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Work-Life Balance

Myths and Truths: A Medical Student Perspective of Neurosurgery

By Career, Women in Neurosurgery, Work-Life BalanceNo Comments

Janine S. Hsu, MD

Diana Ghinda, MD, PhD

Neurosurgery is undeniably one of the most intriguing, challenging and rewarding specialties. It is also considered one of the most competitive specialties — as a result, many medical students self-exclude from neurosurgery based on preconceived notions of the field. This is especially true of female trainees, who see in neurosurgery a specialty dominated numerically by men. However, at the University of Ottawa, the Neurosurgery Medical Student Chapter is working to change these existing biases about the specialty. In terms of gender-based interest in neurosurgery, a third of the members of the neurosurgery interest group are female. In 2020, out of the 91 aforementioned students seeking surgical mentorship, four out of 13 who listed neurosurgery as their top choice were female. All of the club executives are female, as is our staff sponsor, Eve Tsai, MD PhD, FAANS, as well as our resident mentors, Diana Ghinda, MD, PhD, and Janine S. Hsu, MD. Having an all female organizing committee was not intentional. Perhaps some subconscious part of us gravitated towards seeking female mentors — a testament to the need for representation. Dr. Tsai, the only female staff neurosurgeon at the University of Ottawa, has provided us with this representation and serves as unspoken encouragement for other women to pursue a traditionally male dominated field such as neurosurgery.

Her leadership and mentorship have dispelled some of the most common myths we held about the specialty, as well as brought to light some of the important realities of being a female neurosurgeon.

Myths about neurosurgery

Adam Sachs, MD, MA

Myth #1: Having a family is difficult, especially as a female neurosurgeon

“It’s possible; you can have a family, that shouldn’t stop you. Dr. Tsai [female neurosurgeon] has done it, as have many others” according to Adam Sachs, MD, MA. The AANS Neurosurgeon has published articles on this topic, including The Challenges of Starting a Family During Neurosurgical Residency Training and Women in Neurosurgery: Walking the Balance Beam of Life.

 Myth #2: Your whole life must be about neurosurgery

Safraz Mohammed, MBBS, FRCSC

Many neurosurgeons have interests outside of their work that they are able to pursue: advocacy, sports and artistic endeavours. Read the six-article series Hustle, Think, Work, Play: Sports & Neurosurgery published in the AANS Neurosurgeon.

Myth #3: Poor patient outcomes

 “A lot of neurosurgical patients go on to live regular, normal lives, or even better lives than before. Patients often think that when they are referred to see a neurosurgeon that their prognosis is going to be grim, but this isn’t always the case. There is so much you can do as a neurosurgeon to help restore a patient’s quality of life” according to Safraz Mohammed, MBBS, FRCSC. A recent report from the Great Ormond Street Hospital for Children suggests that adverse events are a minority in neurosurgery.

Myth #4: I’ll be operating for hours on end on one case

One of the benefits of a career in neurosurgery is the variety of procedures one can perform. These procedures all vary in length and you can tailor your practice accordingly. Many neurosurgical procedures can be lengthy, but as the surgeon you are engrossed in the task at hand and time will fly.

Truths about neurosurgery

Truth #1: The hours are long, but it gets better

Residency is grueling and the hours are long. Neurosurgery is one of the busiest services at a hospital and thus requires a large time commitment. As you progress in your career, you gain the ability to tailor your schedule to your liking. You will always be busy, but there are ways to adapt and adjust.

Truth #2: You won’t be a trainee forever, but it will take time

Neurosurgery has one of the longest residency programs and many often go on to pursue fellowships. The length of the training required prepares you to be confident as a staff surgeon on call when confronted with a challenging case in the middle of the night.

Truth #3: Neurosurgery requires relentless dedication

Neurosurgery is demanding, like any specialty, and it requires continuous training, responding to urgent cases and dedication.

Truth #4: It is a physically, mentally and emotionally demanding career

It is true, but that’s why residency is a training program. You are trained to become a competent surgeon, which includes developing physical, mental and emotional resiliency.

Our mentors have helped us to better understand the myths and truths of a career in neurosurgery. The keys to dispelling myths are early exposure to neurosurgery, more hands-on opportunities in the form of workshops and demonstrations, mentorship programs pairing students with residents, fellows and staff and increased representation for women. For those who think that a career in neurosurgery is unattainable, there are ways to steer yourself toward the path — find a mentor and find out how they did it. Seek feedback from your mentor on how you can improve yourself as an applicant and person. Seek guidance from as many people in the field as you can. Spend time in the division learning about the specialty, finding out the myths and truths yourself. Get involved in research or service projects related to neurosurgery and the neurosciences. This AANS Medical Student Chapter at the University of Ottawa has been working in collaboration with the Division of Neurosurgery to offer as much early exposure as possible and hope to stimulate more interest in neurosurgery!

Editor’s note: We hope that you will share what you learn from our posts. September is Women in Medicine Month, which honors physicians who have offered their time and support to advance women with careers in medicine. We invite you to join the conversation on Twitter by following @Neurosurgery and @WINSNeurosurge1 and using the hashtag #WIMmonth.

Eve Tsai, MD, PhD, FAANS
Ottawa Hospital Research Institute
University of Ottawa
The Ottawa Hospital
Ottawa, Canada


Alexandra Beaudry-Richard, MD-PhD Candidate
University of Ottawa
Ottawa, Canada



Anahita Malvea, MD
University of Ottawa
Ottawa, Canada



The Time Has Come to Bring Physician Wellness to the Forefront of Our Profession

By Burnout, Health, Work-Life BalanceNo Comments

I chose to be a neurosurgeon because I sought a life bringing healing to those with neurological diseases. After completing my training with a tremendous sense of pride, I was prepared to have an impact on patients and families in their time of greatest need and hopelessness. I ended each day with the knowledge that I had given my all. Like many others, I ignored fatigue and underestimated the accumulated trauma of occasions where I gave all I had, but the patient’s disease won. My blessings were my family, my resolve and my mission.

Eleven years ago, in an unanticipated instant, my resolve was gone and replaced by fear, hopelessness, and a sense of inadequacy. I lacked the skills to process emotions I had never acknowledged. I could not turn for support to loved ones lest I lose their respect. I was trapped. I was one of the grim statistics — a burned out and depressed physician. The administrative, clinical and personal stressors had whittled away my physical and mental reserves.

Every year almost 400 physicians die by suicide. Simply reading that sentence should be enough to give anyone who has dedicated their lives to helping and saving others cause for concern.

Two recent articles on burnout of U.S. neurosurgeons and neurosurgical residents found the burnout rate was 56.7% for neurosurgeons and 67% for residents. However, paradoxically 81.2% of neurosurgeons and 81% of residents say they are satisfied with their careers. Some of the factors associated with burnout for neurosurgeons included anxiety over future earnings and the ability to achieve work-life balance outside the hospital. For residents, the key factors were hostile faculty and social stressors outside work, such as debt.

Our work in neurosurgery involves the brain health of our patients, and integral to maintaining their brain health is taking care of ourselves while sustaining a work-life balance. A lot has changed in neurosurgical training and technology in recent decades. Now is the time to challenge the status quo. We need to raise awareness about physician wellness and remove the stigma and the tendency to keep physician burnout a secret. Burnout can lead to anxiety, depression, suicidal thoughts, marital and family stress, anger issues, addiction and substance abuse — any of which can lead to dissatisfaction and, ultimately, physicians ending their marriages, their careers and their lives.

Consider the following statistics:

  • Physicians are twice as likely to be dissatisfied with their work-life balance than the average working adult;
  • In 2015, almost 50% of physicians reported they were burned out;
  • Medical students’ rate of depression is 15 to 30% higher than that of the general public;
  • Physicians are more than twice as likely to take their own lives than the general population; and
  • Female physicians are 2.5 to 4 times as likely to die by suicide than women in other occupations.

We can, and should, do better. If we recognize and reduce the stressors that lead to burnout, we can create a supportive environment for physicians that fosters our own physical and mental well-being. This will allow us to provide the best quality care for our patients.

I know recovery is possible. I recovered through ultra-running, friendships, and other coping strategies. Acknowledging insecurities is vital, but it’s how we deal with them that is key. We should show compassion and kindness to ourselves and the members of the teams we lead.

My efforts over the past four years have been to help colleagues focus on wellness strategies and overcoming burnout. I have shared my story countless times with colleagues, medical students and staff. I do this to destigmatize burnout and let those facing pain in silence know they are not alone. I have also taken the empathy resultant from my pain and turned it into a career focused on healing for the vulnerable. In June 2018, I was recruited by Michigan State University (MSU) to help develop a safer and healthier campus following the trial and sentencing of former U.S. gymnastics and sports medicine physician, Larry G. Nassar, D.O., who went to prison for criminal acts of sexual assault. I help to develop strategic initiatives and programs to increase efficiency, safety, compliance and quality practices across all MSU’s health care services to ensure best practices and exemplary care in a learning and healing environment.

We also formed a wellness and patient experience committee. We developed a faculty peer support program to foster an environment that promotes healthy work-life balance, the continued physical and emotional development of our colleagues, role-modeling of professional and healthy behaviors, and compassionate recognition of unhealthy behaviors. Under the leadership of Claudia Finkelstein, MD, our peer support program offers a safe way for physicians impacted by adverse events, medical errors, litigation or other workplace stressors to talk about their experience and emotions with someone who has empathy from having “been there.” The goal is to ensure all physicians understand stress management and burnout prevention, and to make resources available to help.

We must all listen, learn and heal with each other to achieve a healthier, more peaceful and purposeful life with optimum performance in body, mind and spirit. We must remember we are never alone. And we must find hope even in the darkest moments for the lessons learned can give us insights on how to bring light to others.

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 @Neurosurgery and using the hashtag #PhysicianBurnout.

Anthony M. Avellino, MD, MBA
Michigan State University
East Lansing, Mich.

Our Health Care Workers Are Struggling — That’s Why I Introduced Legislation to Help

By Burnout, Health, Work-Life BalanceNo Comments

As the husband of a physician, I like to say that issues affecting health care workers aren’t just dinner tables issues — they’re breakfast, lunch and dinner table issues. This has never been truer than it is during the current coronavirus crisis.

When the greater Chicago area was overrun with COVID-19 patients this past spring, my wife, an anesthesiologist, was among those on the front lines placing intensive care unit (ICU) patients on ventilators. She did so while wearing a welder’s mask that she purchased from a hardware store because there was simply not enough personal protective equipment (PPE) to go around. Our children and I could not have been prouder of her bravery, but we worried about her constant exposure to the virus and the pressures of being a frontline health care worker during a pandemic.

Although case numbers have come down in our area, the virus is far from quashed, and any amount of progress feels fragile. For many who served in hot spots like New York City in the early days of the pandemic — and those in areas currently experiencing surges, like Miami and Houston — navigating the emotional toll of being on the front lines has proven to be among the pandemic’s greatest challenges.

As with so many other areas of policy, the COVID-19 crisis has forced us to confront the ways we have failed as a nation to look out for the well-being of our health care workforce. Too many have struggled in silence for decades; now, they have been called to respond to a once-in-a-century public health crisis without an emotional safety net. It is for these reasons that I introduced the bipartisan Coronavirus Health Care Worker Wellness Act (H.R. 7255), along with my colleagues Reps. John Katko (R-N.Y.) and Frederica Wilson (D-Fla.). This legislation seeks to accomplish two goals:

  • First, the bill will authorize U.S. Department of Health and Human Services (HHS) to distribute grant funding to health care providers who wish to establish or expand programs dedicated to promoting the mental wellness of their workers on the front lines of COVID-19; and
  • Second, the bill will authorize a comprehensive, multi-year study on the issue of health care worker mental health and burnout, including an assessment of underlying factors, barriers to seeking and accessing treatment, implications for the health care system and patient outcomes, and the impact of the COVID-19 crisis.

Studies and events of the past several months have confirmed that many health care workers are indeed struggling with their mental health as a direct result of COVID-19. Consider the following:

  • Health care workers have witnessed death on an unprecedented scale, and social distancing orders have put them in the agonizing position of denying families access to their loved ones and notifying them of deaths over the phone;
  • With morgues overflowing, some hospitals have parked refrigerated trucks outside to store additional bodies;
  • Critical shortages of PPE in the spring forced health care workers to re-use equipment or go without it, and there is a fear that shortages could return if cases spike again this fall;
  • Over 135,000 health care workers have been infected with COVID-19 to date, and more than 600 have died;
  • Data from China — a country that experienced an acute outbreak much like our own in March and April — put startling figures on reported rates of depression (50.4%), anxiety (44.6%) and insomnia (34.0%) among frontline workers;
  • Another study conducted between March and May found that the average U.S. health care worker — not just those on the front lines — reported enough depressive symptoms to be considered clinically depressed;
  • Rates of post-traumatic stress disorder (PTSD) among frontline workers are expected to rival those among first responders to the 9/11 terrorist attacks; and
  • Lorna M. Breen, MD — an emergency room physician in New York City who contracted COVID-19 herself — tragically believed she had no choice but to take her own life amid the devastation.

As dire as the current situation is, the unfortunate truth is that burnout and mental health challenges were common among health care professionals long before the world had ever heard of SARS-CoV-2 — something that likely comes as no surprise to members of the neurosurgery community.

COVID-19 will, unfortunately, be with us for an extended period. Frontline workers needed our support back in March — not just with our words, but with Congressional action — and we failed to provide it. We simply cannot overlook this situation any longer, nor can we continue to ignore the importance of the long-term job satisfaction of our nation’s health care workforce. We must pass the Coronavirus Health Care Worker Wellness Act as soon as possible.

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 @Neurosurgery and using the hashtag #PhysicianBurnout.

U.S. Congressman Raja Krishnamoorthi (IL-8)

Burnout to Wellness: Dr. Joseph Maroon’s Journey to a Balanced Life

By Burnout, Health, Work-Life BalanceNo Comments

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 @Neurosurgery and using the hashtag #PhysicianBurnout.

Nitin Agarwal, MD
Chief Resident
University of Pittsburgh Department of Neurological Surgery
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.

Physician Burnout in Neurosurgery: An Under-Recognized Phenomenon

By Burnout, Health, Work-Life BalanceNo Comments

As conversations about work-life balance are becoming more prevalent, and given the stresses associated with the COVID-19 pandemic, there has been a renewed interest in the issue of physician burnout. Burnout is a long-term stress reaction marked by emotional exhaustion, depersonalization and a lack of sense of personal accomplishment. In recent years, the rising prevalence of burnout among clinicians — more than 50 percent according to a Medscape report — has led to probing questions on how it affects access to care, patient safety and care quality. Burned-out physicians are more likely to leave their practices or the practice of medicine altogether, which reduces patients’ access to and continuity of care. Burnout can also threaten patient safety and care quality when depersonalization leads to poor interactions with patients, and when burned-out physicians suffer from impaired attention, memory and executive function.

In addition to the impact of burnout on physicians and patients, according to a recent study published in the Annals of Internal Medicine, the health care system loses more than $4.8 billion a year due to this phenomenon. Although neurosurgeons work long hours, balance outpatient and inpatient practices, and deal with life and death issues, we have paid limited attention to burnout in this field.

For the next few weeks, Neurosurgery Blog will highlight the issue of burnout — including in the field of neurosurgery. Here are some staggering facts about burnout in neurosurgery:

  • A recent survey of 783 neurosurgeons found the rate of burnout to be 62.9 percent among nonacademic neurosurgeons and 47.7 percent for academic neurosurgeons;
  • Poor work-life balance, health care reform and financial uncertainty were the major factors contributing to career dissatisfaction; and
  • Burnout and depression — sometimes associated with emotional exhaustion — were a significant predictor of preventable major medical errors in a study using data from 7,905 members of the American College of Surgeons.

Among neurosurgeons, many factors were found to lower the chances of burnout. High volume surgeons, with stable families, who are intellectually challenged, with leadership roles and a good work-life balance, are more effectively shielded against burnout.

Understanding burnout will push more health care organizations to adopt strategies to protect their members from this phenomenon. Physician engagement will undoubtedly be crucial to the prevention of burnout. We must take the lead by being active and vocal for ourselves, our colleagues and our patients and fight against the forces that erode our mental health and the quality of our work.

Join us in an insightful journey, understanding burnout as it pertains to the field of neurosurgery. We aim to identify the reasons behind this phenomenon and the best strategies to prevent it or minimize its impact on the careers 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 @Neurosurgery and using the hashtag #PhysicianBurnout.

Kimon Bekelis, MD
Vice-chair, AANS/CNS Communications and Public Relations Committee
Catholic Health Services of Long Island
West Islip, N.Y. 



Kristopher T. Kimmell, MD, FAANS
Vice-chair, AANS/CNS Communications and Public Relations Committee
Rochester Regional Health
Rochester, N.Y. 



Clemens M. Schirmer, MD, PhD, FAANS, FAHA
Chair, AANS/CNS Communications and Public Relations Committee
Wilkes Barre, Pa.