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Joseph Maroon, MD, FAANS, tells an interesting story that sets the scene for his journey from burnout to wellness in his book, Square One: A Simple Guide to a Balanced Life.

FLIPPING HAMBURGERS and working at gas stations are jobs some people might do during the summer months in high school, or maybe to make a living if they haven’t pursued a higher education. I, however, did both of these jobs at the age of 41, after I’d been a successful neurosurgeon for over a decade. Decidedly out of order on a résumé, right? But exactly one week after serving as the chief neurosurgeon in an operating room at a premier teaching hospital in Pittsburgh, I was filling up 18-wheelers and figuring out how to use the deep fryer at a truck stop in the small town of Wheeling, located in West Virginia’s northern panhandle.

The reader immediately wants to know how he got to the truck stop, what the circumstances were, and, most importantly, did he make it back to neurosurgery. Fortunately, he did; however, Dr. Maroon’s journey of highs and lows were made public long before his recent book. For the last several decades, he has regularly used his own example of an Icarus-like fall as a teaching lesson for both residents and staff. To this end, it was also the subject of his presidential address — From Icarus to Aequanimitas — to the Congress of Neurological Surgeons (CNS) in 1986.

The stresses Dr. Maroon experienced as a neurosurgeon, the toll on his personal life and the concurrent physical as well as mental decline are today recognized as burnout. At the time, however, burnout was only a taboo topic whispered in the halls of medical institutes. Dr. Maroon famously recounts his story of overcoming burnout after rediscovering a childhood book, I Dare You, by William H. Danforth. In the book, Danforth relates a balanced life to a square, with each of the four sides being labeled as family, physical, work and religious. In a balanced square, each side would have equal length indicating the same participation in each category. Dr. Maroon relates how his “square” was a flatline EKG with his life totally consumed by work.

Using Exercise to Overcome Burnout and Depression

During his recovery from burnout, Dr. Maroon reconnected with his inner athlete. As a former collegiate All-American running back, he used physical exercise to help rebuild both his body and brain to overcome the depression that ensued with his burnout. His passion for exercise ultimately led to him becoming an 8-time Ironman Champion.

With a background in playing football, and realizing his own benefits for mental health with routine exercise, he became an advocate for team sports and exercise.

Burnout to Wellness Programs

As a living example of professional burnout, Dr. Maroon has worked with numerous neurosurgical residency programs, including his program at the University of Pittsburgh Medical Center (UPMC), to advance the recognition and interventions needed to reduce burnout. Neurosurgery as a profession now speaks openly about burnout with the initiation of several wellness programs nationally,

At UPMC, Dr. Maroon, along with a group of senior faculty and residents, initiated a wellness program several years ago based, in part, on the concept of Danforth’s square. The following characterizes the UPMC Wellness Program goals:

  • Improve work/life balance;
  • Decrease psychological stress;
  • Increase social support through activities and mentorship; and
  • Improve general health and fitness by monitoring biomarkers of physical and psychological health.

A significant milestone for the program recently occurred with the dedication of the Maroon Fitness Center. The center is located within a dedicated room in the department with both aerobic and weight lifting equipment that can be accessed by both staff and residents 24-hours a day. Dr. Maroon continues to lecture on the subject of burnout prevention within UPMC and beyond. His leadership by example continues to be an inspiration for past, present and future generations of neurosurgeons.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following  and using the hashtag #PhysicianBurnout.

Nitin Agarwal, MD
Chief Resident

Pittsburgh, Pa.



Jeffrey Bost, PA-C
Clinical Instructor in the Department of Neurosurgery at University of Pittsburgh Medical Center
Clinical Assistant Professor at Chatham University
Pittsburgh, Pa.

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