Work–Life Balance and Burnout

Abstract

Serious consideration of work-life balance and its impact on professional performance and family life have been anathema to generations of surgeons in training and in practice for much of the past century. William Halsted (1852–1922), the father of the first formal surgical residency training program in the United States at Johns Hopkins Hospital, demanded continuity of care from his residents. The restrictive lifestyle and extreme personal sacrifice that characterized Halsted’s training program in the waning years of the nineteenth century remained pervasive in most American surgical training programs for much of the twentieth century—well into the 1960s and 1970s. During those earlier days, surgical residents frequently lived on hospital premises during their residencies, were strongly discouraged from starting families, and were not receiving salaries. Instead, they were gratified with room and board, hospital clothing, and with professional education and training. The Medicare and Medicaid Act of 1965, which was primarily designed to provide for medical care for the elderly and the poor, became one of the first agents of change in the surgical residents’ lives in that it provided for a substantial salary [1]. The basic underpinnings of the surgical residency changed gradually, with surgical residents now at least physically spending part of their lives outside of their training institutions. It was not until the beginning of this new millennium, in the wake of the highly publicized Libby Zion case, that the Accreditation Council for Graduate Medical Education (ACGME) designed and mandated the 80-h workweek for surgical and other residents, placing, among other measures, a cap on the length of the shifts that could be worked [2]. Not surprisingly, this change regarding surgical residents’ work hours generated vocal dissent from some of those representing prior surgical generations. For instance, Josef Fischer, M.D. stated “The 80-h work week is seen as damaging to the essence of surgery’s being. It is the denial of the foundation of…continuity of care.” [3]