E67 Paul Duffy on Sabbaticals

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Chad Ball  00:12

Welcome to the Cold Steel surgical podcast with your hosts Amir Farooq and Chad Ball. We’ve had the absolute privilege of chatting with some amazing Canadian as well as international guests over the past year. While the topics have been broad in range, whether clinical, social or political, our aims for the podcast continue to remain the same. We hope to inspire discussion, creativity, scholarly research, and career development in all Canadian surgeons. We hope you enjoy our second season as we continue to highlight some incredible guests, deliver detailed masterclass sessions on a myriad of clinical topics and introduce some fresh new features such as debate and companion formats. We hope you relish the podcast as much as we do.

Ameer Farooq  01:13

It’s not uncommon for surgeons to think about taking a break at various points in their career. But for many of us, it may seem quite daunting to think about how to make that actually happen. Dr. Paul Duffy is an orthopedic surgeon at the Foothills Medical Center in Calgary, Alberta. He gave some fantastic grand rounds for the Department of Surgery about his experience taking a sabbatical. In this episode, we asked him to share his advice with us and his thoughts about taking a break. A quick reminder to all of our listeners, thank you so much for tuning in every week. If you like what you’ve been listening to, please leave us a review in iTunes. And we’d love to hear your feedback and thoughts at podcast.cjs@gmail.com or on Twitter @CanJSurg.

Chad Ball  01:57

To start us off in a gentle way, for some of the listeners who may not know you as well as we do, you’re a proud Maritimer for sure. Tell us about where you grew up in your training pathway, and how you ended up way out here in the West.

Paul Duffy  02:11

Well, thanks, Chad. It’s a It’s a pleasure to be invited and really appreciate it. Yeah, yeah, I’m from out east. I know for some odd reason that I can’t explain, but Newfoundland is not a Maritime province. It is one of the Atlantic provinces. It’s one of the things every Newfoundlader will tell you for some reason. So I’m from Newfoundland. I grew up in a small town near St. John’s. I finished high school there, I went off and did general studies at Memorial University. And then I went from university, I did this overseas program Canada, World Youth and I ended up in working on a farm in Peru. It was an exchange program with Ontario. And through that it sparked an interest in international development. And then you know, like many things in life, lots of little decisions lead you in a certain way. And I ended up at Trent University in Peterborough, Ontario, doing a degree in third world developmental economics. And in that experience, I was lucky enough to go to Ecuador, and do a thesis year and economic development in Ecuador. And then I finished that degree and kind of found myself at a loss of what to do. I never grew up, you know, with a goal to be a physician, there were no physicians in my family, there’s no medical history. I don’t have any relatives ahead of me that were physicians. But two things kind of struck me once when I was in Ecuador and my brother who also went through a similar path and ended up, who’s a he’s a (INSERT WORD) in Ottawa and the first physician in our family, he came to Ecuador to visit me. And he had more of an impact in the two weeks that he came to visit with ideas and a skill set than I had in a much longer time. So that’s certainly pushed me in a certain way. And I can remember specifically in the graduation at Trent University, the Chancellor because it was a liberal arts university, it was an equity, liberal arts degree. And the Chancellor said, I remember his words exactly. He said, although you may have not learned a skill, you’ve learned to think, which will develop and blah, blah, blah. And it hit me like a ton of bricks that he’s absolutely right. I haven’t learned a skill, I need to learn a skill. And that’s probably one of the first times that I thought about medical school and, and going that path. And from there, the stars aligned. Memorial University at the time changed their admission requirements that you didn’t need any sciences to get in. You just needed a degree. So with an arts degree, I applied to medical school and got in. And that’s how it started.

Ameer Farooq  04:59

That’s so neat that you did a bunch of work and and studying in Ecuador. I didn’t actually know that about you. What was that experience like? And how do you think that shaped you and impacted you?

Paul Duffy  05:12

It just kind of gave me more of a worldview. It pushed where I ended up in medicine and you know, some of the overseas missions and things that I’ve done since I’ve finished orthopedics in my fellowship training. I think it gave me a better appreciation of different paths in life. And because I wasn’t clearly on that medicine path from from an early academic career, you know, that it evolved over time.

Ameer Farooq  05:44

So how did you end up in Calgary of all places? I’s been clearly quite the journey?

Paul Duffy  05:51

Yeah well, you know, after medical school, then, you know, where was I going to go next? And I went the orthopedic route. And I remember the first time I thought of orthopedics in Newfoundland at the time when I went to medical school, most of nephrologists were Irish, they’re all from Ireland. And we had a fairly tough Irish nephrologist, Pat Parfrey, he was a coach of the Irish rugby team. He came in, gave a give a lecture on acid base physiology and he stood in front of the room and he said you know none of you people are smart enough to understand this but I have to teach it anyway so here goes. So I put down my pencil and thought what sub specialties Can I do that don’t require as a base physiology? And orthopedics popped up. That was the first time I’d actually given it a thought. So that’s the route I went I did my orthopedic training in St. John’s. And like a lot of Newfoundlanders I had no intention of ever leaving Newfoundland. So I finished and there was no jobs, so I went to Halifax and I did a fellowship in arthroplasty in trauma with Ross Leighton. And I never, ever imagined myself as an academic or at an academic center or researcher or part of the teaching program. But Ross lit that fire in me and I owe a lot to Ross Leighton. He taught me a lot. After I finished Halifax there were still no jobs, so I went off to New Zealand and I did a locum and I worked in North Island for a little while and traveled around. Then I went to Scotland and did another fellowship, purely just biding time until a job came up in Newfoundland. Nothing came up. I was in contact with Rick Buckley who helped me set up a locum in Calgary. I came to Calgary and worked as a trauma surgeon, went away and did another fellowship in London, England, in public and esterbrook trauma. And then from there, I came back to Calgary, worked again as a locum surgeon that eventually turned into a job. And then my five year plan to stay in Calgary, you know has continued until today. And here I am.

Ameer Farooq  07:56

We previously interviewed Andrew Fury for the podcast about Team Broken Earth. And clearly some of your early experiences, maybe living in Ecuador has shaped some of that passion. But how did you get involved in Team Broken Earth?

Paul Duffy  08:12

Myself and Andrew were residents together in orthopedics in Newfoundland. I was a few years ahead of Andrew, but we were close friends and we still are close friends. Andrew did his orthopedic trauma fellowship at Baltimore Shock Trauma and he was back in Newfoundland as an orthopedic trauma surgeon when the earthquake hit Haiti on January 12, 2010. 250,000 people died in the earthquake. And he was one of the first responders with a group from Baltimore that went down and the experience has certainly impacted Andrew’s life. He caught on to thex, tapped into the charitable culture of Newfoundland and, and put together small surgical teams to go to Haiti to help and to teach. And it took off like wildfire. A lot of people wanted to get involved. I was home from Calgary to Newfoundland on a medical hockey tournament of all of the things. And in the hockey dressing room we got talking about, could we expand this to Calgary? And I brought it to Calgary and as Chad Ball knows well because he was on our first mission. I set up a mission to Calgary and in the first year, we had three teams go. We had a team from the Foothills, from the south hospital and from the Peter Lougheed. And there was a ton of interest and there still is. So that’s that’s kind of how it all took off from there. So, surgical teams from different hospitals go down and we teach and do as many cases and help as much as we can within the time that we’re there.

Ameer Farooq  09:56

You’ve continued to do this work with the group in Calgary, and not just in Haiti, you’ve been to many other places. What goes into creating and leading a mission like that, like, walk me through it a little bit. The kind of planning and preparation that goes into taking a mission and a group of surgeons and nurses and all the rest of it to a place like Guatemala, for example?

Paul Duffy  10:23

Yeah, you know, it’s an interesting experience, because it’s tough, the infrastructure is a struggle. The facilities are a struggle, the travel is a struggle, parts of it are miserable. But it is oddly refreshing to do these kinds of missions. Because you know, it’s easy in our day to day grind here in Calgary, or wherever you are in Canada, as a surgeon, to forget why we do what we do. You get caught up in the struggles of healthcare and data dealing with administration and our time and call schedules and finances and research and teaching. And it’s easy to forget that we’re healthcare professionals, because we take care of people. And we have a skill set that’s useful, and the people need. And you go on these missions, and you know, you get to do what you love to do. So you show up and you make the best of the situation you have, and you teach as much as you can. You help as many people as you can, in the short time that you’re there. You know, that’s the crux of why we go, and it’s the crux of the need for setting it up. You know, any leader, any good leader knows that the leader is effective if you surround yourself by like minded, competent people. And certainly, that’s what I’ve done for our medical missions to Guatemala, and Haiti, that not one person can’t organize all this, there’s a lot of people that chip in and help. And I think we generally underestimate people. But when you give people tasks, I think we can be surprised at how much people can rise to the occasion and help out. So I’m surrounded by a lot of people that do a lot of great work to help this stuff happen in Calgary and in Broken Earth. And Newfoundland, too. It’s a great organization that organizes these trips.

Ameer Farooq  12:24

We talked about this a bit with Dr. Fury as well. But how do you see your legacy? Or sort of the long term impact of the work that you do? And how do you kind of try to build a bit of a base so that when the mission finishes, that the work can continue, and that the impact of that mission goes on beyond your physical presence in that place?

Paul Duffy  12:49

Yeah, I think you need a realistic expectation of what you’re trying to achieve. We’re not going to change the healthcare system in Guatemala or in Haiti or in Bangladesh, it’s not a national change that we’re making. There’s lots of naysayers. You know, there’s issues of medical tourism and all that and I get all that. The individuals that you help when you’re there, it’s life changing what you can do for people, it’s on an individual level, and I don’t think you should actually be discounted. That individual treatment means an awful lot. There’s also lots of other spin offs and certainly for a legacy. For this to have an long impact –  it’s education, you have to educate locally. And that’s a tenant of Broken Earth is to help educate locally. So there’s some sustainability in projects going forward. This also gives locals that you work with, the local health organizations, the local physicians, some reprieve. It gives them a sense that somebody cares, that someone is coming, for no financial benefit or prestige benefit. No one’s looking for a pat on the back, that people care to come and help as much as they can. But the legacy of all this has to be education. And we’ve had a Haitian fellow that’s come here to Calgary and work with us. And he’s still back in Port au Prince right now working hard and we contact him quite a bit. He goes to some of these national meetings, and there’s Haitian Guatemalan surgeons that we need. There’s those connections that are made. I routinely get WhatsApp messages from surgeons in Guatemala with questions on cases and I help as best I can knowing there are limitations or resources and personnel. So it’s those connections that are helpful, and I think the long term legacy is education. But these missions, I think everyone who goes on these, you get more than you give. I think the benefits that people that come back from these nations and how they see the world, how they see their job, how they interact with their colleagues. Because they’ve been on these big missions, does a lot for your home hospital and your home treatment of patients. And I think that’s an extremely important part of these as well.

Chad Ball  15:13

Yeah, I couldn’t agree more Paul. I think when you say you get more than you give, that’s always the case. And we’re all very lucky to be able to engage in those endeavors through folks like you and Andrew and a bunch of others. So I always thank you for that. If we switch gears a little bit, maybe swing back to my initial comments about the sabbatical that you and your family took – I was wondering if you could frame that and introduce that to our listeners as to exactly what you guys did and where you went and over how long?

Paul Duffy  15:44

Sure. Yeah, a few years ago, back in 2016, I took three months off from my trauma practice here in Calgary with my wife and two children which at the time, were age 10 and age eight. We took a three month break from work, a sabbatical, if you want to call it and we went around the world. We left Calgary we went via Vancouver via Tokyo to Thailand, to Bangkok to Koh Phi Phi to Chiang Mai Chiang, to Kuala Lumpur. And from there we went to Turkey to Istanbul, to Ephesus on the coast, went to Cappadocia. To Marmaris, and we went across to the Greek islands. And then from there we went to Rome, to Ancona, cross to Croatia, then we did the Dalmatian islands and split down to Dubrovnik, made our way up to Venice, went through Europe. We then ended up in Barcelona, went over to Morocco, hiked and spent a few weeks in Morocco. And then from there to London and then the highlight of the trip headed back to Newfoundland to visit Mom. And then back to Calgary.

Chad Ball  17:00

Yeah, you definitely have to stop and visit mom after that. There’s no doubt about it. Yeah, that’s an amazing trip. Tell us about why? What led you? What were the factors that went into that – that pretty brave and very cool decision?

Paul Duffy  17:19

You know, it’s funny, because the why of that trip has raised all kinds of discussion. And there’s no mystery behind it. The idea that we would do a big backpacking trip with our children was something that me and my wife had spoken about, before we even had kids, that it was just part of our lease plan, we always thought it would be a good idea. And once it got spoken about it was the kind of thing that, you know, we had to do it, we would have felt like we failed to fulfill a promise to each other. So the when portion of it was when the kids were the right age. And for us that was age ten and eight, maybe that would have been better than eleven and nine, but you know, I think that’s soft. The “why” is just because you only get one ride. Because we love to travel. I love my family. We love sharing experiences together, it certainly made us a better family and we were a good family to start with. But we still talk about this trip. And it’s changed our relationships with each other for the better. Not that there was any issues before, but the “why” was simply that it was just part of our plan.

Chad Ball  18:38

That’s amazing. There’s so many things that we want to ask you about, specifically, but let’s start with the work component of it as a surgical podcast. So what were the mechanics of that sabbatical? How did you convince your partners to help you out? You know, as a trauma orthopod, obviously, your job is reasonably modular I think it’s fair to say. So, how did you make the work side of it function well?

Paul Duffy  19:04

Well, you know, my scenario. My logistics of my job, made it feasible. And by that I mean that I’m a fee for service, academic trauma surgeon that the majority of the work I do is in a daily trauma room. I do arthroplasty a couple of elective days a month. I have elective clinics. I do research. I do some medical legal work. But you know, I’ve got supportive colleagues that we can distribute, call, and OR time, with the group. The group are willing to support me taking three months off because it’s a fee for service. So this wasn’t a paid sabbatical. I paid into a program where I took three months off and simply just stopped working for three months.

Chad Ball  20:03

That’s amazing to have that support. You know, it doesn’t surprise me, given how awesome your partners are. One of the things you talked about, amongst many that, that I’ve thought a lot about since since your grand rounds was that you sort of outline an experience where as you go through it, it took you a certain amount of time to essentially wind down and then you got to the point where you seem to be so relaxed and enjoying the experience so much in real time, to the point that somebody would ask you what you did. And you were sort of forgetful that you were an orthopedic surgeon. Tell that story, because that was great.

Paul Duffy  20:42

Sure. Yeah. You know, just to back up a little bit: it speaks to the culture of surgery, this trip. So this raised a lot of eyebrows. You’re doing what? You’re taking three months off? What’s wrong? The first impression from most people, is that I was taking three months off because there was a problem. Either I was burnt out, I had a drug dependency, or I was getting divorced. And it was something that I had run away and fix. And that simply wasn’t the case. We were just taking three months off. But it’s the culture that we live in for a surgeon, that they end up in the busiest part in their career to take three months away – it’s not something that happens. You know, if you think of your own life, and I think most people as a surgeon, when was the last time you had three months off in your life? Probably never. I mean, never you get summers off in high school. That’s not three months, then you go to University, you go from term to term to term, you go to your job, sabbatical, medical school, engineering, whatever. Three months is not something we ever take off. And do nothing, just enjoy yourself and spend time with people that you’re closest to. So you know, some people take 10 day vacation, some people take two week vacations, and it was a new experience for me to have three months away, because you know, you go on vacation. And if breakfast is taking too long after you sit and gather for a while you start getting antsy. You go to Mexico to Mexico and sit by the pool and most of us think it’s a great vacation, but most surgeons will sit in that lounge chair for probably 40 minutes till you’re up and wandering around and looking for something to do. So it’s our personality to be busy. And you know, it took me three, four weeks before breakfast, could turn into five games of crazy eights. And then just hanging out with the family before I got rid of that sense of “I should be doing something different”, or “I shouldn’t be doing something that’s productive”, not just no quotes, wasting time. And crossing that threshold to where you truly relax, was a fairly positive experience for me. And I told you this experience, we were sailing in Croatia, we sailed all day, we pulled into one of the Dalmatian islands, and another boat pulled up next to us. And he had cracked a pint and handed it to the guy. Next thing, you’re chatting back and forth. And, you know, he said, so what do you do? And I was like, what do you mean what do I do, we just sailed from the last island! And he said no, what do you do for a living? And it took me like 5-10 seconds to kind of think,  what do I do? It wasn’t at the forefront of my mind. And it may seem like nothing, but it just changed. You know, how you’re seeing the world. Because we define ourselves, a lot of us as surgeons, we define ourselves as surgeons, when we need to define ourselves greater than that. And to be able to step away from it, and see yourself outside of that definition, it’s fairly introspective, and it gives you a very healthy look at yourself to see, you know, where you’re going and where you came from.

Chad Ball  24:03

That’s an amazing story. You guys were gone for three months, as you mentioned, what’s the right length of time to try and do that? And I realize that’s gonna vary from experience to experience from person to person. But what’s your sense of that longitudinal component?

Paul Duffy  24:17

You know, we talked about this and the reason I took three months is because privileging is three months. If you’re away, at least in Alberta, if you’re away for more than three months, you need to reapply for privileges. If you’re away for under three months, it’s just like you went away for the weekend, as long as somebody is covering your patients and your pager and all the rest. So three months, also the kids were turning eight. So taking them out of the school. We left the day they finished school in June, and we got back in September. So they didn’t miss that much school. At the time, one of my concerns was that it was too long. And you know, I talked about this in one of the talks: that there was lots of advice on why this was a bad idea; it was too long, it’s too expensive, it’s too hard to plan, it’s not fair to your colleagues, you’re gonna lose your work skills, kids are going to be homesick and miss their friends, it’ll spoil the kids. None of it came true. Especially, “was it too long”. If at the end of the three months, somebody could have flicked a switch and said, you can go for another three, all of us would have jumped on that in a second. By the end of the three months, we were not ready to come home. And not ready to just get back into life again. We enjoyed it that much.

Chad Ball  25:32

That’s amazing. You and I have talked a fair bit about some of the experiences that your kids had at that age. In particular, I was wondering if you could talk about, you know, selecting that age. In particular with your kids, as the destination in terms of the travel. But also, I’m curious, what are some of the longer legacies within your kids and within your family since you guys have been back after that experience?

Paul Duffy  26:01

You know, that’s a great question. The thought that travel will spoil your kids could not be more reverse. You couldn’t flip it. I mean, we didn’t stay in fancy five star hotels, this whole trip, the kids got to see some of the world. And there is no better teacher than experience and travel in my opinion. You know, there was so many stories and situations and conversations that me my wife had with our children that we would never have had in our regular day to day lives. You know, we stayed with a rural family in rural Thailand in the jungle, and you know, questions came from that. We visited a Buddhist temple in Bangkok. And then conversations around different religions of the world came up. We went to a Women’s Cooperative in Morocco, you know, and my daughter asked, “why do women need a cooperative?” And the whole issue of women’s rights and how the world works – that came up. We went to so many different places. We were in Greece during the whole Greek debt crisis. And it all came to a head. We were in the center of Greece when CNN showed there was fires and protests and everything else. But the conversations that I had with an eight and a ten year old about money and debt and responsibilities and finances, you know, you’d never have them listen and really appreciate it as much as they would if they weren’t immersed in a cultural experience. So, you know, I think kids soak up the details. You know, they try on cultures, like they try on clothes. It builds courage, it builds resiliency, and I think it leads to smaller egos, and bigger minds.

Chad Ball  28:03

That’s so well said, you know, the truth is, too, it’s important for our kids to see struggle. Not just locally or regionally, but internationally. You know, it’s a relatively privileged upbringing in many ways to grow up as a surgeon’s kid. I think you may have seen some of our colleagues do that exceptionally well. And some of them do it poorly. But I think the visual witnessing of absolute struggle in life can go a long way.

Paul Duffy  28:32

Yeah. I think if you teach your kids they can live without electronics and, and they can see different cultures and you teach them grit and resiliency, then you take them a long way.

Chad Ball  28:44

Yeah, that’s well said. What was it like when you came back at the end of the three months and reintegrated into your job and your practice, both clinically and surgically and then, you know, with your partners as well?

Paul Duffy  28:57

You know, it was a concern of mine. It was a fear that you know, you go away for three months and you have to warm back into things. But my first day back, I remember specifically I kept the call, I kept the trauma list, because it was chaos. It was poly traumas and multiply injured. It took 10 minutes to feel like I’d never left. And I don’t mean that in a negative way. I mean, in terms of just being back in the saddle, and being able to look at the logistics of a complex case and sort things out and have a plan going forward. So, you know, I think if you’re out there and you’re thinking about taking a sabbatical, three months is not going to do you in. I think we do this our whole lives. You spend a long time praying for it. You’re not going to forget it all in three months.

Chad Ball  29:50

Yeah, that makes sense. It’s well said but you know, to be fair, that is a certainly a founding fear of many folks, many surgeons when they talk about taking time off. You know, it’s interesting for sure. Is this something that you and your wife or maybe your kids are going to do again?

Paul Duffy  30:07

Absolutely. You know, I would go tomorrow if I could, especially with COVID and being tacked down. Yeah, we would. I mean, as the kids get older, lives get more complicated friendships more important. Kids are harder. They spend less time with you and more time with their friends and their perceived problems get bigger. But yeah, we’ve certainly talked about it, and it is in the plan to do it again.

Chad Ball  30:33

Wow, it sounds amazing. Where do you guys think you’re gonna go?

Paul Duffy  30:35

We talked about just spending time in Southeast Asia, and just spending more time in a singular location to really get to know one area. We also talked about South America.

Chad Ball  30:47

Wow, yeah that would be phenomenal. Yeah, Southeast Asia is incredible. Cambodia, in particular, always a place I love. I mean, you certainly, without any intent, I get it, you sell this really well. And it’s something I think that’s caused a lot of us would have seen you talk about it cause for pause and try to think about maybe doing it. Let me ask you from the outset, how do you plan it? What sort of pieces of advice would you have both from the work side of things and more importantly, from the trip side of things?

Paul Duffy  31:23

Well I think the first question you have to answer is why? Why even take three months off? Like is it because you want to travel? Is it because you want to, you know, set your retirement and look for somewhere to spend your retirement? Is travel something you enjoy? Is the unknown of the next day something that’s stressful for you or something that’s exciting for you? Who are you going to travel with? So you know, taking time off, doesn’t have to be travel, it can be time off to, you know, hone, a skill, hone your music skills. To read all the literature you want to read to, you know, to do some other passion. For me it was travel. It’s something our family really enjoys, and it seemed a very natural fit. But for other people that may be music, literature, spiritual martial arts, volunteer work, you know, who knows, ski trips? So why you’re doing it, and to make sure it’s the right thing for you. And a supportive group for sure. You know, it’s not cheap to take three months off, and not necessarily the cost of the travel because you can do a trip like this fairly inexpensively. But you’re not going to earn an income for three months. So you need to be in a situation where that is not too stressful for you or you’re not so stretched that those three months are not a plausible thing for you. Which is a whole other podcast in itself, you know, finances and happiness. The fact that it’s not a linear relationship. So how do you plan it? Well what we did was just surf the internet. I found a few key things that we wanted to do you know, what was on my bucket list. Interestingly, on my bucket list was in Nepal, and to do a hike to some of the base camps. But just as we were planning this, that earthquake hit Nepal, I don’t know if you remember that a few years ago. So about two weeks before we’re supposed to go, all that changed. So a few of the core trips that we had were the sailing trip in Croatia, the hiking trip and Morocco. A hotel in Santorini. And that was it. The rest, we just kind of made up as we went. We picked the flights, and then we just filled it in day by day. And it is shocking how easy it is to fill the day. You don’t have to have the whole thing planned. You just need a rough schedule, and an open mind and the rest will take care of itself. And just trust that it’ll fall into place. Because I can’t say we had one boring day on the whole trip. And we certainly didn’t plan every day.

Ameer Farooq  34:09

One thing I wanted to zero in on again, Dr. Duffy, without belaboring the point is the “why” thing. And there’s sort of two parts to what I wanted to ask. One is you’d you’d plan to do this, you know, it sounds like from the outset with your wife, that you were going to do this and you sort of had that vision in your mind. And obviously it sounds like you would do that again. But why do you think it’s so important that surgeons kind of touch base and remind themselves about who they are as people outside of their personalities as surgeons? Because, you know, like, I think for a lot of us that is a big part of our our personality.

Paul Duffy  34:47

You know, that’s that’s a very insightful question. Why is it important? You know, I’m not saying a sabbatical is not necessarily important, but defining yourself outside of just a surgeon is extremely important. We are very bad, as surgeons, at taking care of ourselves. That burnout is real. The syndrome of burnout, with physical, emotional exhaustion, cynicism, and this feeling of lack of accomplishment and ineffectiveness affects a lot of us. 15% of surgeons at some point in their career will not be able to do their job because of alcohol dependency, mental health issues, or drug abuse. We’ve got an extremely high rate of burnout. And it varies for every different surgical specialty, but most surgeons, most surgical groups have burnout rates between 30 and 40%. And some are high. You know, the concept that burnout is because you’re weak or because you’re not prepared and you shouldn’t be a surgeon couldn’t be further from the truth. The paradox of burnout is that it’s often the surgeons that are the hardest working, the most dedicated, the most empathetic, the most wanting to see their patients do well, that are most primed to burn out because they give everything to the practice. And unless you put your own oxygen mask on first and take care of yourself first, you’re no good anybody else. So as surgeons, we need to realize that burnout is real, that it’s not a sign of weakness, that it can happen to anybody, and that we are horrible at diagnosing it. And, you know, the joke in orthopedics is, you know, the best way to treat a broken femur is to not break your femur. The best way to treat burnout is to not burn it. And to not burn out, you need to acknowledge it, and you need to prevent it. And by preventing it, we need to know who we are, we need to see it come. So taking care of ourselves means defining yourself outside of just being a surgeon. So if you had to write down five things to describe who you are, five of those should not involve medicine, we have to have other sides of our personality. Because it’s healthy, it’s healthy for longevity. At some point, you’re going to retire. And you’re going to be the person who used to be a surgeon, and you’re still going to have a life ahead of you. Your kids may be impressed that you’re a surgeon, but they need you to be a dad and they need you to be a lot more than a surgeon. So, you know, I think a sabbatical is helpful in that regard. But it doesn’t have to be a sabbatical. You just need to find a passion or some other interests outside of medicine to help keep you healthy.

Ameer Farooq  37:56

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