Beyond Burnout: Surgeons Rethink What Makes Careers Sustainable

Burnout has become a familiar way to describe the strain facing surgeons, but improving well-being requires looking beyond individual resilience to the environments in which surgeons work, the careers they build, and the sources of meaning that sustain them.

During the Clinical Congress session “Beyond Burnout: Restoring Purpose, Autonomy, and Joy in Surgical Practice,” four speakers examined how professional fulfillment changes throughout a career, as well as how surgeons and healthcare organizations can create more sustainable paths forward.

Culture Can Mitigate Moral Injury

For surgeons, some of the most difficult professional experiences arise from serious complications and adverse outcomes that challenge deeply held beliefs about their responsibility to patients.

Sunil K. Geevarghese, MD, MSCI, FACS, a transplant and hepatopancreatobiliary surgeon at Vanderbilt University Medical Center in Nashville, Tennessee, distinguished these experiences from everyday frustrations such as inefficient workflows or administrative burdens. Major complications can threaten a surgeon’s identity, trust, and relationships, creating vulnerability to moral injury.

That vulnerability can vary throughout a career. Early career surgeons may be particularly susceptible because they have not accumulated the reputation and positive outcomes that Dr. Geevarghese described as “protective equity.” Vulnerability can increase again later in a career as surgeons encounter questions about aging, ability, and judgment.

But workplace culture can alter that trajectory.

“Culture is everything. We can shift these vulnerability curves. If you’re in a hostile work environment, it will increase your vulnerability, no matter what stage of the game you’re at. However, in a supportive culture, I believe protective equity can be conferred,” he said.

Changing surgical culture also means reconsidering expectations about how surgeons respond when things go wrong.

“We are trained to be confident and infallible. What we need is culture change, where we accept humanity, destigmatize self-doubt, and encourage seeking help with dealing with the accumulation of a lifetime of complications.”

Build a Career That Can Last

Questions about building a fulfilling career begin almost immediately after training. Early career surgeons face pressures to establish themselves clinically while pursuing research, teaching, leadership opportunities, and responsibilities outside medicine.

“The goal isn’t to simply survive the first several years after our training, but to build a foundation for a career that’s successful, sustainable, and meaningful,” said Maureen D. Moore, MD, FACS, an endocrine surgeon at Cooper University Health in Camden, New Jersey.

Doing so requires being deliberate about opportunities. Surgeons may feel pressure to say yes as they establish their careers, but every commitment carries an opportunity cost.

“The question really isn’t, ‘How much can I take on?’ The better question to ask yourself is, ‘What deserves my time?’” Dr. Moore said.

Mentors, sponsors, coaches, and peers can help surgeons identify priorities and define success on their own terms. Ultimately, sustainability also requires protecting an identity beyond professional achievement.

“Your goal isn’t to have the fullest calendar. Your goal is to have a calendar that reflects your priorities at that given time,” she said. “You need to protect the person behind the surgeon.”

Volunteerism Can Reignite Purpose

For some surgeons, service may provide another path toward professional fulfillment.

Theresa L. Chin, MD, FACS, a trauma surgeon at University of California Irvine Health, described surgical volunteerism as an opportunity to reconnect with patients and communities while addressing gaps in access to care. Opportunities can range from international capacity-building programs to free clinics and other community initiatives.

“On an individual level, it really invigorates that sense of purpose and that meaning of what it was to just care for patients,” she said.

Healthcare organizations could support such work through benefits such as volunteer time off, but service should remain optional rather than becoming another demand placed on surgeons.

“For some, volunteering would be more work and burn them out more,” Dr. Chin said. “For others, it renews that sense of why we started this, why we enjoy taking care of patients and really rebuild that community connection.”

Making Professional Agency a Core Competency

Nicole M. Fox, MD, MPH, FACS, a trauma surgeon at Cooper University Health, argued that the environment in which surgeons practice has fundamentally changed. Financial pressures, administrative demands, rapidly evolving technology, and changing expectations mean traditional career models may no longer be sustainable.

“We can’t expect to do things the way we’ve been doing in surgery for the last 20, 30 years and expect it to work today. It’s not going to happen,” she said.

One response is to make professional agency a core competency.

“We must start talking about teaching and modeling this concept of agency,” Dr. Fox said. “You need to understand what matters to you, identify choices and trade-offs, shape your role over time, and understand that you are going to evolve in your career.”

Healthcare organizations have a role, too, by providing supportive leadership, opportunities for growth, skill development, flexibility, and greater control over how surgeons work.

“Rigid career pathways, a single definition of success, a lack of flexibility and autonomy—those don’t work anymore,” Dr. Fox said. “We didn’t do anything wrong. We did the best we could. Now we’re starting to know better about evolving the professional, and we’re obligated to do better.”

Clinical Congress registrants can view the session on demand on the Meeting Platform.