Career reflections of retired surgeons.

Abstract

COVID-19 has changed the way we practice surgery.1 Furthermore, the pandemic has allowed us, indeed forced us, to reflect on those parts of life and work that are most important and rewarding.2 Retired surgeons have a unique perspective to understand progression, fulfilment and regret across a career.3, 4 The aim of this study was to categorize and describe the impressions and reflections from retired surgeons regarding their career in surgery. In early 2021, retired surgeons from across Australian and New Zealand (Table 1) were asked to participate in an anonymous survey (supplementary file 1). An invitation to complete the survey was distributed via Fax Mentis to Fellows of the Royal Australasian College of Surgeons (RACS), promoted on the RACS website as a news story and sent by email from the RACS administration team to the RACS fellowship who were over the age of 65 years (N = 4654). Only those who answered ‘yes’ to indicate they were retired or transitioning to retirement were able to complete the survey (supplementary file 1). The survey was adapted from published research from the USA.4 The University of Wollongong and Illawarra Shoalhaven Local Health District Health and Medical Human Research Ethics Committee approved the study (2020/ETH00309). Questions asked related to demographics, most and least rewarding aspects of their career, and advice on education and training. Quantitative data was analysed descriptively and qualitative data was analysed using Braun and Clarke's thematic analysis method.5 A total of 114 retired surgeons (2.4% recruitment) completed the survey (average age = 78 years; range 62–93 years; year retired range 1997–2020). The majority of respondents were male (96.3%), currently retired (retired = 75%, semi-retired (working part-time as a surgeon to transition to retirement) = 25%), previously worked in general surgery (41%) or orthopaedic surgery (22%) and from both private (40%) and public hospital (41%) sectors. Participants reported that the most rewarding aspect of being a surgeon was being involved in patient care (87%), training junior surgeons (70%) and working in a team environment (38%). The least rewarding components of working as a surgeon were maintaining a work/life balance (53%) and the reduced ability to spend time with family and friends (40%). They also reported that if they had their chance to do it all again, they would spend more time with their family (52%). The qualitative answers provided by the participants as to what advice they would provide and what training and education was essential for younger surgeons to complete could be categorized into five (Table 2) and seven themes respectively (Table 3). ‘Keep an open mind, collaborate widely. Do not focus on making lots of money—you will be well paid. Do not lose sight of your family. Engage in life’. ‘Embrace work/life balance at an early stage in your career. Enjoy your work and family, keep humble’. ‘Constantly review one's practice and standards to ensure they are maintained’. ‘Get the best surgical education and training you can before entering practice’. ‘The most effective surgical outcomes come from team work, the worst from failure to consult’. ‘Collegiality is all-important. Working as part of a team will be to your advantage and to those around you—particularly your patients. Never be afraid of saying you “do not know” and never be afraid of seeking advice’. ‘Be readily available for patients and their problems. Patient care and support are your prime consideration’. ‘Listen to your patients. They will give you at least a differential diagnosis if not the diagnosis and what concerns them most’. ‘Do not worry about apparent obstacles, obstacles are there to be overcome’. ‘Go for it! If you have what it takes, there is no better way to contribute, and you have plenty of satisfaction along the way’. ‘Train in a centre that has a huge surgical volume and surgeons who will allow you to progress in surgery under their direct supervision. Being turned loose too early leads to plateauing of your experience and skills’. ‘Lots of operating. Lots of patient interaction’. ‘Be a generalist prior to subspecialisation’. ‘Breadth of training remains fundamental to the provision of better patient care, communication skills, and leadership training are essential requirements’. ‘Gain as much surgical exposure under supervision as you can before going it alone. Where possible work alongside colleagues’. ‘I believe a more formal senior mentoring system has merit. Senior surgeons may appear old fashioned and conservative but usually have squired a lot of wisdom along the way’. ‘Learning to listen to patients with empathy. Particularly learn to ask what a prospective patient's expectations of surgery really are’. ‘It is rarely clinical errors that trip them up. More usually it is the non-clinical aspects of the patient interaction where problems arise, or where surgeons have poor insight into the extent of their own skills and abilities’. ‘The completion of a training program as specified by the RACS’. ‘The RACS training is an excellent baseline’. ‘…a couple of years working in appropriate units in overseas countries’. ‘Definitely try to get a rural posting during advanced training and postgrad training overseas if this can be arranged’. ‘More interest on basic sciences, especially anatomy’. ‘Surgical training requires a comprehensive knowledge of Anatomy, Physiology, Pathology, Investigation options and Clinical assessment in order to establish a diagnosis’. ‘The very important role of surgery related research and how rewarding even a small amount of time being involved in research, clinical or basic can be, as well as enhancing one's own practice’. ‘Research experience: it will be the basis for repeatedly rejuvenating your career and satisfaction’. Retired surgeons have a particular perspective to reflect on a career in surgery. The most common advice they offered related to self-care, training and experience, relationships with colleagues, patient care and perseverance. The training and education reported as essential were both practical (skill acquisition and overseas opportunities) and philosophical (working in a team and with a scientific basis). Information from this study provides young surgeons with the wisdom of retired colleagues and enables training bodies to benefit from a unique appraisal. Among the responses, local education programs, hands-on workshops, online training modules and the development of specific teams led by an experienced mentor are all strategies that could be used to provide a supportive training environment to the young surgeon.6, 7 Further investigation is being conducted by RACS using a similar survey with results to be released in 2022. Perhaps now is a very fitting time to reflect, learn and to prosper. Lyndel Hewitt: Investigation; methodology; project administration; writing – original draft; writing – review and editing. Bruce Ashford: Conceptualization; investigation; methodology; writing – original draft; writing – review and editing. The authors of this study would like to thank the participants of this study for their valuable contribution. In addition, the authors would like to thank the Royal Australasian College of Surgeons (RACS) for the distribution of this study information to potential participants. Open access publishing facilitated by University of Wollongong, as part of the Wiley - University of Wollongong agreement via the Council of Australian University Librarians. The data underlying this article cannot be shared publicly to meet the ethical requirements of the HREC providing permission for the study. De-identified group data can be shared on reasonable request to the corresponding author. Appendix S1 Supporting Information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.