How is mental wellness being addressed among orthopedic residents, fellows?
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Click here to read the Cover Story, "The toll of perfectionism: Burnout in orthopedics."
Some progress made
Physician wellness is a hot topic among health care workers. Burnout has been found to be common in physicians along with low job satisfaction, high stress and low quality of life rating.
This has been found to affect all stages of practice and training. Physician wellness includes both mental and physical health.
Physicians have extremely high suicide rates, which are more than twice that of the general populations, with surgery being one of the most at-risk specialties. There are studies suggesting one physician dies by suicide every day in the United States.
Orthopedic surgery has come to acknowledge the importance of addressing the physical and mental health of residents and fellows. Since the early 2000s, work-hour restrictions have been instrumental in allowing residents and fellows more time for work-life balance. Although some have criticized these work-hour restrictions, the forced “new normal” has become routine and gone are the days of residents living at a hospital for days on end. The American Academy of Orthopaedic Surgeons now includes wellness topics at its annual meetings, as well as wellness activities. The orthopedic specialty societies also include mental health and wellness lectures at their annual meetings, which are available in person and online.
The importance of physician wellness has also been acknowledged by the American College of Graduate Medical Education, which surveys residents, fellows and faculty regularly and many of its questions pertain to how trainees’ mental and physical health is being respected and protected. Many institutions provide free, anonymous counseling services for their residents and fellows. Additionally, graduate medical education programs at orthopedic institutions, such as Stony Brook Medicine, offer residents and fellows activities such as puppy socials, yoga and meditation.
Although there is still plenty of room for improvement, there has been some progress during the past 15 years in acknowledging the importance of physician wellness and some positive steps toward addressing physicians’ mental and physical health needs.
- Reference:
- Kalmoe MC, et al. Mo Med. 2019;116:211-216.
Samantha Muhlrad, MD, FAAOS, is the chief of hand surgery and hand surgery fellowship program director in the department of orthopedic surgery at Stony Brook Medicine in Commack, New York.
Emotional needs must be addressed
Trainee wellness is a big issue in medicine, in general, and specifically of concern in surgical training.
The long hours and stressful situations in which our residents find themselves are associated with feelings of despair, helplessness and anxiety. For many, this is the first time in their life that responsibility lies significantly on their shoulders or the first time they may fail to achieve a goal. All of these issues were compounded by the impact of the COVID-19 pandemic on all health systems and frontline providers.
In response, many training programs have developed “wellness committees” to support the trainees as they confront the stress of life and the job. NYU Langone Health has recognized this and provides 24/7 support services for trainees who may feel overwhelmed. Our medical center has focused on recognizing the efforts of all of those involved in the care of our community with sponsored social events and gifts. Within the NYU Langone Department of Orthopedic Surgery, mentoring, feedback and close monitoring of each trainee has been stressed.
We have studied resilience and burnout in our residents and can now identify those who may be struggling and provide early interventions to avoid some of the consequences related to these phenomena. Our efforts to help provide relief from the daily orthopedic grind and reduce stress include sponsoring various athletic teams that participate in city wide leagues, after-hours social events to allow residents and sometimes faculty to gather outside of the regular hospital-work interactions, ski trips and summer pool/beach outings. Finally, support of various philanthropic missions that are important to the trainees is another way our department provides help beyond the clinical, educational and research training we provide.
In summary, hospitals and departments that provide surgical training must address the emotional needs of those they train and allocate the necessary resources to do so.
Kenneth A. Egol, MD, is the Joseph E. Milgram Professor of Orthopedic Surgery and vice chair of the department of orthopedic surgery at NYU Grossman School of Medicine and NYU Langone Orthopedics in New York.
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