Your life’s work should be fun. If it’s nothing more than a job, it’s time to find your passion.

That was the message from SSAT President Nathaniel J. Soper, MD, who recounted his professional journey Sunday morning at DDW® during the annual SSAT Presidential Address.

Nathaniel J. Soper, MD

“I feel a great passion for what I do,” said Dr. Soper, the Loyal and Edith professor and chair of surgery at Northwestern University, Chicago, IL. “Surveys tell us that more than half of surgeons feel the symptoms of burnout. We can wrestle ourselves and our colleagues out of the quagmire of burnout through passion.”

Passion wasn’t on the curriculum during Dr. Soper’s surgical residency at the University of Utah Medical Center in the 1980s. But it was a quality that he saw in his early mentors.

“I had no idea of what kind of surgery I wanted to do, but I caught the bug to be a research surgeon,” he recalled. “What surprised me, what captured me, was the boundless passion that my mentors had for GI surgery.”

Surgery in the 1980s was in the doldrums, Dr. Soper explained. What were called minimal-access techniques at the time — including non-resective gallstone treatments such as dissolution and shockwave lithotripsy, endoscopic therapy for GI bleeding, endoscopic polypectomy, biliary stenting, endoscopic sclerotherapy, angioplasty, and percutaneous gastrostomy tubes — were slowly replacing traditional surgical procedures. Thirty years later, GI surgery accounts for more than half of general surgery practice.

An informal survey of leading surgical directors identified five major advances that have transformed surgery from backwater to cutting edge: improvements in imaging and interventional radiology, the development of quality metrics and quality improvement techniques, subspecialization, improvements in flexible endoscopy, and the rapid advance of laparoscopy and minimally invasive surgery.

“The most salient advance has been the laparoscopic revolution,” Dr. Soper said. “The adoption of minimally invasive surgical techniques continues to lead to smaller and smaller incisions, which result in less post-operative pain for patients, faster recovery and improved outcomes. The holy grail is to perform procedures completely noninvasively.”
Laparoscopic equipment continues to improve. Early procedures were conducted using tiny TV screens at the end of a tube. Today’s procedures are displayed in magnified detail on high-definition screens using ever more sophisticated tools inserted through smaller ports and natural orifices.

But even as the tools and techniques of surgery become more refined, more precise and less invasive, the nonmedical burdens of surgery have grown. The required use of tools such as electronic medical records has depersonalized the practice of medicine, Dr. Soper said, as surgeons and other practitioners spend more time documenting patient encounters than they spend talking with patients.

These administrative tasks demanded by insurers and others can lead to emotional exhaustion, Dr. Soper said. Meanwhile, the hamster wheel of relative value units-based medical practice reduces the sense of personal accomplishment.

“These three factors — depersonalization, emotional exhaustion and reduced personal accomplishment — were first identified as contributing to burnout in 1974,” Dr. Soper said. “Given the current state of medicine and medical practice, it’s easy to see why half of surgeons suffer from burnout.”

Burnout may be common, but it is not inevitable, he added.

Burnout is a function of both environment stress and how the individual reacts to the stress. Academic and institutional leaders have an obligation to tip the field in favor of the practitioner by mitigating stressors that can contribute to burnout, Dr. Soper said. Surgical leaders also have a personal obligation to act as role models to actively counter burnout.

“Share your passion with those around you at every opportunity,” he advised. “We know that 20 percent of surgical residents leave the field. Passion can make the difference. We can all be positive role models to demonstrate the joy and the passion that we feel and practice every day. We can’t teach trainees to have passion, but we can model it every day. Our grit and our passion are our antidotes to burnout.”