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A LEADING Australian surgeon wants a complete overhaul of surgeons’ working hours after a US study showed burnout and others indicators of distress among surgeons correlate directly with increasing work hours and the number of nights on call.
Professor Guy Maddern, chair of the Professional Development and Standards Board at the Royal Australasian College of Surgeons (RACS), said surgery needed to move away from the current “cottage industry” approach to a more shared model.
Professor Maddern said a more shared approach, with three to four surgeons taking shared responsibility for a pool of patients, would mean surgeons would not have to be on every night for their patients.
He was commenting after a study, published in the Journal of the American College of Surgeons, found that working 80 hours or more a week and being on call for 2 or more nights each week were associated with a higher rate of depression, burnout, decreased quality of life, lower career satisfaction and increased work and home conflicts.(1)
The study analysed results from a survey of 7900 American surgeons.
The prevalence of burnout was 30% of surgeons working less than 60 hours a week, 44% of those working 60–80 hours a week, and 50% of those working more than 80 hours.
Those who worked more than 80 hours a week reported a higher rate of medical errors compared to those who worked under 60 hours (10.7% vs 6.9%), and were twice as likely to blame burnout for the error.
Surgeons in the specialties of trauma, cardiovascular surgery, transplantation surgery and urology worked the longest hours and had the most nights on call.
The authors said burnout had implications for patient safety and personal wellbeing, and if it resulted in early retirement, it could exacerbate workforce shortages.
It was imperative to find effective ways to reduce burnout as a quality improvement initiative, they said.
Professor Maddern said the need for a complete overhaul of the approach to surgeons’ working hours was exacerbated by the changing demographic of surgeons.
“Generation Y is not going to work the way the baby-boomers work. They want lifestyle, family time.”
For rural areas, a successful model of care similar to one being implemented in South Australia, which involved a rotating roster of surgeons, could be introduced, Professor Maddern said.
Professor Maddern said although rural surgeons on call every night might not receive a lot of call-outs, there were constant pressures.
“The trouble is you never know when you are going to get a call, you can never have a drink, you are never off duty and whenever the phone goes, you have no idea whether you are going to be dealing with a bus that has rolled over with 20 injured people or someone with an ingrown toenail,” he said.
Associate Professor Bruce Waxman, a co-author of the RACS guidelines on safe working hours, said one of the solutions to burnout was to make surgeons aware of it.
Colleagues who recognised symptoms of burnout in a surgeon should point it out to the surgeon and also to the medical board under mandatory reporting requirements, he said.(2)
The RACS safe working hours guidelines of 2007 recommend the total number of working hours should be 70 hours or fewer per week and the most frequent on-call roster should be a 1 in 4 rotation.
But Professor Waxman, director of general surgery for Southern Health in Melbourne, said there was no legislation mandating safe working hours for consultants, who might get only 4 hours’ sleep a night if they were on call and operated during the night and then had a surgical list the next day.
Some solutions that had been suggested included teamwork among surgeons working in group practices, a better approach to sleep hygiene and providing better back-up for on-call surgeons, he said.
1. J Am Coll Surg 2010; 211: 609-619.
2. Fact sheet: new reporting obligations. Australian Health Practitioner Regulation Agency.
Posted 8 November 2010
I worked briefly as a general surgical registrar. I had an all-day list, saw emergency patients the whole evening, and was called in at midnight to deal with a multi trauma which took until 6am to sort out. I called in at 7am to say I need 3 hours of sleep for the next all-day list, and arranged my resident to go in and assist while I slept. When I turned up at 10:30am, my seniors told me to toughen up or reconsider my career.
I reconsidered my career and got out of surgery. My life is much better now, work satisfaction is much higher, pay better, and I have much happier colleagues and family around.
I don’t know why they short staff the surgical department to such an extreme. I was earning much more in overtime pay than my regular salary, enough to employ another two registrars to share the load. But obviously surgical admin is so dense they can’t see the light. And the old nasty surgeons keep going on about young registrars not having enough experience. “In my days everything was so much better, we use to work for years without a break”. And they were proud of it too!
Good luck to those stressed-out, poor communicators still doing 100 hour shifts. They bring it onto themselves.
As a surgical registrar working 80 hr weeks and 1:2 or 1:3 on call, I think any consideration of safe hours needs to be across the board. In my experience, surgical registrars and consultants are the only ones completely left out of safe rostering.