• Neurosurgeons Talk: How I Manage Competing Demands

    The questions we asked the neurosurgeons:

    1. What's the best advice you have for managing the mix of personal and professional obligations?
    2. How do you best cope with the stress of the specialty while at home?
    3. Where is the line between work and private life as a neurosurgeon?


    Ron L. Alterman, MD

    Professor of Neurosurgery at Harvard Medical School, Chief of Neurosurgery at Beth Israel Deaconess Medical Center, Harvard Medical School

    I have found that having interests outside of neurosurgery is essential to dealing with the stresses of leading a neurosurgery division. Time with friends and family is revitalizing, particularly if one is engaged in activities that distract from the daily rigors of our profession. For me, those pursuits include aerobic exercise, yoga (which has completely eliminated past flare ups of back pain), biking, skiing, SCUBA diving, books, movies, and cooking for friends. And, as a life-long New Yorker and Yankee fan now living in Boston, long debates about baseball are always enjoyable.


    Andrew R. Conger, MD

    Geisinger Medical Center, Danville, PA

    As a new attending, I am still learning how to balance professional and personal obligations. This is a demanding career, one that can easily consume me if I allow it. I was fortunate enough to become busy clinically very soon after starting, but this created some workload problems because I was trying to get too much done in a day. I had to learn reasonable expectations for getting cases done at my institution, remembering that I'm not yet as efficient as my mentors, and the system at every institution has its own idiosyncrasies to navigate. Communication is key to establishing expectations-both professionally and for my family. I am learning how to prioritize my workload so I can set limits on professional obligations and get home at a reasonable time most days.


    Daniel W. Fults, MD

    Professor of Neurosurgery,University of Utah Health Care

    I am convinced that the field of neurosurgery attracts people who feel energized by stressful situations. Nevertheless, there are limits. One source of stress is our patients themselves and the lifealtering neurological diseases they struggle to overcome. I believe it is essential for neurosurgeons to detach themselves sufficiently from their patients to avoid internalizing their suffering, and this practice does not come naturally to a caring physician. I do not think that we should rigidly separate our minds into work and leisure compartments. That approach leads to a shift-work mentality that erodes the profession. I do advocate for interweaving professional life with leisure and recreation continuously. For example, making time to do something fun every week. I have devoted my entire career to academic neurosurgery and can extol the balanced strategy of combining clinical practice with research and academic helps to create a stress-neutral workweek.


    Randy L. Jensen, MD, PhD

    Professor of Neurosurgery, University of Utah Health Care

    My best coping strategy for dealing with stress is getting involved in various projects. My family and I enjoy canyoneering in Southern Utah and the necessary planning to make these trips happen brings our family closer and allows me to forget some of the stressful aspects of a neurosurgical practice. I also enjoy building hot rods or restoring old cars. There is nothing more therapeutic than using an acetylene torch, plasma cutter, or TIG welder. The mental exercise of planning the project, finding and ordering new parts, and then implementing it can be extremely satisfying.

    Over time I have become less concerned with separating my personal and professional life. Early on I found it to be stressful to compartmentalize these two worlds. The line between work and private life becomes more blurred for me as time goes on. I enjoy the interaction with our resident and medical student trainees and taking part in their education. I enjoy the research, both basic and clinical, of neurosurgical practice. I enjoy working with individuals who are not only respected colleagues, but also a second family. I enjoy serving my community, church, and my family. All of these thing are inseparable. I often take care of personal business during the work day to allow for a brief diversion from stressful situations. And, on the other hand, it would not be unusual for me reflect upon a particularly difficult patient problem or a perplexing research question while participating in an activity with my family or while pounding a stubborn bolt off of a 1959 Rambler station wagon.


    Craig R. Kelman, MD

    Department of Neurosurgery, Virginia Commonwealth University Health System, Medical College of Virginia

    My best advice for managing the mix of personal and professional obligations is to dedicate your full attention to whatever you are doing. When at work, be at work. When at home, be at home. I have children ages five, three, and one who greet me at the door and want to spend time with me. The first thing I do is put my phone on the charger in order to give them my full attention and ignore anything non-emergent. I appreciate the little moments and have realized we don't need some kind of grandiose plan to have fun. Simply being present with my children and my wife has lead to richer and more fulfilling interactions. This has, in turn, allowed me to recharge and be happier and more productive at work.


    Alfredo Quiñones-Hinojosa, MD, FACS

    William J. and Charles H. Mayo Professor; Chair, Neurologic Surgery; Mayo Clinic, Jacksonville, FL

    The best advice I have for managing the mix of personal and professional obligations is that personal and family obligations come first. Professional obligations are important, but you cannot be successful professionally without taking care of yourself and your family. With our limited time, the ideal situation is when we can merge them both. Mike Lawton, Mitch Berger, George Jallo and I go on what we call "Mission Brain" trips, and, we bring our families. Being able to share our experience with our loved ones and having them understand, first hand, what we are trying to do is really quite special.

    When I come home, I try to spend time with the children. Whether that means watching a movie, hearing about what they learned in school, or going to church together. I also find that working out is a good way for me to relax. In our profession, we deal with a lot of people who are very ill and looking for hope. I think it is important to be strong in spirit so that we are better able to provide hope. Right now, I am sitting outside enjoying the tranquility of nature, with my dogs running around playing with the kids. I think family pets are important as they can bring much joy to you and your family.

    We deal with complex patients in our profession. I think we need to embrace our passion and dedication to our patients, and it is important to have families that understand our love of neurosurgery. This is a team effort. Your family is part of your team. My family gets involved with our patients through various social events where they get more of an understanding of what we do and why we do it.


    Christopher D. Roark, MD

    Assistant Professor, Department of Neurosurgery, University of Colorado

    My life is more manageable because I have neurosurgical partners who I trust and like. Being a vascular neurosurgeon, I am on call one week in three. During a call week, I do not plan any significant family events. My wife is a physician and understands that during these weeks my job will take precedence over outside responsibilities. Stress is unavoidable, but there is no set pattern for stress reduction. I have found that having a "non-neurosurgery" book on my bedside table is helpful. As neurosurgeons, we see a small and very ill subset of the human population. It is crucial for me to expose myself to the writing, thinking, acting, and believing of others. Participating in the beauty of humanity reminds me why it is a privilege to be at the bedside of the sick and infirm in the middle of the night when it is my turn.


    Rafael A. Vega, MD, PhD

    Department of Neurosurgery, Virginia Commonwealth University Health System, Medical College of Virginia

    As far as I am concerned, the line is drawn once we step foot outside of the hospital. But I believe it is impossible to truly separate ourselves from our work, especially when we are so passionate about what we do. However, in order to truly be successful in the operating room day in and day out, the ability to enjoy time outside of work goes a long way. For me, that includes going for a run along the river trails, getting away for a weekend, or enjoying an evening out with the colleagues, where work talk is typically off limits! As a group, these moments bring us closer together. Individually, it allows us to take a deep breath and enjoy the fresh air. As one of my prior chiefs said it best, "Sometimes you have to choose life over knife!"

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