Issue 24 / 25 June 2012

WORKING in teams and being aware of the warning signs for burnout could help surgeons avoid the work–home conflict experienced by their US colleagues, says an Australian surgeon.

US surgeons reported difficulty in integrating their personal and professional lives, and this conflict was driving moves to reduce work hours and/or change practice, according to research published last week in the Archives of Surgery. (1)

The researchers reported that these changes could have “substantive manpower implications for the surgical workforce”.

Dr John Quinn, executive director for surgical affairs for the Royal Australasian College of Surgeons, said the experience was similar in Australia, although he queried the accuracy of the US data due to the random nature and low number of the responses.

“Work–life balance is tricky”, he said. “Surgeons are working long hours, their family life does get affected, it does cause burnout, and it does cause career dissatisfaction at different times for both men and women.

“The implications for Australia are the same as in the US in that the community … is ageing and the need for surgery increases as people are ageing”, Dr Quinn said. “We too have a shortage of surgeons and want more surgeons. At the same time, surgeons want to work fewer hours, so there’s a mismatch in the middle somewhere.”

The US researchers reported work–home conflicts were more common among surgeons working longer hours, those in an academic medical centre, women surgeons, and those with children. Surgeons who experienced a recent conflict were more likely to have symptoms of depression, had worse overall quality of life, drank more alcohol, were less satisfied with their relationship with their partner, and were more likely to plan on reducing their work hours or moving to a new practice

Women surgeons, who represented 14% of the 7197 respondents, were most intent on reducing clinical hours when aged in their 40s. The researchers said this was perhaps when child rearing was at its most intense.

They said both organisational and individual responses were needed to reduce work–home conflict and optimise the clinical workforce. They proposed organisational solutions such as greater autonomy in scheduling, more allowance for job sharing and onsite child care, and individual measures such as aligning personal and professional goals.

Dr Quinn said Australia was already addressing some factors that contributed to burnout and career dissatisfaction.

“Surgeons [in Australia and New Zealand] are working more in teams — particularly in major hospitals, but also in private practice — and I think that does decrease some of the burnout”, he said. “[They are] not having to solve the whole world’s problems single-handedly and I think those things are important also in work–life balance.”

Dr Quinn said raising awareness of the signs of burnout and when to seek help was also crucial in maintaining work–life balance in the surgical workforce.

Dr William Milford, chair of the AMA Council of Doctors-in-Training, said the US research focused on older surgeons — with 59% of respondents aged 50 years or over — and he suspected younger, Australian doctors would not have the same experience.

He said there was a generational change among all doctors, who were less willing to accept the personal sacrifices that have been made in the past.

“We’ve seen a reluctance to make the same sacrifices from a personal basis, with doctors of both genders wanting to spend time with family and aiming for things like the 4-day week”, he said.

However, this too will impact upon the medical workforce. “It has significant implications for the workforce in that the work done by a generic doctor now does not equal the work that used to be done by a generic doctor 10–15 years ago.”

Dr Milford said the research confirmed the importance of doctors prioritising their personal wellbeing.

“This sort of information makes doctors more aware of the implications of their career decisions”, he said.

– Nicole Mackee

1. Arch Surg 2012; Online 18 June

Posted 25 June 2012

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