From Jeffrey Feldman MD (Children’s Hospital of Philadelphia)
Thanks for curating this group of articles on burnout and including the videos from Dr G – he is bingeworthy. I agree with you that most of the efforts to address burnout seem misguided and I would argue are actually counterproductive since they consume time and resources that could be applied to actually solving the problem. You can see ongoing evidence of the systemic problems underlying healthcare employment when you see what is happening as human resources are scarce – most of the time the solution is to throw money at it which only perpetuates the pressure of high volume, high throughput work environments which I believe are one of the root causes of burnout.
My main reason for this email is to share my concern that the current efforts to address burnout fail to recognize the role of professionalism as a strategy to both prevent burnout and enhance patient care. In my own career, a big part of my job satisfaction derived from my role providing anesthesia services to patients, often complex and challenging. When patient care required spending more hours at work than I would have preferred, the satisfaction of being a member of a respected, quality anesthesia department has always been a tangible reward. The current focus on work-life balance seems to put all the weight on the life side as the solution to burnout. We have all put a huge amount of our life effort into developing the skills to be able to provide expert care to patients and demonstrate the value of our specialty to the organizations where we work. The opportunity to use those skills and leave the work day knowing that they were put to good purpose in my view, is one of the most important strategies for preventing burnout that does not receive much attention.
You are right that addressing burnout will require fundamental changes by teams of visionary leaders from politics, insurance, healthcare organizations and others. We might need to take some lessons from other countries where access to elective care can be delayed because sufficient resources are not available to provide immediate care. Like many aspects of our world in the US these days unfortunately, the systems for solving these problems collectively simply do not exist.
From Danielle Galia CRNA
Is there any evidence based confirmation that opioid sparing anesthetics have any impact upon post-operative pain? I am fearful that if we swing away from providing effective analgesia intra-op, we are promoting more post-op pain that is under treated. For example, when the regional block wears off, are these patients in terrible pain?
From Elliiot J. Krane MD
Can you point me to any study, even 1, that shows the existence of opioid induced hyperalgesia in human beings? I don’t think I have read one. I think this is an example of a rodent study extrapolated beyond all reasonable boundaries.
From Allison Fernandez MD
The next installments of Women of Impact in Anesthesiology are now on-line (https://www.asahq.org/education-and-career/women-of-impact). I am in awe with all of the women that I have interviewed so far. They have accomplished so much professionally!!In these new segments we talk to Jane Fitch past President of the ASA. We talked about her transition from nurse anesthetist to anesthesiologist. Some comments that struck me was to get involved with the anesthesia societies to expand your network. She also pointed out that burn out is a real issue especially in the advent of COVID. Dr Fitch commented that she is concerned female anesthesiologist are not supported during the pandemic when caring for their personal lives while maintain their career. Finally, we talked about diversity, equity and inclusion and her past experiences with gender bias. “We got to make it so that anesthesiology a welcoming specialty for everyone”. She also mentioned if you face bias to report it and lean in on your support system.
Vidya Raman Professor of Anesthesiology at Ohio State University commented women face more challenges in academia than men. She talks about setting goals for yourself to get ahead in leadership. She encourages women to interview for positions even if you are not 100% qualified as you learn from these experiences.
Linda Mason MD the Past president of ASA also talks about gender bias and how we also have to learn more about bias and microaggressions. We have to work together to change our culture to combat bias. She talks about anesthesiologist get involved at the medical school to encourage students from a diverse background to become anesthesiologists.
Lauren Thornton MD a pediatric anesthesiologist and one of the few Native Americans in our field. She talks about her experiences working on the front lines during the COVID pandemic without adequate PPE. We talked about discrimination that she faced because of her gender and race. But she reminds us how important it is to take care of yourself so you can be there for your family, colleagues and patients. Dr Thornton encourages young anesthesiologist to seek out mentors don’t just let them be handed to you and she hopes to pay it forward.
Meg Rosenblatt MD the chair of the anesthesiology department at Mt Sinai Morningside and West. She is recognized as the first anesthesiologist to administer intralipids to treat local anesthetic toxicity. She credits this experience with changing her career path. She talks about the importance of paying it forward especially for women and encourages everyone to be a mentor or sponsor. I also have a chance to interview another seasoned leader
Roberta Hines MD past chair of anesthesiology at Yale University. She believes that anesthesiology is the best field as you can balance your clinical and academic life. Dr Hines talks about” Creating goals and timelines and be honest with yourself to prioritize your goals.” She also feels that you can pivot your career and skills to grow your career. A mentor is someone who helps you prioritize your goals.
Tracey Straker MD MPH MS Professor of Anesthesiology at Albert Einstein School of Medicine also talks about the importance and positive benefits of having a mentor. She believes that mentors provide guidance that can really propel your career forward.
Sponsorship is also important as Crystal wright MD Associate Professor and President of the Texas Society of Anesthesiology also comments that her program director encouraged her to participate in resident component of the ASA and the Texas Society of Anesthesia. She believes that anyone can be a leader as long as you have passion about a topic and she also believe that as you increase your self-awareness is how to hone in on your leadership skills to become a better leader.
I encourage you to listen and /or watch the series I have learned a lot from talking to the women leaders in anesthesiology and I am sure you will too. I want to thank all the Women of Impact for their continued support.
From Alan Klein MD
Another “oldie but goodie” article discussing the pros and cons of awake vs anesthetized intubation: Duncan HP, Zurick NJ, Wolf AR. Should we reconsider awake neonatal intubation? A review of the evidence and treatment strategies. Paediatric anaesthesia. Mar 2001;11(2):135-45. doi:10.1046/j.1460-9592.2001.00535.x