Longer First-Year Resident Shifts May Equal More Burnout

The Accreditation Council for Graduate Medical Education (ACGME) announced that medical residency programs can begin increasing shift hours for first-year residents starting in July 2017. While this new policy is aimed at improving outcomes for both patients and residents, it has many critics who claim that it may lead to increased burnout. I am agnostic on the hours, but I am passionate about burnout prevention.

Shift Increases

Currently, shift hours for first-year residents are capped at 16 per shift. In July, that number of maximum shift hours will increase to 24 (with an additional four hours devoted to taking care of patient hand-offs). Despite this change, 80 hours is still the maximum weekly amount for first-year residents. 

The change is aimed at improving all of the following:

  • Patient Care Continuity
  • Clinical Teamwork
  • Resident Learning Experience

Using The 8 PRACTICEs of Highly Successful Surgeons, we should start with a Passion for Performance Improvement. 

Critics of the New Policy

The new shift policy has its fair share of critics – among them the American Medical Student Association. These critics contend that increased hours will lead to increased stress, burnout, sleep deprivation, and mistakes. I am not saying it is good, but reality is that sleep deprivation, stress and mistakes are a part of medicine. Our shared goal is to minimize all three and maximize care continuity, teamwork and resident learning experience.

Sure, total weekly hours are still capped at 80, but that doesn’t mean that residents are using that time for rest and effective stress reduction. There are also many stories of the pressures placed on residents to bend or break the rules. 

Can we all agree that the human body, mind and soul needs time to rest and recharge? 

If we all aim for improvement, mistakes are less likely to occur, and we will also improve patient care continuity, clinical teamwork and resident learning experience.

The 8 PRACTICEs of Highly Successful Surgeons

I have struggled first-hand with burnout in my time as a medical student, through residency, and in private practice. Through these experiences I have developed my own signature methodology for preventing burnout. I call it the 8 PRACTICEs of Highly Successful Surgeons. This system is designed to help all physicians across all specialties prevent burnout by encouraging healthy habits, and finding your own rhythm. Drop me a line today to learn more about the 8 PRACTICEs and prevent burnout before it strikes.

Overcoming Common Fears that Hold Doctors/Surgeons Back

Fear is a powerful roadblock. Some doctors experience fear every day at work. This can negatively impact professional growth, as well as patient care. In a recent article and podcast, Dr. Pamela Wible interviews therapist Sydney Ashland about the “Top 10 Fears that Hold Doctors Back.” In this article I’d like to review these common fears, and expand on how to conquer them through the lens of my own personal experience.

10 Fears that Hold Doctors Back

Here are the top 10 fears that hold doctors back (from Dr. Wible’s article):

  • Low Self-Confidence

  • Financial Concerns

  • PTSD/Guilt

  • Family Responsibility

  • Anxiety & Depression

  • Health Issues

  • Addiction

  • Isolation

  • Lack of Direction, Passion, Purpose

  • Abuse Cycles

It’s important to understand these fears so we can recognize them in our loved ones, our peers, and ourselves.

Overcoming These Fears

So once we recognize these fears, how do we take proactive steps to overcome them? Here are a few tips:

  • Building Confidence. Confidence is the result of success or even the enjoyment of trying something over and over again regardless of outcome. Make regular small achievable goals. Alternatively, know that most highly successful people have "failed" hundreds of times and keep trying.

  • Seek Professional Help. If you are struggling with addiction, or experiencing feelings of guilt, PTSD, anxiety, or depression, reach out to a professional for help.

  • Take Care of Yourself. Learn to just breathe. Deep breath in through the nose. Deep breath out through the nose. Repeat two more times. Use this at times of stress, sadness, anger, and more.

  • Connect with Like-Minded Surgeons. Sharing your experiences with like-minded doctors and surgeons, and hearing their stories as well, can help you feel less isolated and help you regain your passion.

  • Use the debt snowball. Dave Ramsey has a strategy that helps you stay motivated to pay off your debt. As with my 8 PRACTICEs methodology, personal and practice wellness is built off of the momentum and confidence created from paying off your smallest debts first.

The 8 PRACTICEs of Highly Successful Surgeons

I myself have dealt with my share of fears throughout medical school, training, and during my time in practice. Using these experiences I developed my signature methodology – The 8 PRACTICEs of Highly Successful Surgeons. This methodology helps doctors and surgeons of all specialties to find balance and rhythm in their daily lives and practices, and also overcome these common fears. Ultimately, it’s all about creating a lifestyle and practice that is sustainable and successful. If you’d like to learn more about the 8 PRACTICEs and how they can help you, feel free to reach out to me at any time.

4 Ways to Conquer Surgeon Burnout

There are many factors that can contribute to burnout among surgeons, doctors, and other medical professionals. It is not all about diet, exercise and sleep, but these three are basic foundations that increase our ability to go after the other factors. This article will offer four tips for conquering surgeon burnout and its related symptoms.

Try to Practice What You Preach

If you notice, many of my articles point out the simple practices of diet, sleep and exercise. I am not a perfect example, nor is anyone for that matter! If we are going to restore our passion and strive for performance improvement, we need to abandon perfectionism, and just get better. I have made tremendous progress in diet and exercise by using baby steps. I preach performance improvement, not perfection. How can you do better at something you tell others to do?

Set Realistic Goals

Each successful achievement makes it much easier to reach the next. There is little harm in overachieving on a goal that was a little too easy to reach. However, when we fail to reach a goal, usually one of two negative things results:

  1. Our motivation to reach the next goal is decreased.

  2. We make excuses that justify the failure, therefore making it easier to justify a failure each time.

Create momentum with success, by reaching your goal and maintaining it.

Say No

Surgeons tend to overexert themselves at work. If only we could do everything we wanted! Unfortunately, that’s just not the way we’re built. Saying yes to everything at work will likely lead to excess stress, exhaustion, and burnout. Know when and how to say no at work and you will become much more successful.

Diet, Exercise and Sleep

We’ve talked about these three factors at length, and they are important to understand. If any of these three are managed poorly, the results are lower energy levels and higher stress. Use each of the first 3 ways above to attack all three issues.

All of these tips tie into my burnout prevention methodology - The 8 PRACTICEs of Highly Successful Surgeons. I developed this system after dealing with burnout first hand in my own practice. It can be applied to any physician in any specialty. Focusing on finding your rhythm in your work and home life is the ultimate goal to conquering burnout in the long run.

Performance Training in Golf, Yoga & Surgery


My golf game improved the most when others were tracking my handicap. In fact, that summer I received the “Most Improved Award.”

At the time, I didn’t realize the correlation. Why? Because I wasn’t focused back then. I was given the opportunity to practice regularly. I also received some private and group coaching. I wasn’t intending to be competitive. I was just given an opportunity by my father to get better at something I might enjoy doing. The intention was to have more fun.

The Game of Golf / The Game of Life

In many ways, the game of golf is a reflection of the game of life—a long journey laden with ups, downs, hazards, rules, difficult shots, easy putts, and an ample sprinkling of both misfortune and good luck.

Golfers like that.

The sport offers its players beauty, unpleasantness, hilarity, disappointment, exuberance, heartbreak, and just about every other feasible emotion. No two rounds are alike and, in much the same way, no two days are alike.

Golfers like that as well.


But, most importantly, golf transcends skill or athleticism—it employs handicapping which makes it possible for any group to go out and compete.

I can go out tomorrow and play competitively with professional golfer Jordan Spieth, President Jimmy Carter, and Serena Williams, not because we’re all equally skilled and athletic, but because our respective handicaps level the playing field.

I like that aspect of the sport the most.

Age, strength, speed, height, skill—the handicap accounts for and then offsets all of these differences and more.

Golf brings people together, but not at the expense of competition. Handicapping offers golfers a way to measure their development and performance, but against the game as opposed to against the opponent.

It is an incredible principle, and one that would be fascinating if we could adapt it to other segments of life and Surgery!


I really enjoy yoga—but I’m not nearly as talented at its practice as many others. During the early part of my yoga practice, I would only measure my performance by the standard of “I’m still not as good as that person.”

With yoga, I give myself the opportunity to practice regularly. I also receive some private and group coaching. I am not intending to be competitive. I am giving myself the opportunity to get better at something that is good for me. My intention is physical wellness.

In fact, I should receive “The Most Improved Award!”

Informal Handicapping

While yoga doesn’t have a formal handicapping system, it does have an informal one.

Yoga is about self-improvement which can be measured in our well-being.

I have learned that I’m "competing" against myself—getting incrementally better—but sparing me the indignity of having to measure my talents or skills directly with someone who is lightyears ahead of me in practice.

Yogis like that as well.

Measuring Development Against the Practice, Not Others

Yoga encourages us to strengthen, stretch, balance, focus, and look inwards without judgement. Yoga allows us to appreciate how each day is different. We can come in tired, stiff, sore, stressed or steeped in emotion, but we will almost always leave each session stronger, more energized, flexible, relaxed, focused and healing.

Yogis like that as well.

Yoga offers a way to measure our development and performance, but against the practice as opposed to against the others without a specific handicap.


How is performance improvement tracked in surgery? What about a handicap for surgery?

What if surgeons were given a handicap based upon their performance in their ten most recent cases?  

Surgical Handicapping System

I think this would be an incredibly interesting way to measure competence in surgery—I’m not saying it would be the best way, I’m just saying a handicap (or something like it) might be a way to stimulate performance improvement directed at the positive outcomes or final outcomes, without focusing on our background experience, years in practice, or negative outcomes.

Applied to surgery, a handicap could help us closely monitor our development—or regression—as surgeons, and that’s a benefit to us, our employers, and our patients.

And like in golf, the decision to share our handicap should be up to us or “the club” that we belong to.

Or like in yoga, the informal handicap could encourage each of us to improve our performance and development without judgment and against the practice of surgery as opposed to against others.

As a result of my practice of yoga, I am leading a healthier, more sustainable life and practice. I am more recharged, mindful, and a better surgeon. I give myself the opportunity to practice regularly. I also receive some private and group coaching. I am not intending to be competitive, though I could be. I am giving myself the opportunity to get better at something that is important to me. Being a surgeon.

Patients like that.

My intention is quality patient care.

Patients like that as well.

But, what do you think?

If the “handicapping” system isn’t right for surgery, what is? Is there something we as surgeons can adopt? Or something unique that we can create?

I’m curious to hear your thoughts. Share them below.

My Plea to Join a Humanitarian Mission - Guest Blog by Ray Imatani, MD

My friend and colleague Dr. Ray Imatani is passionate about surgeon-led Humanitarian Missions, so I wanted to share his request directly with the SurgeonMasters Community. Although this particular plea from Dr. Imatani is addressed directly to Orthopaedic Surgeons, I know you will all benefit from his inspiring words. And, remember, the need for our skills and specialties is truly unending! Hope you feel inspired!


Jeff Smith, MD

The Need for Orthopaedic Trauma Care

Across the world, there's a need for orthopaedic trauma care, and nowhere is that need more pronounced than in developing nations that are incapable of offering medical care to the standard we enjoy here in the United States. A standard we take for granted all too often.

This is a need I have seen first-hand.

During the last decade, I’ve gone on four extended missions to different developing nations as a member of organizations seeking to improve the health and welfare of impoverished peoples.

The experiences I’ve enjoyed during these missions merely affirm my resounding belief that our obligation as first-world physicians is to make a more-focused effort at improving the standard of orthopaedic care in places as far away as Chad and Madagascar, and as close as Haiti and Mexico.

Treating Trauma in the Third World

It is in nations like these where the inability to treat trauma—predominantly the result of road traffic accidents—is a significant cause of death and disability. No one—not politicians, not aid workers, not wealthy benefactors—is better suited to address this inability head-on (pardon the pun) than orthopaedists, specifically tenured surgeons who honed their skills in a time of more rudimentary surgical technology. (Not that the help of more junior orthopaedists and surgeons wouldn’t be valuable or appreciated!)

Senior orthopaedic surgeons have hands-on experience in the treatment of major traumatic injury with minimal technology and minimal support, which is the standard operating environment in most developing nations.

But these missions are about more than the work that’s done for the patients.

In fact, some of my most rewarding experiences have been derived from working with and teaching the native orthopaedic physicians who will eventually be tasked with taking over surgical procedures for the local community.

Advice for Getting Involved

A few words of advice for those of you looking to get involved…

  • Find a country that uses English as the primary medical language, and plan on making a two to four-week commitment of your time.

  • If you’re unsure about next steps, there are several organizations you can partner with, including Doctors Without Borders and Health Volunteers Overseas. These groups are adept at helping doctors find the right trip—a trip that meets your expectations in both commitment and exposure to risk (some of the volunteer opportunities will be in areas of high-danger—think Syria).

  • Remember, trauma, not arthritis, is the epidemic, and no surgeon should consider their career complete without participating in at least one overseas mission to an impoverished nation.

The world desperately needs the help of talented orthopaedic surgeons like us. Help, not solely in the form of money or equipment, but in the form of surgical expertise that can be delivered in both the operating room and in the classroom of impoverished and developing nations.