Original article
Benjamin Gafsou, Marie-Christine Becq, Daphné Michelet, Florence Julien-Marsollier, Christopher Brasher, Souhayl Dahmani. Determinants of Work-Related Quality of Life in French Anesthesiologists. Anesth Analg. 2021 Oct 1;133(4):863-872. PMID: 33543868
Editorial
Amy E Vinson. Home Is Where the Heart Is, but What About That Other Place You Spend Your Time? Anesth Analg. 2021 Oct 1;133(4):860-862. PMID: 34524985
In the July 21 PAAD, “Burn out among anesthesiologists; enough studies time for action”, we stated that “Institutions often turn a “blind eye” to dysfunctional workplace characteristics that may promote burnout and have negative employee consequences. Modifying individuals is much simpler than modifying the workplace. It would behoove institutions to spend less time holding wellness and resilience seminars and spend more time correcting the institutional causes of burnout”.
In today’s PAAD we review an original article by Gafsou et al. and an accompanying editorial by Amy (AKA David v Goliath) Vinson, that essentially confirm our previous PAAD conclusions, namely, “fixing the burnout problem” is not about “meditation, yoga, mindfulness, resilience training”, rather it should be about fixing our toxic work-place environments, or as Amy states in her editorial, “the culture of the workplace and the quality of management”. For those that still don’t understand that burnout is a patient safety issue (and climate change is real), poor work quality of life is associated with reduced staff engagement, increased turnover, and higher rates of medical errors. Indeed, Gafsou et al.’s article, which surveyed nearly 1/5th of the anesthesiologists in France, found that factors associated with increased quality of work life (WRQoL) included long-term employment, higher annual income, lower weekly workload, higher satisfaction with workplace ambiance, better quality of relations with the hospital management and colleagues, better OR organization, and more participation in organized team activities…. or, as Amy summarized, “what mattered the very most in how people perceived their work–life was their relationship with their boss and the feel of their workplace culture”. The point this article drives home is that in financially constrained times the single most important investment that can be made by a healthcare organization is in quality management. “People don’t quit their jobs—they quit their bosses”. Where I (RM) feel the real “bang for your buck is” in figuring out how to foster a culture of respect, appreciation, and connection.
Gafsou et al. studied another intriguing area: the effect of personality traits on perceived quality of work life. Extraversion, conscientiousness, and openness were associated with increased WRQoL, while neuroticism was associated with decreased WRQoL. While personality traits may not be modifiable (we all work with surgeons and passive aggressive perioperative personnel) I (RM) have always found it infuriating that the literature tells us that certain personality traits contribute to higher quality, more empathetic physicians, and as this study points out, perhaps more satisfied physicians. Yet, we don’t rigorously screen for personality traits or emotional intelligence in the medical school application process. Why are we still using the traditional yardstick of MCATs and GPAs when we know that highly empathetic, emotionally intelligent people will make the best physicians and better yet, future leaders in medicine?
Beyond the safety issues caused by the toxic culture of medicine there is another elephant in the room. Everyone reading this knows that we are at a critical junction in sustaining our work force. No one seems to be talking about this out loud, but at the recent ASA/SPA meetings everyone I (Myron) spoke to in private who are in leadership positions in anesthesiology and pediatric anesthesiology, were fixated on staffing issues and faculty shortages. The issue isn’t Covid, it’s our toxic work environment as I (Myron) learned only too well while I worked in Colorado. Rebecca and Norah are leaders of SPA’s well-being special interest group (now a committee…YAY!) and are working with many of you in demanding changes in our workspace. Remember culture eats strategy for breakfast— we must change the culture of medicine if for no other reason than the sustainability of the healthcare system. Please consider joining us on our SPA committee and participating in this work, or as the famous Hebrew scholar Hillel stated almost 2,000 years ago, "If I am not for myself, who will be for me”?
Rebecca Margolis DO, FAOCA , Norah Janosy MD, Myron Yaster MD