Work–Life Balance for the Modern Neurosurgeon: Her/His Perspective

Physician work–life balance has gained significant attention in the last few years as the rates of burnout among physicians have increased. Burnout is defined as a state of mental and physical exhaustion caused by one’s professional life.1 It leads to exhaustion, cynicism, and adversely affected work productivity, patient outcomes, and interpersonal relationships. Although work–life balance applies to all professions, physicians find it especially hard to achieve, with almost half of U.S. surgeons being unsatisfied with their work–life dynamic.2 The decision to pursuemedicine as a career comeswith an inherent understanding that patients will always be a priority. The work–life imbalance begins during residency, where 60% of residents and fellows report experiencing significant work stress.2 Eventually, very few learn to cope and only one out of every five neurosurgeons can achieve a goodwork–life balance.Women physicians have higher rates of attrition as compared with men. This article aims to highlight the issue, increase self-awareness, and provide strategies to cope and have a better work–life relationship (►Table 1).


Introduction
Physician work-life balance has gained significant attention in the last few years as the rates of burnout among physicians have increased.Burnout is defined as a state of mental and physical exhaustion caused by one's professional life. 1 It leads to exhaustion, cynicism, and adversely affected work productivity, patient outcomes, and interpersonal relationships.Although work-life balance applies to all professions, physicians find it especially hard to achieve, with almost half of U.S. surgeons being unsatisfied with their work-life dynamic. 2 The decision to pursue medicine as a career comes with an inherent understanding that patients will always be a priority.The work-life imbalance begins during residency, where 60% of residents and fellows report experiencing significant work stress. 2Eventually, very few learn to cope and only one out of every five neurosurgeons can achieve a good work-life balance.Women physicians have higher rates of attrition as compared with men.This article aims to highlight the issue, increase self-awareness, and provide strategies to cope and have a better work-life relationship (►Table 1).

What Is Work-Life Balance
While there is no clear definition, work-life balance denotes a state of mind where an individual is content with the personal as well as the professional aspects of life.The balance gets skewed for both academic and nonacademic clinicians in different ways.The work-life balance is usually a challenge for institutional practitioners, with their academic and clinical responsibilities.Work gives us professional gratification along with financial stability, while time with family gives us joy.The struggle continues to increase as both personal and professional responsibilities grow in life.Burnout is more common in doctors with children and night calls. 3It causes personal unrest, higher divorce rates, attrition, work dissatisfaction, depression, and suicidal ideation.

The Barriers: Taking Stock
As doctors, we are never taught to formally disconnect from work.Residency trains young neurosurgeons to be tough and resilient.The hours are long and doctors are always expected to be available.Signing off as soon as the work is done is often misinterpreted by peers as a lack of dedication and professionalism.Neurosurgery has a long learning curve with higher case complexity, morbidity, and longer patient recovery times compared with other specialties. 3et we continually try to overcome these hurdles and strive for excellence.During the weekends too we are occupied, attending conferences, webinars, writing manuscripts, or editing videos.On the other hand, devoting more time to family means cutting down work time, which translates into lesser income and financial instability.Thus, keeping these scales steady is not ever easy.Exhausted surgeons have poor clinical judgment and higher rates of medical errors, and thus begin a vicious cycle. 4Professional unhappiness spills over in personal life, creating unrest and ruining other aspects of life, which in return creates hostility toward the work environment, reducing productivity.Breaking this cycle is vital.Studies have "Never get so busy making a living that you forget to make a life."-Dolly Parton, singer DOI https://doi.org/10.1055/s-0043-57250.ISSN 0973-0508.
shown that neurosurgeons in private practice had higher financial gains but equally higher rates of dissatisfaction and unhappiness as compared with those in academic institutions (62.9 vs 47.7%). 5

Perspectives of Women in Neurosurgery
Emotional and physical adaptations to fit into and stay in the stereotypical "surgeon" role may lead to exhaustion and burnout in women surgeons as the author (A.P.) has herself felt.Women may often find it difficult to command respect at work compared with their male counterparts and have to strive harder to prove themselves. 6Women also have more domestic responsibilities than men, the most vital one being child care.These gender-specific obstacles can make women feel isolated at work.Probably, with increasing numbers of female colleagues or mentors, women can develop a strong support system at work and maintain a good work-life balance. 7Women who have a strong support system at home with help from family members have lower stress levels.They can devote more time to work and achieve better academic success.Those who are not able to get that support go on to choose easier career paths after competitive residencies to avoid being overstretched.Some take on academic roles, which allow them flexibility in work hours, while others may even consider changing specialties to have a smooth work-life dynamic. 6,7anning Ahead and Time Management Time management skills should be a doctor's best friend.Start by observing your routine, and maintain a planner.Highlight the hours spent at work and those for personal needs.This will help identify the weak spots.Prioritize all important personal and professional commitments and note them in the planner way ahead of time.
Plan for the unplanned!Have specified surgical days and expect them to go longer.Plan family time and combine them with lighter workdays.Set dedicated family routines such as dinner together every day, each Saturday spent with the parents or spouse and kids, vacation time out each year.Once these personal goals are set well ahead of time, they can be adjusted with our busy schedules more efficiently.Life is not perfect and there will be some bad days but continue to focus on the bigger picture and things will fall in place.
Last but not the least, it is important to have some time for self-care and to destress.Once away from work, declutter the mind and disconnect mentally.Engage in leisure activities; inculcate a hobby.Exercise is the best stress buster.Other activities such as listening to music, catching up with friends, and taking a vacation also help.Some use meditation to reduce stress.In extreme cases of burnout, these simple measures may not be enough.It is then vital to recognize this and immediately seek professional help. 5

Organizations' Role
The workplace can either make or break you.The organization and the leader play a pivotal role in work-life balance.The importance of including techniques of time and stress management early on as a part of formal medical education cannot be stressed upon more.Following widespread awareness over burnout in 2003, the ACGME (Accreditation Council for Graduate Medical Education) changed its guidelines and streamlined resident work hours, which showed improvement in resident quality of life. 8Happy doctors have better patient outcomes with fewer errors in judgment. 9

Commentary
Organizations also need to increase awareness and highlight the concept of a good work-life balance.They must conduct regular wellness programs for employees and have dedicated human resources personnel allocated for assessing the work conditions.Peers must look out for one another.A buddy system at work can do wonders.Although women are more vulnerable to burnout, they are also more likely to look out for one another and seek professional help when needed. 10 Other useful strategies are monitoring total work hours, timely counselling sessions to assess levels of stress, on-campus facilities for employees for recreation such as a gymnasium or a sports complex, and day-care centers for children.
As a leader, know your team well and create a positive work atmosphere for them.Have open discussions and exchange ideas for constant improvements to create a better workplace.

Self-care Is Not a Luxury, It is Necessary
Too often amidst the constant noise of magnetic resonance imaging (MRIs), serum electrolytes, Glasgow Coma Scale (GCS), and deficits, the concept of "self" is lost.Try to find at least 20 minutes of uninterrupted "me time."Even the most successful hedge fund managers working 18-hour days have been known to schedule meditation sessions or a "centering" activity where they are alone and quiet for 20 to 30 minutes each day.This "me time" benefits your health, mental clarity, relationships, and level of happiness.
Proper diet and exercise are critical, especially in professions that are mentally draining.Commit to eating foods that will boost your energy level and keep your system running smoothly.What you eat not only can impact your short-and long-term health but also can affect your stress levels.Exercise and physical activity are great ways to feel better, gain health benefits, and have fun.As a general goal, aim for at least 30 minutes of physical activity every day.

Family Time: Quality of Life
Our families contribute most to our sense of well-being, which translates to better work ethics.It usually takes a few minutes after returning home to refocus on what is going on at home.Always try and leave hospital conversations out of the menu and make time to "de-brief" the kids and ask each one in turn about their day, their classes, and their exams and get involved with their school projects.Involvement in your children's lives is a quality metric that you should often check.Every week, ask yourself if you have given each member of your family enough time.If not, try to schedule an hour or even a few minutes of alone time with that child.Invite friends and families to join and build memories that you would want your kids to have forever.Measuring the quality of your relationship with your significant other is also something you should do regularly.
Be a team always.Provide and value your spouse's patience and temperament: a trait that neurosurgeons often lack.

Conclusion
Burnout has been a silent pandemic among clinicians, often considered as an edge of a cliff in the dark.Work-life balance, though difficult, is not unscalable.Its importance lies in having happy doctors who eventually provide better patient care.The key is a multifaceted approach with selfawareness, time management, teamwork, and support from the organization.We need targeted interventions at different stages of one's career to manage work-life balance.The approach would be different for a trainee resident and a practicing consultant.Create a clear distinction and do not carry work back home.The three pillars for mental wellbeing are personal, professional, and social aspects of our lives.Devoting time to each will create a better work-life dynamic.

Table 1
Strategies for establishing a work-life balance for early career neurosurgeons Integrate the four domains of life: work, home, community, self • Assess your time distribution and areas where too much time is being devoted Time management• Make a framework and be prepared to trade off some aspects • Make room for yourself outside of neurosurgery • Always ask yourself the reason for taking on new work and the risk-reward involved Indian Journal of Neurotrauma © 2023.The Author(s).