IS THERE LIFE AFTER SURGERY?

Diagnosis and treatment of career burnout among surgeons

by Stephen Rosen, PhD, New York, NY

It's no longer a surprise that many surgeons are reconsidering their career options.

• 25-40 percent of 1,302 physicians are "seriously thinking of leaving medical practice altogether¹
• 63 percent of 1,302 physicians would not recommend clinical medicine as a career to their children²
• 31 percent of 1,100 young physicians (under 40) "would not become a physician again"³
• surgery contains the largest portion of high earners, in a survey of 10.620 physicians, 13% of whom are surgeons⁴
• surgery contains a disproportionate representation of burned-out physicians, based on anecdotal evidence and the following case vignettes of surgeons who consult us for "career versatility/ mobility/ renewal planning"....
• a successful surgeon in otolaryngology, 57 years old, says he has "had it," and retires "to be a stock broker." Diagnosis: late-career malaise. Treatment: plan for orderly, stimulating transition to retirement.
• a thoracic surgeon, age 38, author of more than 40 journal articles on surgical procedures, income above $400,000, moves into "health-related law" Diagnosis: early-career regret. Treatment: systematic reassessment of skills, options, strategies to reach new goal.
• a heart surgeon, 45 years old, "wants to be his own boss", cannot tolerate hospital administrations, and pursues his dream to become a management consultant. Diagnosis: severe mid-career burnout, de-compensation, burnout. Treatment: stepwise examination of personal issues, emotional re-education

In each case vignette above, practicing surgery well was rewarded by being asked to do it again. Thus, each of these burned-out surgeons continues unhappily doing well-paid surgery. However, each one pays a very high price for ignoring their truest preferences.

Working outside our preferences consumes great energy. By comparison, working within our preferences or most-enjoyable skills is effortless and serene...the difference between perspiration and inspiration. "Each of us," Max Weber said, "must find and obey the demon that holds the very fiber of our being."

A "Theory Of (Career) Victory": Treatment For "Burnout"

A "theory of victory" is the phrase attorneys use to describe how they're going to win a complex case. Career management specialists, similarly--based upon a diagnosis of surgeons' career distress, career burnout, and career regret--may urge their surgeon clients to develop their own "theories of career victory." Key career goals are then attainable step-by-step, encouraging the certitude and confidence that comes with emulating good role models of those who have segued into other occupations. (The hardest part is getting started, thus the saying, "imperfect movement is better than perfect paralysis.")

Like a map and a compass, a theory of victory also gives potential career-changers (and there are many in all fields) directions and clear views of the treacherous terrain, obstacles and barriers to overcome. The US Bureau of Labor Statistics reports that currently and for the next few years, about 12 million individuals will change occupations per year.⁵

What is your own theory of career victory? How do you develop one that fits you?

Communication Your Career Distress

Surgeons are not career counselors, and for this reason alone it makes sense to discuss career problems with trusted medical colleagues only.

Silence on career distress as a policy simply doesn't work among professionals whose careers, well-being, and patients may be jeopardy. It doesn't work because without holding up the "career ailment" to responsible technical scrutiny, it cannot be dealt with. Silent career distress resembles a cancer that needs surgical attention...."don't ask, don't tell" simply delays advancing to the heart of the matter.

Not only do surgeons have very high standards of performance for themselves and others. But they recognize that specialist care in medicine affords distinctively beneficial tools and techniques. So, too, does "specialist care" in career management.

Career Treatment For Early-, Mid-, and Late-Career Burn-out

Career management specialists develop career satisfaction among physicians in three phases. Designed to help career-disaffected surgeons accept the process because it's systematic, logical, and rigorous; it's met the reality-checks and field-tests of highly skeptical professionals like other surgeons; and, importantly, the process works. Simply put, the three phases consist of answering the following questions sequentially:

1. Who are you?
2. What career options emerge from whom you are? How do you fit with what's "out there".
3. How do you get to where you want to be?

From the answers to these questions emerge an individualized own theory of victory for career satisfaction. Let's look at these in more detail.

Phase (A) Who are you? That is, what are your (1)interests, (2)skills, (3)values, (4)skills you most enjoy using that will eventually fit or coincide with (5)marketplace niches and needs. This multiple intersection, or "five-fold coincidence" of circumstances, benefits greatly from an objective outsider's observations and guidance. Most career experts use assessment exercises, paper-and-pencil instruments that are normed to populations of other professionals like you who have the same interests and skills as you --and who say they are happy in their work. This approach is as scientific and systematic as it's possible to do in the often-imprecise ("fuzzy" or "soft") art of career mobility/versatility planning. As one of the above surgeons remarked, the self-assessment process is "softer than granite, harder than astrology, but ultimately rewarding."

Phase (B) What career options emerge from the first Phase's "five-fold coincidence" of an individual's: (1) interests, (2) skills, (3) values, (4) most-enjoyable-skills, and (5) fit to the marketplace? What medical and non-medical career options or directions are therefore available to anyone contemplating a change? What does this systematic exploration, sequential process, and logical evaluation define specifically for each of us? This phase, "career options exploration and research," leads to specific strategies that move us along the path to our new goals.

Phase (C) How does one get from here to there? Is it possible to "market" ones self with integrity, dignity and self-confidence? How do career-changers tell people they are an <X> when everyone can plainly see they are <a surgeon>? This requires finding out enough about <X> to be able to bring to our conscious attention our own unique qualities that overlap or dovetail with <X>. And what's <X>?

The "five-fold coincidences"-- interests, skills, values, most-liked skills, and fit-to-the-market--when uncovered, gives us enough confidence to evolve from a surgeon to a new career as our case vignette surgeons are doing. They learned to assert their most positive-yet-true preferences that a new and satisfying career demands. We have to give up what Thorstein Veblen called "trained incapacity"-- a state in which specialization has strengthened one set of muscles at the expense of others needed now.

"Occupational mobility can be thought of as a process that helps insure the smooth operation of the economy. In most cases, it allows individual workers to improve their job satisfaction increased pay, status, and responsibility, or through better working conditions. At the same time, occupational mobility is a prime means for the economy to adjust to new demand conditions...[which] can be beneficial from the standpoint of both the individual and the economy"⁵

Some of us facing the taboo (but apparently pervasive) subjects of career burnout and career change may have to learn to flex and exercise our unused muscles. Today's increasingly Darwinian marketplace for versatile professional talent may also require us some day to have multiple careers and options. If and when the day arrives, perhaps the above vignettes and methods, and knowing it is possible, may help ease the transition.

REFERENCES

1. Stamps,PL,Boley Cruz, NT, Issues in physician satisfaction,Ann Arbor:Health Administration Press, 1994;221.
2. Stamps & Cruz, loc. cit.,1994.
3. Greenberg,B, California Physician, Dec.1995;22-33.
4. Goldberg,A, Medical Economics Continuing Survey, March 25, 1996;142-157.
5. Markey,J.P. and Parks,W, "Occupational change: pursuing a different kind of work" Monthly Labor Review, Sept 1989, Vol. 112, No 9

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