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.

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

Golf

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.

Handicapping

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!

Yoga

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.

Surgery

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.

A Novel Idea for Safety, Productivity and Less Stress

Sometimes the key to peak performance isn’t rooted in rigid discipline, trendy gadgets, or the latest app.

Sometimes the key to peak performance is a service or technology uniquely applied to a surgeon’s life, like the one my mentor, colleague, and fellow orthopaedic surgeon Dr. Richard Santore applied a few years ago.

His application? — Hire a Town Car service to drive him to and from work Monday through Friday.

Hire a Town Car?

OK—technically the idea isn’t Dr. Santore’s (he borrowed it from a few of his joint replacement friends in NYC and LA) but considering Dr. Santore is the one who brought it to my attention, I’m going to give him the credit.

Now, I wholeheartedly realize how pretentious this sounds.

Paying $900 per week for a car service, Jeff? Are you CRAZY?! You think THAT is a good idea?

But the truth is…it is a great idea for some surgeons.

Allow me to explain, as Richard explained to me...

Safety

In the day-to-day life of a surgeon, time is precious and every free minute sacred.

The more tasks you can take off your plate—tasks that really don’t need your attention or expertise—the more effectively you can focus on the things that do require your talents.

By outsourcing the responsibility of driving to a professional whose sole purpose is to get from Point A to Point B safely, Richard reduces the risks associated with commuting (speeding tickets, car accidents, sensory overload, and undue stress) to a minimum.

Stress

Driving to and from the office or hospital every day in heavy traffic isn’t a pleasure—it’s a pain.

A gauntlet of fast cars, untimed stop lights, honking horns, bicyclists, and pedestrians you must carefully avoid in order to get to the place where your actual skills as surgeon are put to use.

Instead of waking up every day to curse the impending commute, Richard smiles knowing he’ll be able to catch up on the news with a cup of coffee, take phone calls, check his email, and get valuable consulting work done while somebody else handles the driving.

Productivity

Since his one-way commute time is about 35 minutes, Richard spends 70 to 80 minutes in the car every day. With someone else handling the driving, there’s a lot he gets done in that time.

Besides, Richard has more consulting work to do than he can handle, and his hourly billing rate—$700—more than offsets the expense of the car—$85 including tax and gratuity for one-way to the hospital and then his office one mile away.

Imagine having a ‘really good stock broker’ who could take a $200 investment and give you $500 return daily—that’s what the car service is to Richard.  (His billed time $700 - $200 cost = net $500 or 250% return)

The car service isn’t an expense—it’s an income producing investment, with the car doubling as a WiFi-ready, mobile office.

And when the traffic is bad, he gets even MORE work done!

Expand Your Schedule

So, if you’re a surgeon looking for a creative way to expand your schedule, consider hiring a car service to handle your commute. Look at the operating expenses, cost savings, and planned revenue.

-Jeff

PS—Have your own creative way of freeing up time and getting more work done? Email me at jeff@jeffsmithmd.com to share your story.