New England Surgical Society Members' Perspectives on Practice and Exiting from Surgery
Lucy Ruangvoravat1, Walter Longo1, Anne Larkin2, Kristine. Olson3
1Surgery, Yale School of Medicine, New Haven, CT; 2Surgery, University of Massachusetts Chan Medical School, Worcester, MA; 3Medicine, Yale School of Medicine, New Haven, CT
Objective: We sought first person data on how confident members of New England Surgical Society are with accepting changes in practice options and potential transitions away from operating as they advance toward late career. We aimed to compare this with confidence in practice setup and balance among surgeons who are early on in their careers.
Design: Anonymous survey distribution to NESS membership in 2021. Participants were asked to read statements regarding confidence in practice management, insight into their own ability to practice safely and quit operating appropriately (image 1). Their agreement with these statements was then graded on a Likert scale (1= strongly agree to 5= strongly disagree).
Participants: Overall Response rate: 16.7%, completion rate: 67%. Respondents: surgeons in multiple practice settings including academics, private practice, and military medicine and self-identified as early, mid, or late career. 6.5% were residents or fellows.
Main Outcome Measure: We anticipated that ability to manage practice demands and confidence in navigating the aging process or other transitions away from clinical practice would be highest in late career surgeons.
Results: Mean values in agreement or disagreement with each statement were compared between early, mid, and late career surgeons. Standard deviation between these values was also assessed. Early career surgeons were more diverse in both race and gender with 43% identifying as white and 57% as male, while Mid and late career surgeons were majority white (82% and 94%) and male (61% and 84%). Most late career surgeon stated they were over 60 years of age (82%) with the rest age 50-59. Confidence in ability to have control of workload and financial stakes decreased from early to late career. Confidence in insight into their own safe practice also decreased from early to late career. Agreement in ability to comfortably judge when to stop operating was highest among surgeons who identified as mid-career. Confidence in support structures for the aging surgeon also was highest among mid-career surgeons. Late career surgeons expressed the most disagreement with statements of confidence in support structures for aging and insight regarding when to stop operating.
Conclusions: The surgical community including regional and national societies can further study how to best address surgeon confidence in transitions through career stages. Dignified, organized pathways for transitioning away from operative practice or retiring fully from a career in surgery need to be created. Reliance on the surgeon to judge their own safe practice and devise their own timeline may lead surgeons to continue operating beyond their comfort and satisfaction, or beyond when they may be safe. External assessments may be helpful to enable graceful transitions in clinical practice.
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