Finding Balance in a Demanding Career
Neurosurgery is unquestionably a demanding profession, requiring years of dedicated training and professional development, maintenance of exquisite attention to detail and technical skill and an ability to maintain empathy in the face of the often-devastating consequences of conditions we treat. In order to ensure longevity in a profession that requires long work hours, physical stamina and mental focus, it is critical to nurture all the life elements that sustain us.
While balance for neurosurgeons is mostly elusive in the traditional sense of the word, we must strive to find the type of cognitive balance that comes from living a fully integrated life. To provide the best service for our patients, we need to optimize our own spiritual, emotional, mental and physical health. Whether we gain strength from our religious commitments, the love of family and friends or leisure-time activities, it is important to attend to our inner life as much as we do our work duties. The people I have known who have the most career satisfaction also seem to be the happiest. They view their careers as their missions in life, and they have found ways to weave multiple aspects of their nature into their careers.
This is not to say that we do not all struggle through periods of adversity, or experience rough patches with work, family or our own mental health. In fact, many physicians encounter periods of extreme stress, fatigue, depression, anxiety or burnout, and neurosurgeons are no exception. Physician suicide is at an all-time high and it was recently reported by the American Psychiatric Association that physicians have the highest suicide rates of any profession in the U.S. We are losing a doctor every day by his or her own hand. Unfortunately, social stigmas regarding depression still exist and our training conditions us not to seek help for any form of perceived weakness. Furthermore, there are strong barriers to seeking assistance, not the least of which is fear of losing the ability to practice medicine should problems be revealed. The threat is this is more than loss of a livelihood, which is significant enough. It is also the loss of an identity, a vocation, a calling. While physician assistance programs are more readily available and attention on wellness and avoidance of burnout has gained public attention, we clearly must do more.
Reasons Postulated for Physician Burnout
- We have massive responsibilities to those who entrust their lives to our care and these do not stop for nights, weekends and time off.
- The current medical and surgical environment is fraught with additional stressors that most of us did not anticipate when we chose what we thought would be a relatively autonomous existence.
- Increasingly, our decision-making is called into question.
- The lifeblood of what we do — the patient-physician relationship — is being intruded upon in previously unimaginable ways.
- The threats and realities of malpractice accusations and litigation are a constant presence and exert undue influence on medical decision-making.
- Increasing regulatory and documentation burdens that have little to do with the human beings in front of us seeking our help can sap the joy from our day-to-day work lives.
- The obstacles to maintaining economically viable practices are getting broader and higher.
- Hospitals and payors demand more and more of our time and intellectual capital to fulfill their own needs.
- Technological changes in communications, while revolutionary, can leave us feeling more isolated than ever.
On top of it all, we live in a broader context — in what can oftentimes feel like an era of social, political and economic uncertainty. All of these factors can eventuate in feelings of vulnerability and lack of control. It is therefore of primary importance that we gird ourselves against these forces of negativity by attending to our own health and emotional needs.
We often feel so harried and overwhelmed with work that we feel we can exert little independent influence over the societal, economic and regulatory pressures on our time and energy. These are more than just annoyances and irritations; they are matters of import affecting our ability to provide better lives for our patients. However, it can be empowering to participate in our organizations, which do so much more than simply voice our concerns publicly. Individuals within organized neurosurgery, working diligently on behalf of our patients and our profession, serve to bring patient needs to the forefront of public discourse and actually change policy, in addition to advancing knowledge and technology and educating others. It never ceases to amaze me how much intelligence, talent and work ethic our colleagues bring to the table to tackle the complex issues affecting our daily professional lives and our patients’ lives as they battle disease and injury.
Many of us also give back by volunteering in our communities, in medical or other capacities. Others participate on hospital or clinic committees and do administrative work to improve care delivery. Still, others focus on mission work, education or research of important questions in our field. We must bear in mind that one of the best means of giving back is by maintaining well-balanced lives and careers and simply taking good care of our families and our patients.
This issue of AANS Neurosurgeon focuses on these tough issues and highlights the ways that some of our colleagues achieve their own personal balance. Regardless of the manner in which we choose to contribute, finding purpose in our world on a daily basis, in ways large and small, will allow us to face the challenges of this generation, ensure the future of neurosurgery and impact the very fabric of society at large now and in the future.
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