Latest / Behind The Knife: The Surgery Podcast / Wellbeing and Mental Health in Surgeons
Transcript
- Surgeon Wellbeing and Mental Health === Speaker: [00:00:00] Hey everyone, and welcome back to Behind the Knife. I'm Steven Thornton, one of the general surgery residents at Duke, and a Behind the Knife surgical education research fellow. Today, I'm fortunate to be joined by Dr. Yang and Dr. Collins. Dr. Yang is a thoracic surgeon at the Massachusetts General Hospital, and Dr. Collins is a surgical resident at the University of Pennsylvania. Today, we'll be talking about some of the exciting work that they've collaborated on to understand and promote wellbeing within surgery. I'm also joined by my co-fellow, Agnes. Agnes, do you wanna introduce yourself? Speaker 2: Hi, everyone. Thrilled to be here. My name is Agnes Premkumar, and I'm a surgical education fellow along with Steven. And I'm a general surgery resident at the Creighton University of Phoenix. Speaker: It would be great if you guys could tell our audience a little bit about yourselves. Dr. Yang, could we start with you? Speaker 3: Well, thank you so much, Steve and Agnes, for having me. Really excited to be here. I'm a thoracic surgeon at Mass General, and I've been interested in well-being and mental health for quite some time. Actually, [00:01:00] probably my interest started as a college student working with really close mentor of mine, Dr. Harrison Pope, who is a psychiatrist at Harvard Medical School. And then in between college and medical school, I did a Fulbright Fellowship where I studied the prevalence of depression and other psychiatric comorbidities in China. And then I revisited well-being personally myself when I injured my back while picking up a patient during patient transport and having to try to work through the process of getting better from that injury, and then also felt a lot of pressure from the residency experience to make sure not to take a single day off from that. So it definitely got me thinking about different cultural expectations and pressures of well-being and what it means to be tough and things like that. And I'm excited right now. We've been studying different mental health topics and well-being topics and working with [00:02:00] Reagan, working with Kerry, and trying to come up with ways to quantify well-being and figure out what is affecting surgeons and our trainees right now. Speaker 2: Great to have you, Dr. Yang. Reagan, if you wanna go ahead and introduce yourself. Speaker 4: I just wanna thank you all for having me on today. I'm excited to talk about this work and have this open discussion with you. Kind of my why or how I first got involved in this space was actually similar in the co- in college. As a college athlete, I felt like I experienced a training environment that very much mirrored what surgery at least seems to be so far to me. It's intense, it's demanding, and of- often frankly dismissive of mental health, though I think things have changed a lot in the last decade or so. I saw firsthand several teammates that were struggling with depression, anxiety, eating disorders, even suicidal thoughts, yet the attitude from leadership was often you just kind of tough it out, like that's what you do as an athlete. And [00:03:00] at that point in time, I didn't really feel like I had a voice to do anything about it besides just be there for my teammates as much as I could be. And then during medical school, tennis actually Connected me with Dr. Cunningham in that mentorship relationship and my arrival in Boston actually for my research year with her coincided with some time off that she took for personal reasons which if no one's watched her presidential address for the AAS from a few years ago, I'd highly recommend watching that and that can provide some context there. But I think in working with her and seeing her personal struggles and how she became an advocate in this space, it finally gave me an opportunity to, one, work on the data that we'll discuss today, and find some sort of a voice to at least be an advocate for my peers and then hopefully, like, my future colleagues. Speaker 2: So we touched on this a bit earlier, but you work with Dr. Cunningham and you led a study investigating surgeon mental health and suicidality. That study was definitely impactful and was published in the Annals of Surgery and JAMA. [00:04:00] But for those of us who haven't read those papers, what are some key findings? Speaker 4: Absolutely. Happy to talk about that. So this work really started as a collaboration through this, um, that was focused on better understanding mental health across really the surgical training continuum because we didn't have a ton of updated data in the kind of post-COVID era. So the initial study, which was published in Annals in 2023, I think, was a national survey of we had over 600 individuals across all training levels, so medical student up to full professor, where we assessed several different domains and wanted to really just characterize the current state of mental health among these individuals. So depression, anxiety, PTSD, alcohol use, all of those things, along with suicidal ideation. And I think the main one-liner finding of that study was that nearly one in seven respondents reported suicidal ideation within the past year, [00:05:00] which I think that in itself deserves a bit of a pause. Like, that's a lot more than I think we probably expected, and it's pretty sad to hear that data. Some of the other things that we looked at were depression, anxiety, PTSD, and it was anywhere from about 15 to maybe 20% of individuals screened positive for actively meeting criteria for those diagnoses using some of the formalized questionnaires that we included in our survey. And then another thing that I found pretty interesting in that first study was looking at medical errors. So among respondents who perceived a medical error in the past three months, they actually had higher rates of depression, anxiety, and PTSD. So I think that kind of circles back to this idea of, like, our profession itself has a lot of kind of triggers or hard things that we go through and don't necessarily have an avenue to cope with it, or at least [00:06:00] have the right space to work through that. So that's kind of study one, and then the second part of it was to move forward to try and see if we could figure out some more modifiable risks or ways that we could maybe intervene to help people who are struggling in this space. So in this study, which was published in Journal of Surgical Research a, a year or two later, we looked at some of these wellbeing factors associated with suicidal ideation, and what emerged from that is we found that higher professional fulfillment, higher resilience, higher self-valuation, and then, like, lower loneliness scores were all associated with decreased odds of suicidal ideation. I know that was a lot of data, and will probably prompt a lot of good discussion there, but that's the background at least of some of the work that we've done over the last couple years as a group. Speaker: Yeah, I really appreciate you sharing all of that, Brig, and, and I'm so thankful for the work that you've been doing in this space I think it's helping to make our culture not only healthier, but as a [00:07:00] consequence, stronger. Dr. Yang, I'm curious your reflections on the findings of those two studies. What do you feel like are the key actionable steps that we can take as a result of this work? Speaker 3: I wanna commend Reagan and her leadership and Kerry Cunningham for bringing attention to these really important issues and really helping advance the field with this extremely impactful work and research. And from this research, it's clear that our surgical programs need to do better. And na- nationally, it's important for the program leadership to try to figure out ways to make mental health a key area to promote psychological safety, to make sure that the environment is just much more positive than in the past and much more supportive. And I think every program responds to this differently. So some [00:08:00] places that I've talked to, they're focusing on a psychological first aid kit, for example. So what to do when you go through acute trauma, for example, or when you lose a patient, or when there is a really stressful situation in the operating room. And, and then other places are working on things that are a little bit-- that are related, but maybe not quite focused just on mental health. So for example, wellbeing and nutrition, ergonomics, and other elements that try to reduce burnout. So it does seem, though, that no program is doing everything And so I think that this is a call to action to try to get people across the country at every single program to pay attention to all these different issues because they all are important. And without a broader awareness and focus of this, you're gonna continue to have [00:09:00] these star- startling statistics the next time you do a survey. Speaker 2: Yeah, I think those are great points, Dr. Yang. I think it's important that we kind of implement or address this in kind of every level, starting from residents to attending surgeons. And then Reagan, going back to you, how have you seen that your findings have shaped you showing up as a resident? Has it influenced how you've interacted with your peers? Speaker 4: Absolutely. I think it, it would h- be hard for it not to shape how I have kind of started residency or at least approached these types of discussions with my peers. I think what's resonated with me, at least with my experience so far in my training program, is how open even, like, the chiefs and senior residents have been about their own, not necessarily struggles, but at least their own help-seeking behaviors. And I think that you can only do so much as a surgical intern to try and set that culture as much as you'd like to. When you walk into a new place that everyone's been there for multiple [00:10:00] years at that point in these seven-year training programs, you're trying to find your own kind of space, your own voice, and a lot of the culture has already been set, and you can change it in certain ways as you progress. But I think what's been really reassuring is to see chief residents say, "Oh, yeah, like, I have a therapy appointment tonight. I know someone who does it after hours. They can meet at, like, 8:00 or 9:00 PM, and they do it virtually." So I think things like that have been really reassuring to see this year because I wasn't sure ... You never know exactly what you're getting yourself into, as much as you'd like to think you do. And I think that things like that are really helpful, especially at the junior resident stage. To pivot a little bit, we know from data that surgical residents who enter training have relatively low baseline rates of depression and these other mental health disorders, and that surgical training, whether it's a byproduct of the training itself or just the expectations or whatever it [00:11:00] may be during this stage of life, we see a significant increase in the prevalence of these mental health disorders. And those increased rates don't stop after training. It, it prevails throughout your career. So I think that it's important that we, yes, look at this broadly across all training levels and across the- your whole career. But I think it's really important that we support junior residents and just residents in general before the problem gets out of hand, and trying to provide them at least with the resources to cope with the different stressors that, that we face in training. Speaker: I think those are such great points, Reagan, and I really appreciate how you guys are grounding this conversation in the data. I mean, when I first learned that coming into residency my peers have lower rates of mental health problems or diagnoses like depression, anxiety, PTSD than [00:12:00] age-matched peers, and when they finish their intern year, it's significantly higher and those rates are durable, I mean, that's just such a troubling thing to know about the experience. And I think those data in conjunction with some data I've seen around suicide completion, in particular early in residency, I think really point to the vulnerability of that transition environment where you're going from being a medical student to being a resident. It's just such a seismic shift in somebody's professional life As somebody who's in that role now, you're a surgical intern, what are the things that you think we're doing well in surgery to support people in that transition? And what are the areas for improvement to help set people up for success as they transition into residency? Speaker 4: Yeah, I think that's a great question. I think in terms of things that we're doing well [00:13:00] on a national scale or just talking about this more, I think it's less taboo or like cliche or like there's less, slightly maybe less stigma around the conversation. Like even some of the more senior attendings at my institution, I feel like I could talk to them about these topics and they aren't gonna blow off the data, which I don't think we could necessarily say 10, 15, 20 years ago. So I think that's been pretty reassuring to see people understand that there is a problem, and just because training was done a certain way 30, 40 years ago doesn't mean it necessarily has to look the exact same way today, that we can still support residents and train them well because ultimately that is the goal, is to come out of training ready to practice and practice safely. But I think we can still do that while protecting the mental health and wellbeing of our surgical trainees. So I think one thing that we're doing well is just having these conversations and we're working to, [00:14:00] working against some of the stigma that, that has persisted. I think ways that we can improve, we've seen in some of the different initiatives across the country, but I think more than anything, something you see across a lot of different studies is a barrier to getting help is time. Like, frankly, like, that's probably one of the biggest things you notice as you transition from a medical student to a resident. You thought you didn't have time as a medical student but that, that you really did compared to residency. And your time isn't your own, and even when you maybe are off, you are there late because you care about your patients and it is ultimately like up to you at the... Like, it's just a different role that you're playing as a resident than you were as a medical student, so that's a big transition. And I think trying to find the time to prioritize your wellbeing, prioritize your mental health is a huge barrier for trainees. So I think some things that we've seen- [00:15:00] And certain institutions do is protect time for this. So for example, I think nearly every training program across the country has one day a week where you have either M&M or you have grand rounds, and then you have your formal didactics. I think that's pretty similar across the board. And then there's a couple programs that call it, like, the fifth Tuesday of the month. So whenever there's, like, a fifth whatever day that you have that sort of education time of the month, that's protected for you to spend prioritizing your wellbeing and things like this. 'Cause I think without providing that protected time, it's really hard to prioritize it. And I think it also sends a message from leadership that they care that you're doing that as well, because you'll bring your best self to work if you're able to take care of yourself at home as well. Speaker 2: Yeah, I completely agree with that, Reagan. I think the institution overall needs to care Speaker 4: and value wellbeing for it to reflect downwards in the resident level as well. Speaker 2: And then pivoting to you, Dr. Yang, what do [00:16:00] you feel like the culture around mental health is? As an attending surgeon, how has it changed, and what ways do we still need to change in the future? Speaker 3: Yes, so there, there's been a lot of progress. To echo what Reagan said, I think that being able to talk about mental health now, that was something that was very difficult to do when I was in residency. And I think a lot of it is because of Dr. Kerry Cunningham and also Reagan's study. It's really changed the perception of mental health and just it's I, I cannot say more strongly how grateful I am for all the leadership that Dr. Cunningham and Reagan have displayed over the past several years to really try to get a national conversation about this and to destigmatize mental health. There are still important structural and cultural challenges though, as you've alluded to, Agnes, and also Reagan, what you've talked about. And I think the stigma is still [00:17:00] persistent, that there are still many surgeons who worry about appearing weak or losing credibility. And then licensing implications is a, I think, a big burden. I think surgeons are worried about burdening their colleagues and being perceived as unable to handle pressure And one of Ragan's earlier papers, for example, the one in Journal of Surgical Research actually talks about this, that there, there is still this stigma that exists. And I think the culture of self-sacrifice, so surgery still strongly rewards or has this, a culture of you have to be able to endure this perfectionism and pushing through exhaustion and prioritizing patients over self. And that gets tied directly into work-life balance and stress and exhaustion. So I think that what it comes down to right now is many surgeons, they're really ex- they're extraordinarily compassionate towards patients, [00:18:00] but still less compassionate towards themselves A- and I think ways around this continue to be awareness, and probably we gotta find a way to give programs more pressure to do more. So for example, my understanding at least is that most surgeons, if they need to seek therapy and help, they have to pay for it out of pocket right now. Or u- unless they have a psychiatrist and they have a known mental health disorder that they're getting health insurance coverage for. But for folks who might just want more support, it's, everything is out of pocket, and that I think is a big burden. And then I think that the type of wellbeing programs that are out there, in general it's very meager still. We talked about psychological first aid kits, and also the pioneering work of Haytham Kaferani about surgeons sometimes being second victims. So this concept of if you have gone through [00:19:00] a big trauma, a big loss, losing a patient or something really devastating happened to your patient, the, the s- surgeon themselves can be the second victim of the experience. And so there are programs now where, for example, at Mass General, having peer support programs and having peer-to-peer support and therapy during these difficult times. That exists, but it's still very meager. It's still in different spots, and it, and it often relies on the generosity of spirit among surgeons and faculty and colleagues and trainees and residents and staff. It's not built in institutionally. You don't have the institution deciding this is, we need to have a budget for this. And so I think those areas need to continue to be improved upon. And this is why it's really important to talk about these issues, and I appreciate Agnes and Steve, you bringing attention to this because I think through awareness and pressure, that will help lead to further change [00:20:00] from leadership. Speaker: Something that really stood out to me in both of your reflections to that question, Dr. Yang and Regan, is this idea of, like, taking care of ourselves being an important part of being a great surgeon. I think so often there's this misconception or, like, conflating self-care with weakness or vulnerability. But- The more I read the work that you guys are doing and the work of other scholars in this area, the more and more clear it is to me that in order to be the best surgeon I can be, in order to be as excellent and as safe as is possible in the operating room, I need to practice as much compassion for myself as I do for patients, and I need to invest in my own health and wellbeing as much as I do that of my patients. So I really appreciate you guys framing this in those terms. Dr. Yang and Reagan, I'd love to hear more about where this scholarship is headed in the future. It's my understanding that there's currently an [00:21:00] ongoing follow-up study through the AAS. Is that correct? Speaker 3: That's correct, yes. And it really stems on, and it builds upon the previous work by Reagan and Carey, showing factors like professional fulfillment, resiliency, self-valuation, and loneliness were strongly associated with suicidal ideation among surgeons. And that raised an important question for us, which was, what are the broader drivers of surgeon wellbeing, and how healthy is the workforce overall, not just psychologically or from a mental health perspective, but also from a general wellbeing, physical perspective? And that's because wellbeing encompasses a lot of different issues. It's more than just about burnout. It includes work environment, psychological safety, sleep, exercise, preventive health maintenance, work-life integration, and all these different topics, and even whether surgeons are [00:22:00] actively taking care of their own health. So really excited that we have this current survey focusing on all these other questions. And then we also still have the original PHS9 survey and the GAD survey for depression and anxiety, and it'll be great to have a second snapshot on how we're doing now in 2026 versus when the survey was done earlier around the time of the pandemic. Speaker 2: I'm really glad to see that this work is continuing, and it'll be interesting to see how with each iteration we get more information about how to make this space better for trainees and for attendings. And I think one of the other points that you had mentioned was how we often normalize self-suffering, and we understand that resilience is important to cultivate, but how do we distinguish that from just normalizing the suffering that we're going through in training and as practicing as surgeons? Speaker 4: I guess from the trainee perspective, and then maybe Dr. Yang can provide a different perspective as faculty, but, I mean, I think [00:23:00] resilience is important. Like, surgery, it's inherently demanding, and as a trainee, as faculty, like, you need to understand and learn the skill of recovering from adversity that you face, whether that's after a shift, after a, a year or w- whatever you're, you're getting through at that time. But I think that resilience can become problematic when it's used to justify systems that produce preventable suffering. So I don't think, like, the act of training should be suffering for the purpose of suffering of like, oh, you're in surgical residency, that sh- like part of it is that you just suffer. And I mean, I think that's a little bit of an old dogma that doesn't necessarily have to be the case. I think there's a difference between helping surgical trainees or whatever stage you're at, helping them develop coping skills to deal with the stressors of surgical training and helping [00:24:00] them get through it using these skills versus expecting them to tolerate harsh environments that are unsustainable. So I don't think that the goal should ever be to remove, like, the challenge from surgery. Like, that's the point of surgical training. It's gonna be hard. Like, you don't want an easy surgical training program, otherwise I don't think that I at least would be a well-trained surgeon on the other side of it. And I think the challenge is part of also what makes it so meaningful is not everyone can be a surgeon. It's a special career that we've, that we're lucky enough to be a part of. But I think that this challenge has to be paired with support from your colleagues, mentorship, psychological safety, to Dr. Yang's point, I think that's very important, and then just access to basic care to be able to help cope with these extreme stressors that, that you're facing and at least develop the skills to get through it rather than just continuing to trudge through it because that's the [00:25:00] expectation. Speaker 3: Yeah, I, I agree. And I think just to add a little bit, the historical discussions of wellbeing often, and resilience often focus on individual resilience. And what the data is increasingly showing is that organizational culture and workplace structure are enormously important determinants of wellbeing. And that's why I'm also really excited about this survey because we're not just merely asking, "Are you burned out?" But we're asking questions like, "Do you feel valued? Do you belong? Can you control your work?" And a lot of these questions were created in collaboration with the thriving from work questionnaires that go beyond just surgical workforce, but the broader workforce. And one thing we wanted to move beyond was simply measuring distress. We wanted to understand what allows surgeons to thrive, and a lot of that does depend on organ- organizational [00:26:00] structure and workplace culture. Speaker 2: Yeah, and taking that a step further, currently as of now, what institutional interventions do you think have the greatest impact for surgeon wellbeing for the next five to 10 years? Speaker 3: That's a great question. I, I do think that it has to be, there has to be multiple approaches. So one is that surgeons and trainees- Need to be able to have free access to support, mental health support without having to worry about paying for things out of pocket. And s- 'cause we had talked about how unless right now you have a mental health disorder and you're actively seeing a psychiatrist and it's covered under health insurance, it's very hard to actually see a therapist or get a life coach, for example. I've gotten a life coach through a program at Mass General as part of a study, and I thought it was great. Like, and I've been to wellbeing talks at other surgical conferences, and everybody seems to advocate for a life coach. But [00:27:00] right now the only way I participated through that was through a study. But I think that sometimes these things just, they are costly and it'd be really important for a program to try to support that type of access to that kind of resource. And other really important areas that I think every program should have, for example, a way of supporting surgeons during intense times of trauma. So what we talked about with the second victim syndrome and having peer support programs built in and so that surgeons can get immediate access when, whenever they have a really difficult situation in the-- or when they're taking care of a patient and family. And then beyond that, I know that other programs, so in internal medicine, emergency medicine that I've heard from other institutions, which I haven't really seen at all in surgery, and so perhaps Agnes, Steven, and Regan, you can tell me if I'm wrong, are just general things to help with [00:28:00] wellbeing. For example, help with childcare, child support, helping with healthy meals. I know at some other non-surgical programs I have heard before that people got access to healthy meals that were shipped to reduce the burden when it's a really busy schedule. I should say, though, there have been improvements over the past decade though, and for example, just having residents w- if they're too tired, being able to call a taxi or call an Uber to go home. I think there are a lot of programs that support that. So don't wanna make it feel like there hasn't been any improvements, but certainly there are a lot more that need to be-- there's a lot more improvement that needs to be done. Speaker: I feel like for me, an important part of being an effective change-maker is being able to look back and recognize all the progress that's been made without losing sight of all the progress that lies ahead. I think you can both fall susceptible [00:29:00] to resting on how far we've come and also fall susceptible to just being frustrated by how far there is left to go and holding those two things in tension like you just described, Dr. Yang, I, I find to be the strategy that has the most resonance. If we have listeners who are hearing this message and they're thinking This is really a topic I'd like to learn more about. I'd like to find a strategy for contributing and trying to move the field forward What do you recommend as next steps for people who wanna join this conversation? Speaker 4: I think a place that everyone can start from every single level is to just try to be an advocate yourself or at least engage in the conversations with your peers. Even if you're an early medical student or early resident and don't necessarily feel comfortable or safe talking about it with senior residents, I think there's always someone in your own peer group that will probably resonate with the conversation or may be struggling. Like, we [00:30:00] know based on the data that numbers-wise someone in your residency cohort is probably struggling with these things. So I think knowing the data is important to, to drive these discussions and realize that it's a lot more prevalent than we may realize, and people are good at hiding some of the struggles, and that's why we're probably so well-equipped for surgery is that we can w- work through some of the challenges that the profession can face. So I think one thing that everyone can do is just get involved in these conversations at every single level and try to look out for each other. I think Dr. Yang talked a little bit earlier about the idea of psychological first aid, so even just doing that. I think it can be a one or two-day training course or just an online training session that you can sign up for. And that can... You can do that at any stage, and that will help you identify some of these triggers or identify any sort of red flags that you may see in your peers or in yourself when you may be struggling with something to be able to help connect people with [00:31:00] appropriate resources. So I think that's something that really anyone can do at any stage. I think knowing the literature. We always say that we want things to be data-driven in surgery and academia, but in this case I think knowing the literature is very powerful in order to engage in these conversations with people who may be naysayers or may not have quite embraced the topic yet. Because by knowing the data you can share that it is a lot more prevalent, and it can affect how we adequately are able to show up to work and take the best care of patients that we can. And I think that's the really important framework, at least that I try to bring to the table, is yes, we should encourage people to do this because it's the right thing to do to take care of one another, but it's also the right thing for our patients. And I think that's the thing that sometimes we can lose sight of, is that we're trying to do best for ourselves but also do best by our profession and do best for our patients, and we can only [00:32:00] do that if we are taking care of ourselves. So I think knowing the data and knowing what's going on in the literature is really powerful to be able to engage in these conversations when people may not be quite as receptive to them. Speaker 3: Yes, and just to add on, I think that helping to do research in this area is really key because this is such a-- There are many aspects of this that are data-free zones right now. Going back to the second- victim situation, there, there are some studies now looking at some interventions, and I think for that, doing research, designing interventions will be really important because that is gonna be what's gonna help sway a lot of the program leadership because of still this existing stigma. But if you can show that these interventions help and they improve not just quality of life, but actually reduce the number of suicides and the percent of burnout, then I think it'll be really incredibly impactful and important. So doing research is [00:33:00] important. I think that overall raising awareness, so for folks listening, it would... And you ha- if you happen to get a survey, we'd love for you to take the survey because in the survey, I think hopefully you'll find it fun This is where I'm putting on my, uh, survey advocacy hat, I suppose. And one of the things I, we really wanted to put in there was just overall preventive health as well. So to check to see if folks are up to date on colon cancer screening, mammography, cervical cancer screening, lung cancer screening, and primary care visits. I, I hate to say this, but as of right now, I do not have a primary care doctor. And so I've been attending for almost seven years now. In the first five years, I didn't have a primary care doctor. I finally got one 'cause my wife really just, she really pushed me to get one. I finally got one, and then my primary care doctor left, and I still don't have one. So I think that overall having awareness, like helping us raise awareness would be incredible. And then the last thing which I've seen be effective is [00:34:00] to go to each-- to go to your institutional leadership, tell them that you care. Is there anything you can do? Hopefully, by this time in 2026, there are actually programs that are existing, but most of the time they are just-- they exist out of the kindness and generosity and the volunteerism of the committee members, and not because it is a actual funded program. And until that changes, though, just by volunteering to be on these work groups, task forces, committees, I think you'll be able to impact your co- your colleagues' health and wellbeing because oftentimes it just takes that one extra person to be able to find that additional resource or to set up that meeting or to get somebody connected to the help that they need. So really encourage just that, at least right now, the individual volunteering of to help raise awareness and to help improve the [00:35:00] culture, the safety, and the wellbeing and mental health for each person's individual program. I would advocate for that. Speaker: Yeah, I know the work that y'all have done really shaped the trajectory of my academic development time, and I wonder if for someone else who's listening they might find some similar inspiration. Dr. Yang, if it's okay with you, we can point our listeners towards your email address if they're interested in participating in this survey. Speaker 3: Yes, that'd be great. I really encourage anybody to, who's interested in this to please email me and would love to have you take the survey. And also just to see whether- How we can collaborate in the future to work to raise awareness and hopefully impact the field in this area. I'll Speaker: include your email in the show notes. Speaker 3: Great. Thank you. Speaker 2: I think we touched on a lot of important topics, and as we all mentioned, hopefully this starts the conversation, and we can take these conversations to our own hospitals and programs to make a bigger impact. Any last-minute thoughts or words of wisdom? Speaker 4: I think we've covered a lot of things today. I know I learned a lot from Dr. Yang. I'm gonna take some of the [00:36:00] ideas about the healthy meals back to my program and see how receptive they are to that today whenever I go in for my night shift. I think ultimately, without engaging one another and continuing to talk about the data, talk about what's going on at different programs, you don't know. A lot of the work in this space may not even be published. People may have their own programs that are working really well at their own institutions or in specialties aside from surgery, and we may not even know they exist. So I think by having these conversations, we can also open up discourse to talk more and share more across institutions about things that may be working that you don't even know exist at your own institution. So I would encourage anyone listening that if you were inspired by today's words or you have a program at your own institution that is doing something really well, to share that with us, and hopefully we can continue this conversation and move the needle forward a little further. Speaker 3: Yes. To squeeze in [00:37:00] would be I think in the future it's important to talk about ergonomics and as, as part of the broader wellbeing. I- it's too much for this podcast. In fact, we didn't have that in our survey because we really wanted to focus on the things we talked about. But, um, for example, in the past our team had looked at for cardiothoracic surgeons what the rate of injuries are, and it's alarming. There's about 64% of people that we surveyed, 600 cardiothoracic surgeons, had musculoskeletal injury, and 30% of them actually had time off from work, and then 20% required surgery or use of narcotics. So I think that's an area of future development as we continue to think about what exactly is the-- what are the most important things for surgeons' health, surgeons' wellbeing. Speaker: Yeah. I think to borrow your phrase, Dr. Yang, in some ways that's a bit of a DFZ, a data-free zone. But I know every subspecialty faces their own unique challenges based on the physical approach for the [00:38:00] cases. That's a great idea. Maybe sometime we can revisit that through the CT lens in particular. Speaker 3: And actually one last thought is I really encourage everybody out there to try to s- see if you can dream big and really see if you can design a, a amazing prospective trial. I, I started doing that, and then just life happened and I-- But one of the ideas I had was this-- Everybody's heard of the Physicians' Health Study or the Nurses' Health Study, and I had this idea of let's do the Surgeons' Health Study. And life happened, and at least for me it's a little bit of a pause. But I think it's such an important area, and I really hope that whoever's out there, and Regan, Agnes, Steven, it might be you or the listeners of this podcast to, to think about a really big prospective study to look at surgeons' health topics. Speaker 2: Well, thank you for sharing your experience. I know this was super helpful for [00:39:00] me, and I'm sure for all the listeners who are listening. So thank you again, Dr. Yang, and thank you, Regan, and thank you to all of our listeners. Speaker: Until next time... Speaker 2: Dominate the day.