Elsevier

Journal of Surgical Education

Volume 71, Issue 1, January–February 2014, Pages 21-31
Journal of Surgical Education

INNOVATIONS
“Back in the Day”… What are Surgeon Bloggers Saying About Their Careers?

https://doi.org/10.1016/j.jsurg.2013.04.005Get rights and content

Objectives

The projected shortage of general surgeons is owing to an increased demand for surgical services and a declining pool of practicing general surgeons. Burnout and attrition of residents from surgical residencies contribute to the latter. Attrition may be caused by the choice of a career in surgery without an understanding of the realities; subsequent recognition of the realities may cause residents to reexamine the opportunity costs of a career in the field. Because weblogs (blogs) are often used for reflection, qualitative analysis of the content of blogs authored by general surgeons may provide insight into the positive and negative realities of a surgical career. These insights may be informative to students as they consider a surgical career, may better prepare residents for the reality of what is to come, and identify targets for improving the culture of surgery and mitigating sources of career dissatisfaction.

Design

This is a qualitative analysis of entries on blogs authored by practicing general surgeons. A systematic approach was used to identify a sample of blog posts. These posts were analyzed using a constant comparative analysis method associated with constructivist grounded theory.

Results

Thirty-five posts drawn from 9 blogs were analyzed. Five main themes were identified in the reviewed blogs. Overall, 104 comments were positive in tone, 74 were neutral, and 147 were negative. There were 96 comments that focused on the rewards of being a surgeon, 88 concerning the practice environment, 57 about the educational environment, 54 about the toll of being a surgeon, and 30 pertaining to nostalgia. The most commonly identified subthemes focused on the training experience (38 comments), a surgical career providing personal fulfillment (35 comments), the impact of the culture of surgery (33 comments), and financial concerns (30 comments). A conceptual framework focused on balance was used to explain how the themes relate to each other.

Conclusions

Themes identified are consistent with prior studies about surgeon career satisfaction. The considerable rewards of being a surgeon were outweighed by the challenges encountered in day-to-day practice. Meeting societal needs for more general surgeons would require efforts to minimize the tolls, to the extent possible, while encouraging individuals drawn to the rewarding work of being a surgeon.

Section snippets

Problem and Background Literature

In 2006, the Association of American Medical Colleges6 called for an increase in the number of medical school graduates, reflecting concerns about a physician workforce that would be inadequate to meet population needs.7 While the shortage of primary care physicians has been widely reported in the lay press and professional publications, the shortage of general surgeons has received less attention.1 The cause of this shortage of general surgeons is multifaceted and reflects both an increased

Methodology

This study design was a qualitative analysis of entries on popular medical blogs authored by practicing general surgeons. A blog is defined as a Web-based narrative written in a first-person journal style.12

Results

A total of 35 blog posts were analyzed ranging from 126 to 3663 words, with the average length of 835 words.23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55 Demographic information was gleaned from information available on the blogs. All blogs reviewed were written by male surgeons, with the possible exception of the “Throckmorton’s Other Signs” where this information could not be determined. All bloggers were

Personal Fulfillment (35 comments)

The hard work of being a surgeon was inherently enjoyable and was fortified by the reward of helping patients. Bloggers expressed a feeling of intense personal fulfillment from being able to positively impact a patient in a tangible and immediate way, which made a difference in another person’s life.

Surgery as a Calling (23 comments)

Almost all comments focused on the challenges of surgery also indicated that surgery was more than a career, but rather a “calling” and lamented that new trainees view it as simply being a “job.”

Culture of Surgery (33 comments)

A hierarchical organizational structure, combined with an aggressive “strong work” mentality and very little tolerance for mistakes or weakness, was viewed as typical of the culture of surgery. “If you have masochistic tendencies, then by all means come join our club.”25 A lack of collegiality and a culture of blame were described as a negative aspect of the practice environment.

Finances (30 comments)

Some bloggers felt that compensation was not consistent with the years of training, large debt, and lifestyle

Training Experience (38 comments)

Thirty-eight comments pertained to the impact of the training experience on career selection and work ethic. Surgeons lamented that training in medical school and residency had changed to a degree that diminished the educational value of the learning experience. Bloggers also commented on failings of a “toxic” medical education process in providing students with critical thinking skills necessary for independent practice. They expressed frustration at the slow pace of curricular change.

Some

Personal Life (20 comments)

Twenty comments reflected the impact of a surgical career on life outside of work. Comments were largely negative, describing how the demands of work placed a strain on surgeons’ free time and often served as catalysts for domestic conflict even during times of relative calm.

Laments about the negative impact of surgery were tempered with statements about a sense of duty and an obligation to patients that superseded the needs of the individual surgeon. Some bloggers commented that the stress

Nostalgia (30 comments)

Many comments were written with a nostalgic tone, with a sense of longing for those “good old days.”

A number of comments highlighted the generational gap between surgeons who have been practicing for many years and current surgical trainees. Most focused on medical students’ lack of work ethic and reluctance to go into surgery because of long hours and diminishing reimbursements, viewed as a drastic change from the attitude of the ‘old guard’, who were willing to sacrifice their personal lives

Discussion

Our qualitative analysis of blogs written by general surgeons provides a view into surgeons’ perceptions of their careers. They shared candid and emotional, personal and professional stories that give readers a view of the complexity of their lives. Even though we identified many comments about rewards, the majority of comments described challenges or were neutral in tone.

Based on our analysis, we conceptualized that surgeons view their careers as a delicate balance between the tolls and

Limitations

Owing to our selection criteria for the blog posts, we have a relatively small sample size in this study. Despite this, theme saturation was achieved, in that themes were consistently reiterated across blogs, suggesting that the blogs reviewed are a representative sample of what surgeon bloggers are writing about their career.

It is possible that only unhappy or burnt out surgeons blog about their careers, which would result in selection bias. Although blogs have been shown to serve a cathartic

Conclusion

We identified 5 main themes pertaining to a career in surgery; toll on the surgeon, rewards of being a surgeon, practice environment, educational environment, and nostalgia. The insights gained from this qualitative analysis may help advisors counsel students who express an interest in surgery, inform students in their assessment of surgical careers, acculturate those who have already made their choices to better prepare them for what is to come, and help practicing surgeons identify and

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    NB: The corresponding author has full access to the data in this study and takes responsibility for the integrity of the data and accuracy of the data analysis.

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