The Impact of Work Hour Restrictions in Surgery

Surgery is a time demanding job and that is indeed one of the reasons cited by female and male medical students alike of why they are not interested in going into surgery. While many people argue that long work hours are necessary to avoid frequent handoffs of care and loss of information, others point out that long work hours are detrimental for both physical and mental health and can lead to additional errors.

A study speaking to this issue comes from the US, where Matthew Hutter and colleagues investigated the effects of mandated restrictions in the work hours of surgical residents. Notably, we are not talking about restrictions that would make their work hours “normal” by any regular-work-person standards. Their work was restricted to 80 hours a week. But even so, they found effects after the changes were implemented including decreased burnout and increased quality of life. However, participants also voiced concerns about reduced quality of care.

These issues are of course also important for part-time work, which seems to be an option that many women in surgery would like to opt for. So how can the same benefits be achieved while maintaining a high quality of care for patients?

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The Best Things About Being a Surgeon

Surgery is a challenging career, but it can also be incredibly rewarding. Here is what some women and men in surgery have to say about why it is so great to be surgeon:

“You’re changing lives. It is a real privilege. You get the opportunity to really engage with people at a really important point in their lives and to make a difference.”

“The smile on the patient’s face when you told them that you – well, not cured them of cancer – but that you had taken away that mass. I think you can’t do that in any other specialty other than surgery. You can’t fix something – of course there are medicines and drugs but they don’t give an instant fix. It’s so rewarding when you’ve done an operation and you’ve done it on your own. You’ve fixed that person. It’s brilliant. It’s a really good feeling.”

“I love how it’s different every day. You’re dealing not only with patients, I’m dealing with the parents as well as the children. It’s not a desk job. You’re working closely with physicians, the nursing staff in wards and theatres. What I love about it is that with surgery you have a direct effect on patients. Whatever you’re doing – you’re taking out that cancer, you’re repairing the hernia, you’re doing something with your own bare hands that helps that patient. … It’s fun, it’s practical. It’s intellectual and practical at the same time.”

“The best part of the job in my current specialty, which is orthopaedics, is that it’s such a team effort. Surgery in general is a team effort, especially in the operating room. It’s a flat system, there is no hierarchy. Anyone can make a call to say ‘oh, this is wrong’ or ‘you need to check this’, so it’s not a case of ‘the surgeon said it and that’s it’. … And also, there are a lot of people involved – Physiotherapists, nurses, occupational therapists – and it’s with the involvement of everyone, that team effort, that you achieve a save discharge for the patient.”

“It’s a wonderful live. It really is. It isn’t a job, it’s a life’s work – which is why I’m still doing it, even in retirement.”

Fitting In or Opting Out?

Although the situation for women in medicine has changed quite drastically in the last couple of decades – in fact, women are now the majority of undergraduate students at med schools – women remain largely under-represented in surgery. This is reflected in how we imagine the prototypical surgeon. If I asked your aunt, your next door neighbour and the person who sold you your coffee this morning to imagine a surgeon, their descriptions might all differ slightly, but more likely than not they would all describe a heterosexual, white, middle aged man. Moreover, descriptions of his character would probably include traits such as “macho”, “pompous” and “one track minded”. But what implication does that have?

Well, we examined just that with a sample of trainee surgeons. In a survey study we asked participants to rate how much they perceived traits such as the ones mentioned above to be true for the prototypical surgeon and for themselves. Moreover, we asked them how much they felt that they fit in with surgeons, how much they identified with their occupation and their desire to “opt out” and leave their profession. We found that those who perceived themselves as being quite different from the prototypical surgeon also felt like they did not fit in. This, in turn, was associated with lower identification with their occupation and higher turnover intentions. Not surprisingly, women generally rated themselves as less similar to the prototypical surgeon than men, but nevertheless this pattern emerged for all participants, indicating that lack of similarity to the prototypical representative of a field can be problematic for everybody and is not just a gender issue, but an issue of minorities in general.

For those who would like to read more on the topic:

Peters, K. O., Ryan, M. K., Haslam, S. A. & Fernandes, H. (2012). To belong or not to belong: Evidence that women’s occupational disidentification is promoted by lack of fit with masculine occupational prototypes.Journal of Personnel Psychology , 11(3), 148–158.