Spine surgery can take a significant physical and emotional toll, but sustaining a long career requires more than just pushing through it. Spine surgeons discuss how they navigate burnout, physical strain and the pressures of the profession.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker’s invites all spine surgeon and specialist responses.
Next question: Patients often spend years in injections and ablations before they reach a surgeon. What is that delay costing them, and where does the referral system break down?
Please send responses to Sophie Eydis at seydis@beckershealthcare.com by 5 p.m. Central time, Sunday, Aug. 23.
Editor’s note: Responses were lightly edited for clarity and length.
Milad Alam, MD. Spine Surgeon at DISC Surgery Center at Palm Beach (Fla.): For me, that’s travel. I make it a priority to plan trips throughout the year because they give me dedicated time to disconnect, spend quality time with friends and family, and experience new places and cultures. Having those moments on the calendar helps create balance and gives me something positive to anticipate during the busiest stretches.
I also think our field should normalize conversations about well-being. We often talk about taking care of our patients, but not enough about taking care of ourselves. Long careers aren’t built on working harder every year. We should aim for sustainable ways to stay physically healthy, mentally engaged and connected to the people and experiences that matter most. Ultimately, being a mentally and physically healthy surgeon, helps us provide better care for our patients.
Bryce Basques, MD. Spine Surgeon and Director, Minimally Invasive and Endoscopic Spine Surgery, Brown University (Providence, R.I.): The physical toll is real, most spine surgeons I know deal with some element of chronic or intermittent pain due to the nature of our surgeries. As I have gone deeper into my career I have thought a lot more about the ergonomics of my cases. Endoscopic spine surgery has been helpful for many cases, as looking forward at a screen is much easier on the neck than looking down through loupes or a microscope. Using navigation and robotics has decreased the amount of radiation I get during cases.
On the other hand, the mental toll of our field is what I think deserves more attention: we work in a high-risk field with very little tolerance for errors, and yet we are human beings and will inevitably make mistakes and have complications. Especially in elective cases, where patients are relatively normal at baseline, complications can be crushing as a surgeon. Fortunately, more attention is being paid to this “second-victim syndrome” and it is important for surgeons to be open with one another about these struggles.
Brian Gantwerker, MD. Neurosurgeon and President of The Craniospinal Center of Los Angeles: In terms of burnout and the physical toll, I have increased my days in the gym, with my family and my time with each patient. I find one on one time with patients helps ensure good outcomes and positive interactions with them that can get you through rough times.
That’s not possible with every clinic day, and sometimes emergencies can get in the way, but any time you can sneak a bike ride, hike or even dinner out with your spouse or friends, it is a good day.
Philip Louie, MD. Spine Surgeon and Medical Director of Research and Academics for the Center for Neurosciences and Spine at Virginia Mason Franciscan Health (Seattle): We spend our careers protecting other people and almost no time protecting ourselves.
Some of the things I have been working on include studying the ergonomics of our spine surgeries. We are wearing surface EMGs and dynamic motion sensors to better characterize where we are at greatest risk of musculoskeletal injuries.
I’m also paying more attention to my own recovery data. I wear a tracker and look at sleep and strain similarly to how I look at patient outcome data. Now, I just need to think of better ways to act on it.
I’m also learning to learn better, figuring out how to stay engaged with learning and seeing how other people learn in fields far outside of healthcare. It’s a fun way to try new things, meet new people and still apply those learnings to our current work. To the point where I’m now writing a book on this.
Issada Thongtrangan, MD. Endoscopic and Minimally Invasive Spine Surgeon at MicroSpine (Scottsdale, Ariz.): Spine surgery is deeply rewarding, but we need to stop pretending it is harmless to the surgeon. Long cases, difficult outcomes, constant pressure, physical pain and burnout are often treated as part of the job. They should not be.
I have become more intentional about ergonomics in the OR, staying strong and active outside of work, using technology thoughtfully and protecting time with my family. Taking care of ourselves is not a luxury, it is how we stay focused, compassionate and able to care for patients over the long run.
We also need to talk more openly about burnout, pain, complications and difficult outcomes. Surgeons do not need to carry the physical and emotional weight of this work in silence.
Jacky Yeung, MD. Neurosurgeon at Yale Medicine (New Haven, Conn.): One of the biggest changes I’ve made is being intentional about protecting time for my family and reminding myself why I entered medicine in the first place, to improve patients’ lives.
As healthcare increasingly emphasizes [relative value units] and productivity, there’s a risk that volume becomes the metric of success. I believe we need to talk more openly about aligning incentives with patient outcomes rather than simply rewarding throughput. Focusing on delivering the best possible care, rather than just seeing more patients or doing more procedures, has been the most important mindset for sustaining both my career and my passion for neurosurgery.
Christian Zimmerman, MD. Spinal Neurosurgeon at St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Without exception, healthcare, and especially surgical specialties, carries a cyclical pattern of weighty physical and emotional pressures, endured differently according to individual personalities.
Silence and sufferance may be one acceptable method, while projection and deference may work for others. The range of burnout among spinal surgeons varies little from that of other specialists, with the reality of systemic stressors and workload becoming more accountable and more prevalent. Frankly, burnout is highest among specialists where perceived levels of appreciation and support are essential.
Counteractive resilience is objective-based, allowing previously experienced events to be both learned from and used to strengthen one’s value system. Choosing a behavioral path of a higher moral standard gives access to acquired cognitive resources, enabling reparative analysis of self-realization and consideration of a more productive outcome.
There does appear to be a genetic predisposition to resilience, for instance, but environmental and situational life circumstances play a role in how behaviors are ultimately expressed.
Subjectively, renewable positive resources are maintained through equally affirmative-minded coworkers, a working environment of support and recognition for all individuals and the acknowledgment of a patient-centric practice and outcomes.
Ultimately, choices are personal and fundamentally self-accountable, and the enigmatic path of healthcare and its uncertain future may be a not-so-deliberate risk. Clearly, it is no longer for the faint of heart.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
