Two Surgeon Couples. Chip Foley Laurel Rice. R. Scott Jones, MD

Transcription

1 Two Surgeon Couples Chip Foley Laurel Rice R. Scott Jones, MD 1

2 Learning Objectives Appreciate the historical context of the discussion. Appreciate the myriad issues which are impactful. Work Issues Non-work Issues Appreciate available opportunities for improving the landscape. Why Were We Invited? FAR FROM ANY TYPE OF GOLD STANDARD Still married Kids = no unplanned pregnancies and no felonies Still enjoy work (for the most part) 2

3 Dual Career Couples 54% of married or partnered couples have both partners in the workforce today. US Census Bureau; 2009 Surgeons today: Men: 50% have a working DP 15-30% of DPs are physicians Women: 85% have a working DP 42-50% of DPs are physicians Dyrbye LN et al; Arch Surg. In press 3

4 ACS Demographics October 2016: 64,302 fellows 5,522 were female (8.5%) 80,180 fellows if students, residents and fellows are included 11,596 were female (14.5%) Jo Byske, MD Assoc. Director, American Board of Surgery 4

5 ACS Survey ,905 responding surgeons (32% response rate) 86.7% (6,815) of responders were men 13.8% (1,090) of responders were women More women responded percentage-wise then men 8.5% of ACS members were women J Freischlag J et al; J Am Coll Surg 2010;211: ACS Survey: Domestic Partners 90% had a DP (domestic partner) 48.8% (3,471) of DPs DID NOT work outside the home 51.2% (3,649) of DPs DID work outside the home 31.9% (1,165) of DPs were physicians 28.8% (335) of DPs were surgeons 68.1% (2,484) of DPs were working nonphysicians J Freischlag J et al; J Am Coll Surg 2010;211:

6 Primary Outcomes Comparing the prevalence of: Burnout A positive depression screen Mental and physical QOL DIFFERENCES BY BY SPOUSAL EMPLOYMENT Chi-square or Kruskal-Wallis All tests were two-sided with type 1 error rates of Logistic regression to evaluate independent associations of the independent variables with burnout and specialty choice satisfaction by spousal employment. Weaknesses ACS Survey 32% response rate Cross sectional = causality cannot be considered Personal (children s health) and professional (subspecialty) challenges not considered Strengths Large sample size Use of standardized instruments to evaluate burnout, depressive symptoms and QOL J Freischlag J et al; J Am Coll Surg 2010;211:

7 ACS Survey: Divorce Prior (to 2008) Divorce DP = stay at home = 15.2% DP = working physician = 14.3% Not stratified by physician type DP = working non-physician = 26.3% Pair-wise comparisons versus: 14.3% = p< % = p< J Freischlag J et al; J Am Coll Surg 2010;211: ACS Survey: Children and Career Commitment to raising children slowed their career DP = stay at home = 19% DP = working physician = 39.8% Surgeon/surgeon = 50.4% Surgeon/non-surgeon MD = 36.1%; p< DP = working Non-physician = 22.8% p< J Freischlag J et al; J Am Coll Surg 2010;211:

8 ACS Survey: Work-Home Conflicts Work-home Conflicts DP = stay at home = 49.1% DP = working physician = 62% Surgeon/surgeon = 69.3% Surgeon/non-surgeon MD = 59%; P<0.001 DP = working Non-physician = 48.1% P< J Freischlag J et al; J Am Coll Surg 2010;211: ACS Survey: Career Conflicts Career Conflicts DP = working physician = 49.3% No difference between surgeons and nonsurgeon MDs DP = working Non-physician = 40.6% p< J Freischlag J et al; J Am Coll Surg 2010;211:

9 Summary Highest divorce rate: Surgeons married to working non-physicians. Highest degree of career slow-down by child rearing: two surgeon units. Highest degree of work-home conflicts: two surgeon units. Highest degree of career conflicts: two physician units. No difference between surgeons and non-surgeons. Survey ACS Survey Maslach Burnout Inventory Primary Care Evaluation of Mental Disorders Symptoms of Depression Medical Outcomes Study Short Form QOL Standard categorical thresholds used to categorize domain scores into low, intermediate and high. 9

10 ACS Survey: Burnout Burnout was statistically the same for all 3 categories: 40% (DP employment status no delta) HOWEVER: High emotional exhaustion: was more prevalent among surgeons with working non-physician DPs (33%) than with stay at home DPs (30.3%; p = 0.03). Multiple variable logistic regression: DP working as a non-physician remained independently associated with high emotional exhaustion. ACS Survey: Depressive Symptoms No difference between surgeons partnered with physicians (31.1%) or working non-physicians (30.5%; p = 0.72). BUT surgeons partnered with stay-at-home DPs were less likely to be depressed (27.3%; p<0.02 for both pair-wise comparisons). 10

11 ACS Survey: Mental QOL QOL ½ SD below population norm: More surgeons in dual-physician relationships were below the population norm = 31.8% compared to: Surgeons with working non-physicians = 27.9%; p = Surgeons with stay-at-home DP = 25.8%; p = ACS Survey: Career Satisfaction No difference in career satisfaction by DP s employment status (70%). Surgeons whose DP stayed at home were more satisfied with their career 76%; p = ) Would become a physician again. Would become a surgeon again. 11

12 Comments from Other Two Surgeon Couples 12

13 Thanks To: Mimi Wynn, MD, Professor, Director Anesthesia, Thoracic Aortic Surgery Program CW Acher, MD, Professor, Director, Thoracic Aortic Surgery Program Ann Lidor, MD, Professor, MIS Rick Feinberg, MD, Professor, Vascular Surgery Caprice Greenberg, MD, Professor, Surgical Oncology Jake Greenberg, MD, Associate Professor, MIS Gretchen Schwarze, MD, Professor, Vascular Surgery Josh Mezrich, MD, Associate Professor, Transplant Kyla Bennett, MD, Assistant Professor, Vascular John Scarborough, MD, Associate Professor, Trauma/Critical Care Evie Carchman, MD, Assistant Professor, Colorectal Surgery Brian Gander, MD, Assistant Professor, Plastic Surgery Stephanie Suprenant, MD, Chief Resident, Plastic Surgery Charles Acher, MD, Chief Resident, General Surgery Two Career Couples/Families Many challenges are not unique to a twosurgeon couple: Large number of hours worked. Lack of control of work hours. Stressful job Quote from Dr. Beverly Woo (circa 1983) Laurel, there are many women working in factories trying to support their families; we have it pretty good. 13

14 Goal Satisfying and happy personal and professional life Make a contribution to society. Plethora of lists of pros and cons regarding 2 physician families Plethora of pointers on how to manage it all. 14

15 Compartmentalization Things we cannot control. Things we can control. 15

16 Things We Cannot Control Social Mores What is expected from men? What is expected from women? Both pose unique challenges. Same sex couples would have their own social mores to contend with. From whence we came. X Amount of Emotional Energy: It is Finite Priorities Family Patients The faculty I work for Women in general Reproductive Rights Maternal mortality Infant mortality 16

17 Two books: Unfinished Business by Anne-Marie Slaughter and Lean In by Sheryl Sandberg 17

18 Similar Books for Men? There should be. I would argue the landscape is still more complicated for women. Examples... 18

19 Can t control so much more Complicated work environments Don t have the mentor or sponsor you need. Work with a bunch of jackasses. Children with special needs Illnesses in the family 19

20 From Whence We Came! Things We Can Control Guess the author of this famous quote: Laurel, if you could pay someone to wipe your hiney, you would do it. Yes I would. TIME OR MONEY 20

21 Time: Family or Work Grocery shopping Cleaning Dry Cleaning Laundry Cooking Every moment counts. Time: Family or Work Interval Training : Times where one works harder and times when one backs off. but stays in the game. THE ONE DIFFERENCE FOR SURGEONS: Maintain surgical expertise. 21

22 Interval Training Possible for: Research Teaching Advocacy Turn the gas up or down. Things to Think About: #1 Excel spread sheet before committing Share ideas about: Money Raising children Shared responsibilities Etc Communication at the get-go. 22

23 #2 Capitalize on individual strengths Multitasker for running the house. Math homework #3 Child Care So much to say here. It takes a village. You cannot worry about the health of your kids when you are at work. Be a parental unit. 23

24 #4 Have something for yourself. Stairmaster Have a lot together Counceling Biking Etc #5 Make sure you have wonderful partners at work: Peyton Taylor Willie Anderson Susan Modesitt Kathie Hullfish Cannot be worrying about the health of your patients when you are not at work. 24

25 Irv Kron, MD 25