye LN, Sloan JA, Shanafelt TD. Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. J Gen Intern Med. 2009;24(12):1318-1321.
- Balch CM, Shanafelt TD. The dynamic tension between success in a surgical career and personal wellness: How can we succeed in a stressful environment and a “culture of bravado?” Ann Surg Oncol. 2011;18(5):1213-1216.
- Dyrbye LN, Shanafelt TD, Balch CM, Satele D, Freischlag J. Physicians married or partnered to physicians: A comparative study in the American College of Surgeons. J Am Coll Surg. 2010;211(5):663-671.
- Balch CM, Shanafelt TD, Dyrbye L, Sloan JA, Russell TR, Bechamps GJ, Freischlag JA. Surgeon distress as calibrated by hours worked and nights on call. J Am Coll Surg. 2010;211(5):609-619.
- Balch CM, Shanafelt TD, Sloan J, Satele D, Kuerer HM. Burnout and career satisfaction among surgical oncologists compared with other surgical specialties. Ann Surg Oncol. 2010;18(1):16-25.
- Balch CM, Shanafelt TD. Combating stress and burnout in surgical practice: A review. Adv Surg. 2010;44:29-47.
- Shanafelt TD, Balch CM, Dyrbye L, Bechamps G, Russell T, Satele D, Rummans T, Swartz K, Novotny PJ, Sloan J, Oreskovich MR. Special report: Suicidal ideation among American surgeons. Arch Surg. 2011;146(1):54-62.
- Balch CM, Shanafelt TD. Combating stress and burnout in surgical practice: A review. Thor Surg Clin. 2011;21(3):417-430.
- Shanafelt TD, Sloan JA, Satele D, Balch CM. Why do surgeons consider leaving practice? J Am Coll Surg. 2011;212(3):421-422.
- Balch CM, Oreskovich MR, Dyrbye LN, Colaiano JM, Satele D, Sloan JA, Shanafelt TD. Personal consequences of malpractice lawsuits on American surgeons. J Am Coll Surg. 2011;213(5):657-667.
- West CP, Dyrbye LN, Satele D, Sloan JA, Shanafelt TD. Concurrent validity of single-item measures of emotional exhaustion and depersonalization in burnout assessment. J Gen Intern Med. 2012;27(11):1445-1452.
- Balch CM, Shanafelt TD, Sloan JA, Satele D, Freischlag JA. Distress and career satisfaction among 14 surgical specialties: Comparing academic and private practice. Ann Surg. 2011;254(4):558-568.
- Balch CM, Shanafelt TD. Burnout among surgeons: Whether specialty makes a difference. Arch Surg. 2011;146(2):385.
- Shanafelt TD, Oreskovich MR, Dyrbye LN, Satele D, Hanks JB, Sloan JA, Balch CM. Avoiding burnout: The personal health habits and wellness practices of U.S. surgeons. Ann Surg. 2012;255(4):625-633.