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Trends in Attrition Rates for Surgical Faculty
LETTERS
REFERENCES
Trends in Attrition Rates for Surgical Faculty Charles M Ferguson, LaGrange, GA
1. Satiani B, Williams TE, Brod H, et al. A review of trends in attrition rates for surgical faculty: a case for a sustainable retention strategy to cope with demographic and economic realities. J Am Coll Surg 2013;216:944e953. 2. Shanafel T, Sloan J, Satele D. Why do surgeons consider leaving practice? J Am Coll Surg 2011:420e421. 3. Maslach C, Leiter MP. The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It. San Francisco: Jossey-Bass Publishers; 1997. 4. Freischlag JA. Invited commentary. J Am Coll Surg 2013;216: 953e954.
MD, FACS
I write to congratulate the authors of “A review of trends in attrition rates for surgical faculty: a case for a sustainable retention strategy to cope with demographic and economic realities,”1 which appeared in the May issue, and to emphasize the role of burnout in attrition and to make the authors and others aware of methods of dealing with burnout. Satiani and colleagues1 rightly point out that 40% of surgeons experience symptoms of burnout and 25% consider leaving their current practice within 2 years for reasons other than retirement.2 Unfortunately, most studies of physician burnout recommend preventative and treatment strategies aimed at the burned out individual, such as taking a vacation, exercise, regaining passion for medicine, and exercise, none of which addresses the causes of burnout so carefully elucidated by Maslach in her 1997 book, The Truth About BurnoutdHow Organizations Cause Personal Stress and What to Do About It.3 Although Satiani and colleagues1 and the accompanying excellent Invited Commentary by Freischlag4 allude to methods to prevent and treat burnout, I believe it is worth reviewing the principles set forth in Maslach’s book:
Disclosure Information: Nothing to disclose.
Pancreatic Duct Ligation: An Idea Revisited Harry S Goldsmith, Glenbrook, NV
I read with interest the article by Soejima and his associates in the March 2013 issue of the Journal of the American College of Surgeons about ligation of the main pancreatic duct during a distal pancreatectomy.1 This article brought to mind one that I wrote on pancreatic duct ligation for Surgery, Gynecology, and Obstetrics more than 40 years ago, entitled “Ligation Versus Implantation of the Pancreatic Duct after Pancreaticoduodenectomy.”2 In 1935, Drs Whipple, Parsons, and Mullins performed the first pancreatic resection, but the operation was done as a 2-stage procedure.3 The 1-stage pancreatic resection of today was first done by Dr Alexander Brunschwig 2 years later in 1937.4 Few realize that what we call the Whipple operation is really the Brunschwig procedure. Dr Brunschwig’s interest in the pancreas began when he was a resident in pathology and with the early death of his father from pancreatic cancer. His work on pancreatic resection was reported in 1942 in his book entitled The Surgery of Pancreatic Tumors.5 However, his work was completely ignored and even up to the 1970s was not cited in American surgical textbooks. It was first remembered in the classic encyclopedic 2-volume work edited by the British surgeon, Rodney Maingot, in his 1974 edition:6
1) Set reasonable work expectations. 2) Give workers control. 3) Reward and recognize in a way that is meaningful for the individual. 4) Build community in the workplace. 5) Build fairness in the workplace. A workplace is perceived to be fair when 3 key elements are present: trust, openness, and respect. 6) Develop, communicate, and live organizational values. Based on personal experience and innumerable discussions with other faculty members who have left academic practice, I believe burnout is the number 1 factor in faculty attrition, and I would recommend that every department chairman and division chief study Maslach’s book and put these principles into practice, not just for the economic benefits, but more importantly, for the educational benefits of faculty retention.
ª 2013 by the American College of Surgeons Published by Elsevier Inc.
MD, FACS
Brunschwig A. (Surg Gynecol Obstet 65:681, 1937; The Surgery of Pancreatic Tumours, 1942)
560
ISSN 1072-7515/13/$36.00 http://dx.doi.org/10.1016/j.jamcollsurg.2013.05.022
REFERENCES
Trends in Attrition Rates for Surgical Faculty Charles M Ferguson, LaGrange, GA
1. Satiani B, Williams TE, Brod H, et al. A review of trends in attrition rates for surgical faculty: a case for a sustainable retention strategy to cope with demographic and economic realities. J Am Coll Surg 2013;216:944e953. 2. Shanafel T, Sloan J, Satele D. Why do surgeons consider leaving practice? J Am Coll Surg 2011:420e421. 3. Maslach C, Leiter MP. The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It. San Francisco: Jossey-Bass Publishers; 1997. 4. Freischlag JA. Invited commentary. J Am Coll Surg 2013;216: 953e954.
MD, FACS
I write to congratulate the authors of “A review of trends in attrition rates for surgical faculty: a case for a sustainable retention strategy to cope with demographic and economic realities,”1 which appeared in the May issue, and to emphasize the role of burnout in attrition and to make the authors and others aware of methods of dealing with burnout. Satiani and colleagues1 rightly point out that 40% of surgeons experience symptoms of burnout and 25% consider leaving their current practice within 2 years for reasons other than retirement.2 Unfortunately, most studies of physician burnout recommend preventative and treatment strategies aimed at the burned out individual, such as taking a vacation, exercise, regaining passion for medicine, and exercise, none of which addresses the causes of burnout so carefully elucidated by Maslach in her 1997 book, The Truth About BurnoutdHow Organizations Cause Personal Stress and What to Do About It.3 Although Satiani and colleagues1 and the accompanying excellent Invited Commentary by Freischlag4 allude to methods to prevent and treat burnout, I believe it is worth reviewing the principles set forth in Maslach’s book:
Disclosure Information: Nothing to disclose.
Pancreatic Duct Ligation: An Idea Revisited Harry S Goldsmith, Glenbrook, NV
I read with interest the article by Soejima and his associates in the March 2013 issue of the Journal of the American College of Surgeons about ligation of the main pancreatic duct during a distal pancreatectomy.1 This article brought to mind one that I wrote on pancreatic duct ligation for Surgery, Gynecology, and Obstetrics more than 40 years ago, entitled “Ligation Versus Implantation of the Pancreatic Duct after Pancreaticoduodenectomy.”2 In 1935, Drs Whipple, Parsons, and Mullins performed the first pancreatic resection, but the operation was done as a 2-stage procedure.3 The 1-stage pancreatic resection of today was first done by Dr Alexander Brunschwig 2 years later in 1937.4 Few realize that what we call the Whipple operation is really the Brunschwig procedure. Dr Brunschwig’s interest in the pancreas began when he was a resident in pathology and with the early death of his father from pancreatic cancer. His work on pancreatic resection was reported in 1942 in his book entitled The Surgery of Pancreatic Tumors.5 However, his work was completely ignored and even up to the 1970s was not cited in American surgical textbooks. It was first remembered in the classic encyclopedic 2-volume work edited by the British surgeon, Rodney Maingot, in his 1974 edition:6
1) Set reasonable work expectations. 2) Give workers control. 3) Reward and recognize in a way that is meaningful for the individual. 4) Build community in the workplace. 5) Build fairness in the workplace. A workplace is perceived to be fair when 3 key elements are present: trust, openness, and respect. 6) Develop, communicate, and live organizational values. Based on personal experience and innumerable discussions with other faculty members who have left academic practice, I believe burnout is the number 1 factor in faculty attrition, and I would recommend that every department chairman and division chief study Maslach’s book and put these principles into practice, not just for the economic benefits, but more importantly, for the educational benefits of faculty retention.
ª 2013 by the American College of Surgeons Published by Elsevier Inc.
MD, FACS
Brunschwig A. (Surg Gynecol Obstet 65:681, 1937; The Surgery of Pancreatic Tumours, 1942)
560
ISSN 1072-7515/13/$36.00 http://dx.doi.org/10.1016/j.jamcollsurg.2013.05.022