Going the Distance: Sustainability in a Regional Anesthesia and Pain Medicine Center

May 2019 Issue

  1. Danielle B Ludwin, MD Associate Professor of Anesthesiology; Program Director, Regional Anesthesia and Acute Pain Medicine Fellowship; Codirector, Faculty Development and Career Advancement Program; Department of Anesthesiology, Columbia University Medical Center Author


How do we create sustainability in an anesthesia career? How do we chart a path that provides professional fulfillment? These are questions that members of our profession often wrestle with. I grapple with them as well and discuss them with my mentors, peers, fellows, and residents. If we consider our work satisfaction on a spectrum, with one end representing engagement and the other end burnout, how do we move toward the positive end and avoid the negative one?

The term burnout was coined by psychologist Herbert Freudenberg, who described it as a response to stress and frustration and to a demand that an individual may make on themselves in terms of a requirement for perfectionism or drive.[1] Christina Maslach developed the Maslach Burnout Inventory (MBI) as a validated metric to assess for burnout. The MBI is composed of three domains:

  • Emotional exhaustion (“I feel burned out from my work”)
  • Depersonalization (“I feel I treat some patients as if they were impersonal objects”)
  • Lack of personal accomplishment (“I don’t feel I’m positively influencing others through my work”)[2]

Burnout has been described as “an erosion of the soul,”[3] and its prevalence for medical personnel is high. In a study of more than 7,200 physicians, 46% had at least one symptom of burnout.[4] Anesthesiologists have burnout rates slightly higher than the average physician surveyed in that study.

Anesthesiologists face several stressors that can potentiate burnout. Being an anesthesiologist requires coping with time and production pressure, functioning in a high-stress environment, taking care of critically ill patients, responding to critical events, and having access to addictive drugs.

In work environments, six factors have been associated with burnout: workload (with inadequate recovery time), control (lack of autonomy), reward (no recognition), community (lack of), fairness (lack of), and values (conflicting between an individual and an institution). From a work perspective, the best-case scenario is an individual finding a job with a workload with adequate recovery, a sense of control, reward (financial and acknowledgment of work efforts), sense of community, fairness, and values that match his or her own.[5]

With those challenges, how do we move toward sustainability? Our relationships—personal and professional—are key. Anesthesiologists pride themselves on control in the operating room. Functioning outside of the operating room in environments that are unpredictable and out of our control requires us to adjust our expectations. Jon Kabat-Zinn, a professor emeritus of medicine at the University of Massachusetts Medical Center, wrote a book titled Full Catastrophe Living that addresses the concept that life encompasses “a supreme appreciation for the richness of life and the inevitability of all its dilemmas, sorrow, tragedies, and ironies . . . the human spirit’s ability to come to grips with what is most difficult in life and to find within it room to grow in strength and wisdom.”[6]


Burnout has been described as ‘an erosion of the soul,’ and its prevalence for medical personnel is high. In a study of more than 7,200 physicians, 46% had at least one symptom of burnout.


For our own personal growth, we must recognize that although we cannot fully control what happens around us, we can control our own reactions. We can engage in self-reflection: What motivates me professionally, what do I like most about my job, why did I choose to be an anesthesiologist?[7]

In my personal experience, one of the greatest joys of my job is engaging and bantering with patients before, during, and after surgery and making them feel more comfortable and relaxed with their perioperative experience. As a regional anesthesiologist, this is a great career fit that allows me to connect with patients and interact with them. Their fear of having a nerve block often metamorphoses into, “That is so interesting; can I watch my nerve block on the screen [ultrasound]?” This is deeply satisfying for me and makes my job rewarding on a daily basis.

As our goals and priorities change over time, we may need to reconsider our job opportunities. We need to ask ourselves, “What are our greatest priorities? Do we have adequate balance between our personal and professional lives? How much professional achievement are we willing to sacrifice to have more personal time or a better relationship with my family or children?”[7] Once we identify our priorities, it will become clearer which responsibilities should get our time and attention.

Those are challenging questions with complex answers. The work of self-reflection is ongoing. Organizations also have a responsibility to provide an atmosphere that allows anesthesiologists to flourish. Goals need to be aligned. Work culture should strive to provide inclusivity and equal opportunities, support, mentorship, nonjudgmental feedback, and debriefing. Engaged work environments feature sustainable workloads with the option of flexible work schedules, supportive technology, and opportunities to empower employees and make them feel recognized and valued for their work. Therefore, strong, supportive leadership is critical for an organization to flourish. This in turn will attract high-quality personnel to work in the department and make a positive contribution for it to grow.

Our society is tempted to want a quick fix or to hold out for an epiphany of what matters most. In our daily lives, we have a chance to decide how we spend our time, with whom we spend it, what is in our control, and what is not. In those small moments, how we spend our minutes, hours, days, and years shape our experiences. Perspective matters. As Winston Churchill stated, “A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.”

We can take each opportunity to mindfully maximize our fulfillment and remember the gratitude and privilege we have for being physicians.

References

  1. King N. When a psychologist succumbed to stress, he coined the term ’burnout.’ Available at: https://www.npr.org/2016/12/08/504864961/when-a-psychologistsuccumbed-to-stress-he-coined-the-term-burnout. Updated December 8, 2016. Accessed March 9, 2019.
  2. Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. 3rd ed. Palo Alto, California: Consulting Psychologists Press; 1996.
  3. Maslach C, Leiter MP. The truth about burnout. San Francisco, California: Josey- Bass; 1997.
  4. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 2012;172:1377–1385.
  5. Maslach C, Leiter MP. Early predictors of job burnout and engagement. J Appl Psychol 2008;93:498–512.
  6. Kabat-Zinn J. Full Catastrophe Living. New York, New York: Dell; 1991.
  7. Shanafelt T, Chung H, White H, et al. Shaping your career to maximize personal satisfaction in the practice of oncology. J Clin Oncol 2006;24:4020–4026.

Tags: sustainability, burnout, stress

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