October 1, 2018 marked the conclusion of the 87th annual Plastic Surgery the Meeting. While I have been to this meeting since I was a resident, this year had a much different tone. The American Society of Plastic Surgeons (ASPS) is the largest plastic surgery specialty organization in the world, drawing together thousands of medical professionals. It goes without saying that this meeting is the place to be to learn about the latest surgical techniques and innovations, not to mention, the amazing opportunities to network. While this held true this year, the focus of this meeting was shifted to physician wellness and burnout. For the first time since I can remember, the program was filled with panels and events focused on this important, yet often overlooked, topic.
As an ASPS Presidential Initiative, the problem of burnout within our specialty was addressed head-on. This problem is ubiquitous and the consequences dire. It is well-established that physician wellness directly influences patient care outcomes. Additionally, the consequences of burnout are real and devastating, with increasing numbers of physician substance abuse and suicide. Unfortunately, it does not spare anyone, irrespective of age, gender, specialty, career stage, or practice model. In the past, plastic surgeons were below average when ranked for burnout, however, that number has since increased to 40–50%. Female surgeons, on average, experience this almost 10% more often than men. It is most certainly a topic that needs to be discussed in our meetings. This year, panels included field experts discussing burnout and strategies to overcome it. Social events were geared to family members and children, encouraging surgeons to include their families in these meetings.
As a member of the newly found Wellness Task Force, I had the opportunity to serve on a panel discussing burnout at different stages in a plastic surgeon’s career. Along with Drs. C. Scott Hultman, Richard Korentager, Joseph Losee, and Ash Patel, we discussed what burnout looked like for each of us. Whether it affected us directly or indirectly, we all experienced it in some way. The take home point, ultimately, is that burnout is extremely personal. It looks different for us all; it’s causes, how it affects us, and our strategies to overcome it all vary. The common underlying theme, however, is the loss of control. Whether it be loss of autonomy, bureaucratic tasks, poor leadership, decreased income, or increased hours, we are unable to change our current situation despite our best efforts. Ultimately, our solutions all included taking that control back in some shape or form. Only then were we able to escape the vicious spiral of burnout.
I applaud our society for bringing this topic to the forefront. I cannot recall the amount of times I’ve spoken to colleagues about how they were doing and their reflex answer was always “everything is great!” Well, oftentimes, things are not always great and we need to create a safe forum in which it is acceptable to talk about this elephant in the room. During our panel, which turned more into an informal roundtable discussion with our audience, it was amazing to see how many people spoke out and shared their own experiences. More often than not, we all share the same burdens and stresses and if we can talk about it, we can help one another, and learn from one another. Hopefully, if we continue to do this, we can remove the negative connotation that is associated with this topic. This is the first step in addressing this epidemic. We need to place importance on work/life balance. While there is not one solution to burnout, obtaining some sort of balance has proven to help. Constant effort must be put into this, however, as our needs and circumstances change over time. We need to unlearn the negative habits taught in training of ignoring our basic needs and putting ourselves last. While these behaviors may have led to our success, they set us up for eventual burnout. We need to recognize the signs when others around us are experiencing burnout. Exhaustion, depersonalization, and lack of efficacy are the textbook definition; however, these symptoms may be subtle in some. More importantly, we need to care. We need to care about others around us and we need to care about ourselves. Not only do we suffer the consequences of burnout, our patients, and families do, as well. It’s time to face this problem head-on and make some positive changes as a profession.
Smita R. Ramanadham, M.D. is a graduate of Tuft’s University in Medford, MA and received her medical degree from Tufts University School of Medicine in Boston, MA. She completed her residency in General Surgery at the University of Texas Southwestern Medical Center in Dallas, TX and in Plastic and Reconstructive Surgery also at the University of Texas Southwestern Medical Center. She is double- board certified in Plastic Surgery and General Surgery. She is currently an Attending Plastic Surgeon and Assistant Professor of Surgery at Boston University School of Medicine.