On October 19th I used this blog to “post” slides during a talk (the two images and one table below) which everyone then accessed via their phones. I was speaking on a panel sponsored by the RAS (Resident and Associate Society at the Clinical Congress of the American College of Surgeons.) The overarching topic was “Sustaining a Career in Surgery” and, as usual, I learned more than the members of the audience… particularly by pondering two specific questions that were asked…

What does it mean when we talk about career sustainability?

When we talk about sustaining a career, most people frame that as how to keep going, how to not burnout, be injured, or worse.  I’ve used the term “sustainability” a lot in my work as an educator, mentor, and leader in surgeon well-being… In fact, eight years ago I published an article entitled “Sustaining a Career in Surgery”. But this panel gave me the opportunity to think deeply about what we mean by “sustain”.

Here’s the definition of “sustain” from Merriam Webster Online: 1 : capable of being sustained 2 a of, relating to, or being a method of harvesting or using a resource so that the resource is not depleted or permanently damaged b : of or relating to a lifestyle involving the use of sustainable methods

Read it again and realize… YOU are the resource this refers to… “a method of using a resource so that the resource is not depleted or permanently damaged.”

The goal is clear… we need to find ways to practice medicine that don’t deplete or permanently damage (physically, emotionally, and spiritually) those who strive to heal others.

Are sustainability and satisfaction the same thing?

Maslow’s hierarchy of needs. Source: “Selfless-Actualization”: Revisiting Abraham Maslow and the Hierarchy of Needs

To answer this second important question I referred to the image above – because Maslow’s hierarchy of needs answers this question and adds something very important.

Sustainability (not depleting or permanently damaging us) is about Maslow’s “basic needs”.

Satisfaction comes from meeting our psychological needs i.e belonging, feeling loved, feeling we are doing something that matters.

And then there is one more layer which Maslow called “Self-actualization”. This is what we really strive for and yet it is virtually never considered a metric we should measure (or at least talk about) when we discuss well-being.

Shapiro DE, Duquette C, Abbott LM, Babineau T, Pearl A, Haidet P. Beyond Burnout: A Physician Wellness Hierarchy Designed to Prioritize Interventions at the Systems Level. Am J Med. 2019 May;132(5):556-563. doi: 10.1016/j.amjmed.2018.11.028. Epub 2018 Dec 13. PMID: 30553832.

If you haven’t read the article by Shapiro et. al, I highly recommend you do, because they translate Maslow’s ideas into the world of medicine. At the top of our professional hierarchy of needs, how we become “self-actualized” is our goal to “heal patients and contribute”.

Which let me to a different question, but one I think is crucial for us as individuals and for those who run the healthcare systems we work in…

Who is responsible for meeting these needs?

*If you aren’t familiar with the critically important concept of administrative harm, you should read this paper: Burden M, Astik G, Auerbach A, et al. Identifying and Measuring Administrative Harms Experienced by Hospitalists and Administrative Leaders. JAMA Intern Med. 2024;184(9):1014–1023. doi:10.1001/jamainternmed.2024.1890

Let me know what you think.